United States: Health-Related Programs Face Deep Cuts In President Trump's Budget Blueprint To Make America Great Again

On March 16, 2017, the President Trump Administration released his first budget outline for the 2018 fiscal year (FY 2018). In an effort to "shrink the role of government," the $1.1 trillion budget proposal calls for a $54 billion increase in defense spending, with a corresponding $54 billion reduction in funding for many federal government programs. In particular, the Department of Health and Human Services (HHS) and the National Institutes of Health (NIH) would absorb double-digit budget cuts, in addition to other consolidation efforts involving those agencies.

President Trump is expected to release a full FY 2018 budget request in May of this year. Although the budget blueprint delivers on President Trump's campaign promise for increased homeland security and military spending, opposition from both Democratic and Republican lawmakers suggests that the proposed cuts are unlikely to fully survive the congressional appropriations process.

Key Health-Related Spending Cuts Under the Budget Proposal

The NIH, a division within HHS, is the principal government agency for biomedical and health-related research. While 10% of NIH funding is used for research within its own facilities, the agency awards nearly 80% of its funding to outside universities, medical schools, and other research institutions. The Trump Administration proposes to reduce the NIH's budget by $6 billion, or nearly 20%—back to its lowest level in 15 years.

The proposed budget cut eliminates $403 million in health professions and nursing training programs because the programs purportedly "lack evidence that they significantly improve the Nation's health workforce."

The proposal also calls for a "major reorganization" of the 27 NIH institutes and centers "to help focus resources on the highest priority research and training activities." So far, the Administration's only request with respect to such reorganization is the abolishment of the Fogarty International Center, a $70 million program dedicated to training scientists in developing nations, particularly in Africa, to detect and control the spread of emerging infectious diseases.

The spending plan also consolidates the Agency for Healthcare Research and Quality (AHRQ) within the NIH. The AHRQ, which supports research on healthcare delivery cost, quality, and safety, could cease to exist under the proposed cuts.

Not surprisingly, President Trump's budget proposal has been met with criticism from those in the biomedical research community. According to a statement released by the Association of American Medical Colleges, major cuts to the NIH would "cripple the nation's ability to support and deliver" biomedical research. Likewise, according to Andrew Rosenberg, director of the Center for Science and Democracy with the Union of Concerned Scientists, "[w]hat this budget does is ignore evidence and undermine our very ability to collect it across the board."

Other Important Budget Details

The budget blueprint also proposes to decentralize the Centers for Disease Control and Prevention (CDC), another agency within HHS, by establishing a state block grant program "to increase State flexibility and focus on the leading public health challenges specific to each State." While this change would lessen categorical funding restrictions, like other block grant mechanisms, it likely would have the effect of reducing federal funding for such programs.

Notwithstanding the proposed cuts, the Administration plans to continue funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the President's Emergency Plan for AIDS Relief. The budget outline also requests an additional $500 million for HHS to "expand opioid misuse prevention efforts and to increase access to treatment and recovery services."

Trump Administration's First Budget Battle; Implications for FY 2018 Proposal

While President Trump's budget proposal sheds some light on his Administration's priorities, it also faces an uphill battle in gaining acceptance in Congress. While lack of support for the budget proposal from congressional Democrats is unsurprising, several GOP leaders have already come out and voiced their opposition to the budget cuts. Rep. Hal Rodgers (R-KY), former chairperson of the House Appropriations Committee, has called the proposed cuts "draconian, careless, and counterproductive." Rep. Tom Cole (R-OK), a member of both the House Appropriations and Budget Committees, described the cuts to NIH and CDC as "short-sighted."

Still, some biomedical industry leaders have expressed confidence that Congress will not end up moving forward with the proposed cuts. "Congress has a long bipartisan history of protecting research investments," noted Rush Holt, CEO of the American Association for the Advancement of Science (AAAS). "We are grateful and encouraged that members of Congress have already spoken out about the importance of keeping NIH funding at healthy levels," added David Arons, CEO of the National Brain Tumor Society.

One additional development to keep in mind in connection with President Trump's proposed budget for FY 2018 is how Congress will address the FY 2017 continuing resolution. The continuing resolution currently maintains government spending at FY 2016 levels, but is set to expire on April 28. By this date, Congress must pass an appropriations bill to keep the government running for the remainder of FY 2017. How President Trump and Congress address this issue could give an indication on whether Congress is willing to work with the President's FY 2018 budget outline.

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