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Federal budget proposal would deal ‘devastating blow’ to medical research
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The Trump administration’s proposed 2018 budget would decimate scientific research and innovation while jeopardizing millions of Americans’ access to essential health care and preventive services, according to leaders of national medical organizations.
President Donald J. Trump’s spending plan — delivered to Congress today with the title “A New Foundation for American Greatness” — proposes nearly $6 billion in funding cuts for the NIH. This would deal “a devastating blow” to medical research, Steven Houser, PhD, FAHA, president of the American Heart Association, said in a statement.
“A cut of this magnitude would force promising research to be left unfinished — or worse, put on hold,” Houser said. “The hope of too many Americans rests on NIH–funded research and breakthrough medical advancements.”
Trump’s proposal — which includes billions of dollars in cuts for other health-related entities and programs, including Medicaid — is designed to trim $3.6 trillion in spending in the next decade.
The plan — based on a goal of 3% annual economic growth by 2027 — is grounded in eight pillars of reform: health reform, tax reform and simplification, immigration reform, reductions in federal spending, regulatory rollback, American energy development, welfare reform and education reform.
“It struck me the title should have been different. The title should have been a ‘taxpayer-first budget’ because that is what this is,” Mick Mulvaney, director of the White House Office of Management and Budget, said during a press briefing this morning. “We looked at this budget through the eyes of the people who were actually paying the bills.”
However, several medical organizations urged lawmakers to reject the proposed cuts and reaffirm a bipartisan commitment to funding for research and disease prevention.
Chris Hansen, president of the American Cancer Society Cancer Action Network, said the budget proposal could cripple critical cancer research and prevention efforts.
“Cancer research is on the verge of significant new breakthroughs,” Hansen said in a statement. “The federal government has played a critical role in our ability to reduce the cancer burden. Such drastic budget reductions would have the potential to devastate the nation’s standing as the global leader in cutting-edge medical research and scientific discovery, hamper progress in detecting cancer early when it’s least expensive to treat and most survivable and severely restrict low-income patients’ access to critical safety-net health care coverage through Medicaid.”
John Meigs Jr., MD, president of the American Academy of Family Physicians, said the organization is “deeply troubled” by the potential impact of the budget request.
“Slashing funds for the critical federal agencies that oversee the health care industry — 17% of the U.S. economy — destabilizes the foundation of services on which patients depend,” Meigs said in a statement. “The dramatic cuts to agencies that ensure health care is accessible, safe and efficient ultimately will harm the health of America on both an individual and community-wide basis.”
Health care funding
In March, Trump’s budget blueprint called for $54 billion in cuts overall, including a 16.2% reduction — equivalent to $12.6 billion — for HHS and $5.8 billion in cuts for NIH.
The budget proposal publicly released today calls for the NIH budget to be reduced from $31.8 billion in 2017 to $26 billion next year.
The plan calls for funding reductions of $1.2 billion for the CDC, $1 billion for the National Cancer Institute, $838 million for the National Institute of Allergy and Infectious Diseases, and $575 million for the National Heart, Lung, and Blood Institute compared with 2017 levels.
The CDC cuts would include a $186 million reduction in programs for HIV/AIDS, viral hepatitis, sexually transmitted infections and tuberculosis prevention, and $222 million from the agency’s chronic disease prevention program.
“It is unconscionable that effective initiatives such as these would be brought to a standstill for the sake of short-term budget savings,” Houser said.
Hansen expressed a similar sentiment.
“Cutting the CDC chronic disease budget by nearly 20% threatens to substantially weaken vital tobacco prevention and cessation programs, as well as important efforts to address nutrition, physical activity and obesity — all significant cancer risk factors,” Hansen said.
FDA funding would be cut from $2.74 billion in 2017 to $1.89 billion next year.
User fees paid by manufacturers of drugs, devices and other products would be increased by approximately $1 billion to pay for product reviews.
The budget proposal includes policies to reduce reimbursement of indirect costs and implement changes to NIH structure to “support the highest-priority biomedical research and development.”
“In 2018, the Department of Health and Human Services and NIH will develop policies to reduce the burden of regulation on recipients of NIH funding consistent with the administration’s initiatives on regulatory reform and the goals articulated for the new Research Policy Board established in the 21st Century Cures Act,” the proposal said.
Medicaid reform
Trump’s budget also proposes reducing Medicaid spending by $610 billion in the next decade, a key component in the president’s plan to balance the federal budget within 10 years. A Congressional Budget Office estimate indicated at least 14 million low-income individuals could lose Medicaid benefits during that time.
The cuts included Trump’s budget proposal would be on top of $800 million in Medicaid cuts called for in the American Health Care Act, the Republican-crafted legislation intended to replace the Affordable Care Act.
“To realign financial incentives and provide stability to both federal and state budgets, the budget proposes to reform Medicaid by giving states the choice between a per capita cap and a block grant and empowering states to innovate and prioritize Medicaid dollars to the most vulnerable populations,” the proposal said. “States will have more flexibility to control costs and design individual, state-based solutions to provide better care to Medicaid beneficiaries.”
Mulvaney said he does not consider the Medicaid reform effort a funding cut.
“There are no Medicaid cuts in the terms of what ordinary human beings would refer to as a cut,” Mulvaney said. “We are not spending less money 1 year than we did the year before. What we are doing is growing Medicaid more slowly over the 10-year budget window than the Congressional budget says that we should or says that we will under current law.”
The full budget proposal can be accessed on the White House’s website. – by Kristie L. Kahl