WASHINGTON -- The Trump administration's is a gut punch to health, science, and research priorities, physician groups and independent scholars said.
The NIH, the Office of the National Coordinator (ONC) for Heath IT, and the Centers for Medicare and Medicaid Services (CMS) -- specifically the Medicaid program -- all saw drastic cuts in the just-released on Tuesday. The National Science Foundation's grant program would see its budget cut 11%.
In addition, the administration's overhaul of safety net programs eclipses any proposals in recent decades.
"Slashing funds for the critical federal agencies that oversee the healthcare industry -- 17% of the U.S. economy -- destabilizes the foundation of services on which patients depend ... Drastic cuts to the [CMS] budget undermine health security for nearly 60 million elderly through Medicare and nearly 75 million adults and children through Medicaid," said John Meigs Jr., MD, president of the American Academy of Family Physicians, in a press release.
He noted that CMS needs adequate funding to support both programs; policy experts have argued that overhauling Medicaid would also hurt Medicare recipients.
"We are very alarmed that the administration's budget will zero out funding for primary care training in the Title VII programs," commented Bob Doherty, senior vice president of the division of government and public policy for the American College of Physicians (ACP) during a press call Tuesday morning.
The ACP was also disappointed to see "deep cuts" to the NIH, reductions in funding to programs that address the opioid epidemic, and the elimination of the Agency for Healthcare Research and Quality (AHRQ).
'Imbalanced, Heavy-Handed'
Other leaders in the fields of science and research expressed similar dismay.
"The president's proposed FY18 budget is an imbalanced, heavy-handed approach to bolstering national defense at the expense of other American priorities, including the research and innovation crucial to national security," said Mary Woolley, president of Research!America in a press release.
"Steep funding cuts for the federal health agencies are counterproductive at a time when innovative research is moving us closer to identifying solutions for rare diseases, new prevention strategies to protect Americans from deadly and costly conditions, advances in gene therapy, new technologies for understanding the brain, and treatments that harness the ability of our immune system to fight cancer," she stated.
Health IT specialists were particularly upset by cuts to funding for the Office of the National Coordinator for Health IT (ONC), as shrinking such investments would threaten the progress of the 21st Century Cures Act.
Lynne Thomas Gordon, MBA, CEO of the American Health Information Management Association, wrote "investment in our nation's health IT infrastructure is critically important if we are to advance new drugs and devices and fully realize the benefits of a learning healthcare system. ONC is a critical partner in this endeavor."
Hard-Line Approach
The budget proposal assumes that the American Health Care Act (AHCA) will be enacted, a provision of which slashes Medicaid by more than $800 billion over a decade. On top of those presumed cuts, the bill trims the program by another $610 billion from Medicaid through 2028 and ends federal funding for Planned Parenthood.
In addition, the proposal takes a hard-line approach to the Supplemental Nutrition Assistance Program (SNAP).
"If you're on food stamps and you're able-bodied, we need you to go to work. If you're on disability insurance and you're not supposed to be, if you're not truly disabled, we need you to go back to work," said Mick Mulvaney, director of the Office of Management and Budget, during a White House briefing Monday.
Overall the U.S. Department of Health and Human Services budget would be reduced by $6.72 billion, including the following cuts, according to the White House:
- $5.8 billion in cuts to the NIH
- $769 million in cuts to the FDA (replaced with increased fees charged to industry)
- $22 million in cuts to the ONC
- $138 million in cuts to the National Institute for Occupational Safety and Health
- $5.7 billion in cuts over 2 years to the Children's Health Insurance Program (CHIP)
These changes to the NIH structure are needed to "improve efficiencies in the research enterprise" and to ensure a higher percentage of spending goes to "direct research costs," said the White House in a document titled "."
To offset the proposed cuts to the medical product user fee program, drug and device developers will be expected to pay more, according to the White House.
"Currently, medical product user fees cover an average of 60 percent of FDA premarket review costs ... Industries that directly benefit from FDA's medical product premarket approval and administrative actions can and should pay more to support FDA's continued capacity," said the administration in its budget addendum.
The proposed budget also halts funding for 14 health professions and nurse training programs focused on "improv[ing] the quantity, quality, diversity, and/or distribution of the Nation's health workforce." The administration argued that the programs aren't achieving their goals. For example, the majority of physicians and physician assistants who complete the Primary Care Training and Enhance Program do not end up working in medically underserved areas, the budget document noted.
Many other federal programs exist to support educating health professionals, it added, while underscoring that the White House had additional funding for the National Health Services Corps.
Romina Boccia, deputy director of the Thomas A. Roe Institute for Economic Policy Studies and the Grover M. Hermann fellow in federal budgetary affairs for the Heritage Foundation, expressed some support from the budget proposal, and called for more cuts to the overall federal budget deficit.
"Long-term budget solvency must include reforms to the largest entitlement programs: Medicare and Social Security. These programs alone consume 4 of every 10 federal dollars, and they are expanding," she said in a press release. "Moreover, this budget would rely on $2 trillion in economic feedback effects for deficit reduction, a figure that is highly uncertain. Greater spending cuts would have lent more fiscal credibility."
'Growing Medicaid More Slowly'
Mulvaney defended the proposed Medicaid scale-back during a second press briefing about the budget announcement.
"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 one year than we spent before. What we are doing is growing Medicaid more slowly over the 10-year budget window than the Congressional Budget Office [CBO] says that we should, or says that we will under current law."
"We've said from the very beginning we support the House efforts [to cut back on Medicaid]. We're looking forward to, and are working right now, with the Senate; working on what their healthcare bill would look like. But we support the American Health Care Act, and that does change Medicaid."
Many policy experts remain unconvinced, particularly because the budget proposes cuts to safety net programs and increasing defense spending.
"Once you take Social Security and Medicare off the table, and once you talk about increasing the defense budget, what you have is one-third of the federal budget bearing the burden of getting to balance. And that one-third of the budget is the low-income safety net programs," said G. William Hoagland, senior vice president of the Bipartisan Policy Center, to 51˶.
"I don't have any problem with getting the debt down, but it's not sharing the burden equally," said Hoagland, who for many years was a senior staffer for congressional Republicans. "Not only is it 'unfair,' but the budget is also completely unrealistic," he said.
Because the proposed budget assumes the AHCA will be enacted, it reduces funding to Medicaid by more than $8o0 billion over a decade -- if the CBO estimates are correct -- and adds another roughly $610 billion in cuts, Hoagland said.
The Senate is already working on its own version of an Affordable Care Act repeal-and-replace in part because so many Congressional members oppose cutting Medicaid. The budget proposal to nearly double those cuts seems to ignore the political reality of the moment, he added.
Some major government healthcare programs were not mentioned in the White House budget documents, including the CDC and the Department of Veterans Affairs' overall healthcare system, although the administration did propose an increase of some $28 billion over 10 years in the VA's "Choice Program" that allows vets to receive services in the community.