This is a guest opinion column

Academic Health Centers are like tropical rainforests: They take decades to develop and weeks to destroy.

Birmingham’s very own medical rainforest—UAB—faces devastation from the “ONE BIG BEAUTIFUL BILL” being debated in the U.S. Senate. The bill proposes slashing National Institutes of Health (NIH) funding by 42%, from $47 billion to $29 billion annually, and cutting indirect cost recovery from 48.5% to 15%. While that might sound like Washington math, but the consequences here at home are personal for all of us, and very real.

Let me spell it out.

Over the last 5 decades, UAB has emerged as a premier Academic Health Center. Owing to its remarkable success, UAB is recognized across the country and around the world as a Center of Excellence in Biomedical Research and Medical Care. The fuel that propels Academic Health Centers like UAB comes, in large part, from NIH funding.

Last year UAB was awarded $380 million dollars in NIH funding. The NIH dollars arrive at UAB because of research grants generated by scientists on campus. Nationally, only one out of ten (10%) grants submitted to NIH are funded; the other 90% are not. As evidenced by the large annual NIH funding awarded to UAB by NIH, UAB researchers are competing successfully for grants at a very high level.

A 42% reduction of NIH funding means that the number of successful grants will drop significantly. Estimates from the NIH projects that the funding cutpoint will drop from 10% to less than 3%, a more severe decrease than the actual drop in total NIH funding because NIH has other fixed commitments that cannot be changed. Based on these numbers it seems likely that the reduction in NIH funding will translate into a loss of NIH revenue at UAB of up to 60% or more.

In addition to the obvious hit on direct dollars at UAB by the sudden drop in NIH funding, the ONE BIG, BEAUTIFUL BILL proposes to reduce indirect cost (IDC) payments to universities to 15%. The current negotiated IDC rate for UAB is 48.5%. So, on top of the large hit to overall NIH funding, there is additional 69% reduction in IDC (as reviewed in al.com, Feb 2025). IDC covers the expenses generated to support the work of the investigator on campus, including costs for space, services, informatics, and administration (legal, financial management, compliance with regulations). More lost revenue.

The secondary impact of the NIH cuts, however, is the most profound. Established researchers, whose ongoing projects are no longer deemed of highest priority, lose their funding suddenly and must shut their program down. People working on the project are laid off, shrinking the entire UAB ecosystem. Many of these researchers are the same doctors who provide world-class, cutting-edge care to patients from across Alabama and the Southeast.

But most critically, young scientists, many of whom have just completed their training, will find it difficult to impossible to secure funding to support their new careers in a funding environment that awards fewer than one in 30 grant applications. These scientists – who represent our future strength and national dominance in scientific research – will have no choice but to abandon a career in science and will need to find work in other fields that likely will do so much less for our country and our state.

If these cuts pass, your next visit to the hospital will feel different—and not in a good way. Fewer doctors. Slower results. Less time with your doctor. Why? Because federal research funding helps UAB attract and retain some of the best and brightest medical minds in the country. Without it, those doctors won’t stay.

That specialist who diagnosed your child’s rare condition? The lung doctor who knew about the clinical trial that saved your neighbor’s life? The researcher working on tomorrow’s breakthrough for Alzheimer’s or cancer? Gone.

And it won’t just be the people—we’ll lose access to the treatments, too. For decades, Birmingham has been a place where world-class care was available right in your backyard. We’ve had early access to new therapies because UAB is a top-tier research institution. Lose the funding, and we lose the pipeline. When your loved one needs the latest treatment, you won’t find it here. And even if you can afford to fly elsewhere, the NIH cuts will have the same impact at every other Academic Health System around the country. We all lose.

And let’s talk about what this means for Birmingham as a city. As the number one employer in Alabama, UAB supports over 4,000 research-related jobs and generates nearly $1 billion in economic impact from NIH grants alone. This is not just about scientists in labs. It’s about secretaries, janitors, IT techs, building engineers, and local businesses that thrive because of a vibrant medical center.

Many families move to Birmingham because of UAB’s reputation. Businesses invest here because we can offer their employees world-class healthcare. Lose that, and we lose one of the anchors that makes Birmingham special.

And all of this for what? The current NIH budget represents just 0.7% of the total federal budget. We are trading our future—our health, our jobs, and our children’s care—for pocket change. A rounding error of the $6.5 trillion dollar Federal Budget.

If you treasure what science and medicine have done for you and this city over the last 50 years, now is the time to act. Call your representatives. Speak out. Because once the rainforest is destroyed, it’ll take a generation to grow back.

To paraphrase Smokey the Bear: “Only you can prevent forest destruction.”

Michael Saag, MD is a Professor of Medicine and Infectious Diseases at the University of Alabama at Birmingham. His opinions are his own and do not reflect necessarily the opinion of UAB nor the University of Alabama System.