President Biden's proposal to create a new Advanced Research Project Agency for Health (ARPA-H) has won early bipartisan support. But a fault line is emerging between the White House and Congressional Republicans over where the agency will be housed.

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The proposal to create ARPA-H dates back to June 2017, when senior staffers in the Trump administration first discussed the possibility of a new agency modeled after the Defense Advanced Research Projects Agency, the U.S. Department of Defense office responsible for massive breakthroughs in technology such as the internet and GPS.

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That proposal didn’t come to fruition, but the Biden administration has given it new life. In its 2021 budget proposal, the Biden administration proposed $6.5 billion to create ARPA-H as a new agency within the National Institutes of Health.

According to STAT News, ARPA-H would take on relatively high-risk research that could fizzle or could produce revolutionary payoffs.

In a speech last month, Biden argued that the agency fills a critical need. “[I]f we don't do something about Alzheimer's in America, every single, solitary hospital bed that exists in America … will be occupied in the next 15 years with an Alzheimer's patient," he said. He added that this prospect would cost "in excess of a trillion dollars."

Creating and funding ARPA-H would require an act of Congress. Last week, Rep. Diana DeGette (D-Colo.) and Rep. Fred Upton (R-Mich.) announced they would include a provision establishing ARPA-H as part of their larger, forthcoming "Cures 2.0" bill.

"The federal government has amazing resources at its disposal, and now is the time to put the full weight of those resources to use to cure some of the world's most devastating diseases, such as cancer, diabetes, Alzheimer's and more," DeGette and Upton said in a statement.

An emerging controversy: Where should ARPA-H live?

Although Democrats and Republicans both appear receptive to establishing ARPA-H, fault lines are emerging around the details.

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In particular, the White House and Congressional Republicans appear to be divided on where the new agency should be housed.

Biden's budget proposed that ARPA-H should reside within NIH, which already manages much of the federal government's investments in health care research.

NIH Director Francis Collins argued to the Washington Post that "it would be a big mistake" to establish the agency anywhere else, as doing so would "immediately create all manner of administrative duplications. There would be potentially a sense of competition about who is doing which part of which project, [and it would] lose the synergy with [an] already deep bench of scientific capabilities in NIH."

But a Republican aide told the Post that "Congressional Republicans are excited about the prospects of an independent agency outside of the bureaucratic structure of NIH." And some outside experts echoed the idea that NIH's existing structure and culture could jeopardize the type of long-shot, big-payoff innovation that ARPA-H is intended to promote.

David Walt, a chemical biologist at Harvard University who previously chaired DARPA's advisory council, said NIH tends to perform "a conservative type of evaluation of innovation." He added, "[T]here's regression toward the mean with respect to things that are incredibly innovative—there's almost always a naysayer in the room."

For her part, DeGette downplayed the significance of the conflict. "Congressman Upton and I will take comments from everywhere and then we'll decide where the best place for [ARPA-H] to be housed is." She added, "But the key isn't where [the agency] is housed—it has to do with the independence and nimbleness it has" (Fakher, STAT News, 4/28; Biden, The White House Briefing Room, 5/27; Floerke/Cohrs, STAT News, 6/22; Ale many [1], Washington Post, 6/23; Alemany [2], Washington Post, 8/22/19).