Five Observations on Trump’s Budget and Discretionary Spending on Health and Science

The FY2018 President’s Budget for the Department of Health and Human Services (HHS) has significant implications for medicine, public health, and science. Below are five observations on the discretionary side of the budget that warrant attention as Congress reviews the President’s proposal:

• Public health emergency preparedness for threats such as pandemic influenza and bioterrorism is and must be a bipartisan priority. While the FY2018 budget proposes the establishment of an Emergency Response Fund, an increase in funding for pandemic influenza preparedness, and maintenance of support for medical countermeasure development and procurement, Congress should ensure that proposed cuts to maximize efficiencies in the preparedness programs at the Centers for Disease Control & Prevention (CDC) and the Assistant Secretary for Preparedness and Response do not jeopardize public health.

• Preventing opioid abuse and overdose deaths is a priority in the discretionary budget as it maintains several important programs supporting states and health care providers across CDC and the Substance Abuse & Mental Health Services Administration at the FY2017 Continuing Resolution funding levels and includes $500 million authorized in the 21^st Century Cures Act for states to increase access to treatment and reduce overdose related deaths. Nevertheless, Congress should examine closely whether the funding proposals, particularly in light of deep proposed cuts to Medicaid, meet the need for medication-assisted treatment and the needs of vulnerable populations such as newborns, children, intravenous drug users, overdose survivors, and incarcerated persons.

• Federal public health funding serves as a critical complement to the efforts of localities and the private sector in improving our nation’s health. While the America’s Health Block Grant Program would provide states an opportunity to focus on a leading cause of death specific to each state, policymakers should carefully consider how separate cuts across CDC and HHS agencies to chronic disease prevention (including tobacco control and obesity prevention), infectious diseases, mental health services, and substance abuse prevention programs (beyond opioids) might increase our burden of illness in the U.S.

• The biomedical research enterprise funded by the National Institutes of Health (NIH) provides scientific, economic, and current and future workforce benefits to the nation. While the NIH-academic grantee partnership deserves study, a nearly $6 billion cut to the NIH could reduce our nation’s ability to find cures and treatments for chronic and infectious diseases.  In addition, the budget proposes to move the Agency for Healthcare Research and Quality (AHRQ) into the NIH as its own Institute called the “National Institute for Research on Safety and Quality (NIRSQ),” and reduces its budget by 16 percent. Maintaining adequate funding for quality health services research is important for improving our nation’s health care system. Should AHRQ become a part of NIH, it should have a mission to work across HHS on issues of health care quality, safety, and cost.

• While the topic was not discussed in the White House budget submission, delivery and payment reform is central to the transformation of health care from a volume to a value-driven system. The Centers for Medicare and Medicaid Services (CMS) has been a leader in this effort, and we look forward to hearing more from the administration on the agency’s continued role – in partnership with health care providers and stakeholders – as a hub for testing new care models and expanding what works in value-based health care transformation.