Trump Proposes Huge Budget Cuts for NIH, Other HHS Agencies

March 16, 2017

President Donald Trump today released an outline of his fiscal 2018 budget that would reduce funding for the US Department of Health and Human Services (HHS) and its National Institutes of Health (NIH) in particular, each by roughly 18%.

The so-called budget blueprint from the White House immediately sparked protests from various sectors of the medical field, with the loudest reserved for the NIH cut.

"Reducing NIH's funding by nearly 20% will devastate our nation's already fragile federal research infrastructure and undercut a longstanding commitment to biomedical science that has fueled advances in cancer prevention, diagnosis and treatment," said Daniel Hayes, MD, president of the American Society of Clinical Oncology, in a news release.

Darrell Kirch, MD, president of the Association of American Medical Colleges, said the proposed reduction would cripple biomedical research and noted that Trump's proposal "is in strong contrast to the strong bipartisan support NIH has received in Congress."

The leaders of the American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP) also expressed dismay about the ax taken to the NIH and other federal healthcare agencies. AAFP President John Meigs Jr, MD, said in a news release that the cuts "would create a domino effect that ultimately will harm the health of America." And ACP President Nitin Damle, MD, warned that the Trump budget "would make America less great."

Trump said in his budget blueprint that the large cuts in HHS, the Environmental Protection Agency, the Department of Agriculture, and other branches of government were needed to offset a $54 billion increase in defense spending.

"These cuts are sensible and rational," he wrote. "Every agency and department will be driven to achieve greater efficiency and to eliminate wasteful spending in carrying out their honorable service to the American people."

The president's budget requests $69 billion in 2018 for HHS, $15.1 billion less than its 2017 spending level. The NIH would receive $25.9 billion, $5.8 billion less.

The NIH budget reduction accounts for 38.4% of the amount Trump wants to lop off HHS. Where the remainder of the HHS cuts — about $9.3 billion — would come from isn't entirely clear.

The Trump budget eliminates $403 million for programs to train nurses and other health professionals. These programs "lack evidence that they significantly improve the nation's health workforce," according to the document. Also slated for demise are discretionary programs within the Office of Community Services such as the Low Income Home Energy Assistance Program and the Community Services Block Grant, freeing up another $4.2 billion. These reductions fall well short of the $9.3 billion that Trump wants to excise from the HHS apart from the NIH.

Budget Calls for Emergency Response Fund for Infectious Diseases

The White House budget plan bumps up spending in some parts of HHS.

The Centers for Medicare and Medicaid Services, for example, has the Health Care Fraud and Abuse Control Program, which returns $5 for every $1 spent. Trump would increase its budget by $70 million. Programs to prevent and treat opioid misuse would receive an additional $500 million in 2018 compared with 2017.

Public health experts were gladdened to see that the budget calls for the creation of a Federal Emergency Response Fund to counter outbreaks of infectious diseases such as Zika. However, no dollar figure is attached to it, nor is it clear whether the fund represents new money or old money that got shuffled around.

"We've been after that [emergency fund] for years, but not as a new program that would cut other programs to pay for it," said Michael Fraser, PhD, executive director of the Association of State and Territorial Health Officials (ASTHO), in an interview with Medscape Medical News.

The Centers for Disease Control and Prevention (CDC) is mentioned once in the budget outline. It "reforms" the CDC by creating a $500 million block grant to state public health agencies that would increase their flexibility and focus on challenges specific to their state.

Tom Frieden, MD, MPH, the CDC's immediate past director, told Medscape Medical News that the Trump administration apparently wants to combine a variety of existing CDC programs that support state public health agencies into a block grant that states could spend as they see fit. The CDC already has a $160 million block-grant program for preventive health and health services.

"Block grants are a bad idea," said Dr Frieden. For one thing, block grants are easier to cut in the future because it's not clear what's getting cut. If the CDC has a specific budget line, say, for diabetes prevention at the state level, there are advocacy groups that will fight to preserve it. "But who's going to fight for a block grant?" Dr Frieden asked.

Block grants also minimize federal oversight to ensure that taxpayer dollars are well spent, he said. With traditional CDC grants, recipients are held accountable for achieving agreed-upon outcomes. "With block grants, there's less accountability."

ASTHO's Dr Fraser, however, looks more kindly on block grants. "Most states would be encouraged by the president giving them more flexibility," he said.

The budget outline provides no figure for total US Food and Drug Administration (FDA) spending in 2018, or whether it will go up or down. However, a few fiscal details emerge. The White House proposes doubling the fees that drug and medical device-makers pay the FDA — from $1 billion to more than $2 billion — to underwrite the product review process. In return, new "regulatory efficiency" would "speed the development of safe and effective medical products." That promise is in keeping with the 21st Century Cures Act enacted last year to streamline the FDA approval process. The Trump budget outline calls for additional funds to implement that law, which would increase the FDA workforce.

Follow Robert Lowes on Twitter @LowesRobert


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