United States: Trump Administration Fiscal Year (FY) 2018 "Skinny" Budget

Ethan Jorgensen-Earp is a Public Affairs Advisor in Holland & Knight's Washington D.C. office

On March 16, the Trump Administration released a summary document of his first presidential budget entitled "America's First: A Budget Blueprint to Make America Great Again." The 62-page budget blueprint, also known as the "skinny" budget, is both short and very high-level compared with past presidential budgets. For instance, the average length of President Obama's budgets, not including appendices, was 200 pages. While the President's budget does not carry with it the force of law, the document has historically served as an important signal to Congress of the Administration's policy and funding intentions for each fiscal year, and thus typically includes fairly detailed descriptions of funding goals for some of the federal government's most crucial health-related programs.

The Trump Administration's budget blueprint provides very basic details on a $1.151 trillion proposed discretionary spending plan for FY 2018. Overall, the budget creates several discretionary cap adjustments that would reverse sequestration for defense – increasing the defense discretionary cap in FY 2018 from $529 billion to $603 billion – and pay for the increase by reducing non-defense spending by a total of $54 billion in FY 2018. The budget blueprint also includes $25 billion in supplemental funding in FY 2017, including $3 billion for the border wall and executive order implementation and $5 billion in defense Overseas Contingency Operations (OCO) funding. This supplemental funding is not fully offset by the cap on discretionary spending, resulting in a deficit increase of approximately $10 billion in FY 2017.

It is important to note that many details are still unknown concerning the funding levels in the budget blueprint and how savings provisions will affect operations at individual agencies. These details are unofficially expected in May, when the Office of Management and Budget (OMB) will release a line-by-line addendum to the budget blueprint.

Below please find a brief summary of the budget blueprint's proposals concerning health-related agencies and programs:

Department of Health and Human Services (HHS):

The President's FY 2018 budget request includes $65.1 billion in funding for HHS, a decrease of $12.6 billion from the FY 2017 enacted levels. Despite the 16.2% overall cut to HHS, the President's budget blueprint explicitly includes funding for the Substance Abuse and Mental Health Services Administration's abuse treatment activities and an increase of $500 million over FY 2017 enacted levels to expand opioid misuse prevention efforts.

Centers for Medicare and Medicaid Services (CMS):

The budget blueprint provides very few funding or programmatic details for CMS despite its oversight over Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). However, the blueprint does specify that the Administration will support efficient operations for these programs by focusing spending on the "highest priority activities necessary" to operate them. The budget blueprint may be largely silent on these programs given that Affordable Care Act (ACA) repeal and replace legislation, entitled the American Health Care Act (AHCA), is still being considered by the House of Representatives and includes sweeping changes to these programs.

In addition, the budget blueprint mentions a focus on increasing savings by curbing waste, fraud, and abuse in the Medicare and Medicaid programs, and includes an increase of $751 million to bolster the Health Care Fraud and Abuse Control (HCFAC) program at CMS.

Food and Drug Administration (FDA):

While not providing a total budget allocation for the FDA in FY 2018, the budget blueprint did expressly recalibrate the FDA's medical product user fees to at least $2 billion, up from $1 billion in FY 2017. Members of Congress and the medical products industry have already come out against the increase in user fees, expressing concern that it would supplant rather than supplement additional needed discretionary appropriations for the agency. In addition, there has been concern that the increase would adversely affect the user fee agreements that had already been negotiated between the medical products industry and the Obama Administration last year.

National Institutes of Health (NIH):

The FY 2018 budget blueprint cuts the NIH budget by $5.8 billion compared with its current funding level. In order to justify this reduction, the blueprint hints at several major changes to the agency, including a major reorganization of the agency's Institutes and Centers, of which there are 27, to focus on high-priority research and eliminating the Fogarty International Center that contributes millions of dollars in grant funding for global health research. In addition, the budget would consolidate the Agency for Healthcare Research and Quality (AHRQ) into the NIH. AHRQ, which has frequently been a target for elimination by congressional budget hawks over the past several years, is currently funded at just over $330 million per year, and it is unclear whether the agency would retain its funding under the umbrella of the NIH. It should be noted that this type of overall funding reduction to the NIH flies in the face of strong bipartisan support in Congress for continued financial support and budget increases for the agency over the past several years.

Centers for Disease Control and Prevention (CDC):

The FY 2018 budget blueprint establishes a novel Federal Emergency Response Fund to respond to public health outbreaks, such as the Zika virus outbreak. It is unclear whether this fund will replace CDC's Emergency Response and Recovery program in its Division of Global Health Protection or whether this will supplement CDC's current activities in emergency response. It should also be noted that the aforementioned AHCA, which is currently moving through the House of Representatives, has proposed eliminating the ACA-authorized Prevention and Public Health Fund that provides nearly $1 billion annually to the CDC's core budget. This amounts to 12% of the CDC's annual funding.

Other Health-Related Issues:

The FY 2018 budget blueprint eliminates $403 million in health professions and nursing training programs but will continue to fund health workforce activities that promote service in health professional shortage areas. It is unclear which of the programs authorized under Titles VII and VIII of the Public Health Service Act will be affected by this cut. Currently, programs under Titles VII and VIII receive nearly $500 million in annual funding.

In addition, the budget blueprint supports direct health care services provided by programs including community health centers, providers supported by the Ryan White HIV/AIDS program at the Health Resources and Services Administration (HRSA), and the Indian Health Service.

Finally, the budget preserved the discretionary funding authorized by the 21st Century Cures Act (Public Law 114-255) for the NIH and FDA. This funding by law falls outside the discretionary budget caps and is directly appropriated for several provisions, such as the cancer moonshot, the Precision Medicine Initiative, and the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative.

President's FY 2018 Budget Blueprint Comparison

President's FY 2017 Budget Request FY 2017 Enacted Level (CR) President's FY 2018 Budget Blueprint
Health and Human Services (HHS) $82.8 billion $77.7 billion $65.1 billion
National Institutes of Health (NIH) $33.1 billion $32.3 billion $26.5 billion
Food and Drug Administration (FDA) $2.8 billion $2.69 billion TBD
Centers for Disease Control and Prevention (CDC) $11.9 billion $11 billion TBD


Trump Administration Skinny Budget Document

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Similar Articles
Relevancy Powered by MondaqAI
In association with
Related Topics
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions