Trump administration considers major HHS cuts

The main point: The Trump administration is considering a more than 30% cut to the Department of Health and Human Services (HHS) budget as part of a reorganization that would eliminate and consolidate many key programs and agencies.

• Why it’s important: The draft document provides the most detailed look yet at the changes under consideration, which would fundamentally reshape HHS and narrow the scope of the government’s health care capabilities.

The details:

• The proposal outlined by the White House Office of Management and Budget, called a “passback,” is a draft of the proposal it will submit to Congress.
• But: It is not final. The proposal is still subject to change before it is sent to Congress, and then lawmakers will decide whether to accept the proposals.

The proposals:

• AHA created, MAHA center stage: The new Administration for a Healthy America (AHA) would be created, absorbing several existing HHS agencies. AHA would be an over $14 billion agency, making up almost one-fifth of the total HHS budget. AHA would include branches for the Surgeon General, primary care, maternal and child health, mental health, environmental health, HIV/AIDS, health workforce, and policy, research, and evaluation. The presidential Make America Healthy Again Commission would take on a more influential role in shaping AHA’s work. $500 million would be given to Secretary Kennedy to spend on MAHA activities, partially determined by the commission.
• Absorbed agencies’ funding cut: Funding for the Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSA), Agency for Healthcare Research and Quality (AHRQ), and a few other agencies would be eliminated. Some of the work done at those agencies would continue under AHA, but AHA’s $14 billion would be well below the collective amount allocated in past years to these agencies.
• CDC: The proposal would slash the Centers for Disease Control and Prevention’s (CDC) budget (by 44%, from $9.2 billion to $5.2 billion) and focus it more narrowly on infectious diseases. Suicide prevention, opioid overdose prevention and surveillance, and the National Violent Death Reporting System would continue, but other injury prevention program funding would be cut. AHA would include funding for health surveillance and data work, including through CDC’s National Center for Health Statistics and work previously led by SAMHSA. Nearly the entire Prevention and Public Health Fund, all of CDC’s domestic HIV work, and its chronic disease programs (including those working on adolescent health and smoking prevention/cessation) would be eliminated.
• NIH: The National Institute of Health’s (NIH) budget would be cut by 40%, from $47 billion to $27 billion. NIH’s 27 institutes and centers would be consolidated into just 8, with some eliminated and some fused together. The National Institute of Mental Health (NIMH), National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) would be combined into a new National Institute of Behavioral Health. Other institutes/centers would also be combined, others moved to AHA or the new Assistant Secretary for Innovation, and others eliminated (including the National Institute on Minority Health and Health Disparities). The proposal would cement the plan to impose a 15% cap on indirect costs that NIH pays to aid research at universities.
• Other programs eliminated: Programs that would be eliminated include MH/SUD programs for minority populations, funding for community mental health clinics, many rural health programs, Head Start, HIV/AIDS care for low-income people, programs related to adverse childhood experiences (ACEs), health care workforce initiatives, etc.