Winners and losers in Trump’s proposed budget for HHS

President Donald Trump’s budget proposal for fiscal year 2018 would reduce funding to HHS by $15.1 billion, a cut of nearly 18 percent, eliminating millions for education and training programs for healthcare professionals, while cutting $5.8 billion from the National Institutes of Health (NIH) alone.

The overall funding level of $65.1 billion would be the lowest for HHS since 2002, but there are a few areas within the agency which would receive extra funding:

• An additional $70 million for Health Care Fraud and Abuse Control (HCFAC) within CMS. The budget proposal said the program has been worth the investment, allowing the agency to “shift away from a pay-and-chase model” and stop improper payments or fraud before they occur.
• A $500 million boost for opioid misuse prevention and efforts to increase access to addiction treatment.
• A $500 million block grant to the Centers for Disease Control and Prevention (CDC) to “increase state flexibility and focus on the leading public health challenges specific to each state.”
• Creates a new Federal Emergency Response Fund to address public health outbreaks, like the Zika virus, though no amount of funding is specified.

The budget blueprint committed to supporting many of the agency’s “highest priorities,” like efficient operations for Medicare and Medicaid and community health centers, without listing a particular funding level.

The number of cuts, however, outweigh the additional funding. The $5.8 billion reduction for NIH would erase the $2 billion boost given to the agency in 2015 and includes a “major restructuring” of the institutes and centers under its umbrella. The $69 million Fogarty International Center, which supports collaboration and research on global health, would be eliminated. The plan also calls for “consolidating” the Agency for Healthcare Research and Quality, without specifying whether it’s being defunded entirely or simply altered.

In a more specific cut, the Trump budget would eliminate $403 million in funding for training programs for healthcare professionals, citing a lack of evidence that “they significantly improve the nation’s health workforce. 

“The budget continues to fund health workforce activities that provide scholarships and loan repayments in exchange for service in areas of the United States where there is a shortage of health professionals,” the blueprint said.

One sector that would take a hit from the proposal is the medical device industry. Under the plan, device companies would collectively pay an extra $1 billion in “medical product user fees” to the Food and Drug Administration (FDA) to cover the costs of regulatory reviews. In return, the proposal said there will be unspecified administrative changes made to “achieve regulatory efficiency and speed the development of safe and effective medical products.”

“In a constrained budget environment, industries that benefit from FDA’s approval can and should pay for their share,” the budget blueprint said.

One area supposedly untouched by the Trump administration’s budget axe would be additional funding for the 21^st Century Cures Act. The blueprint said the money implementing the law would be included for 2018, but the act was supposed to give NIH an extra $4.8 billion, less than what Trump is proposing to cut from the agency.