The Trump administration is expected to introduce its 2018 budget proposal on May 23, which will likely include major cuts to programs for low-income Americans. (Video: Jenny Starrs/Photo: Jabin Botsford/The Washington Post)
Story by Washington Post
Written by Joel Achenbach and Lena H. Sun
President Trump's 2018 budget request, delivered to Congress on Tuesday with the title “A New Foundation for American Greatness,” has roiled the medical and science community with a call for massive cuts in spending on scientific research, medical research, disease prevention programs and health insurance for children of the working poor.
The National Cancer Institute would be hit with a $1 billion cut compared to its 2017 budget. The National Heart, Lung and Blood Institute would see a $575 million cut, and the National Institute of Allergy and Infectious Diseases would see a reduction of $838 million. The administration would cut the overall National Institutes of Health budget from $31.8 billion to $26 billion.
The National Science Foundation, which dispenses grants to a variety of scientific research endeavors, would be trimmed $776 million, an 11 percent cut. NSF had not been mentioned in the administration's earlier budget outline, the so-called “skinny budget,” which was released in March.
“The National Science Foundation last year used your taxpayer money to fund a climate change musical. Do you think that’s a waste of your money?” asked the director of Office of Management and Budget director, Mick Mulvaney, during a White House briefing on Tuesday.
He also noted the cuts to climate change research, saying that, under President Barack Obama, the “pendulum went too far to one side” and the government spent too much on climate science.
“Does it mean that we are anti-science? Absolutely not,” he said. “We are simply trying to get things back in order to where we can look at the folks who pay the taxes and say, 'Look, yeah, we want to do some climate science. But we're not going to do some of the crazy stuff the previous administration did.”
The proposed cuts to the U.S. Centers for Disease Control and Prevention drew an unusually sharp rebuke from former CDC director Tom Frieden, who went on Twitter to describe the administration's CDC request as “unsafe at any level of enactment. Would increase illness, death, risks to Americans, and health care costs.”
In a separate tweet, Frieden listed what he sees as the dire ramifications of the Trump proposal, saying, for starters, that it “Devastates programs that protect Americans from cancer, diabetes, heart attacks, strokes and other deadly and expensive conditions.”
Steven Houser, president of the American Heart Association, called Trump's budget “devastating” and “unconscionable.” He urged Congress to boost funding for NIH by $2 billion rather than cut it by nearly $6 billion.
Rush Holt, CEO of the American Association for the Advancement of Science, said the Trump budget is short-sighted, particularly in assuming that economic growth won't be hampered by cuts in government-funded research.
“There's this rosy optimism that somehow growth will magically occur, and yet it cuts the principal source of that growth,” Holt said. The proposal “savages research. Economists are clear: That’s where we ultimately get our economic growth.”
The full budget document was scheduled to be released Tuesday morning, but the administration inadvertently posted the section dealing with the Department of Health and Human Services late Monday afternoon.
Slashing programs that normally have enjoyed bipartisan support is part of the Trump administration's effort to trim trillions of dollars in spending over the next decade while at the same time paying for tax cuts and increases in military spending.
OMB's March “skinny budget” had delivered a number of surprises, including a call to cut nearly one-fifth of National Institutes of Health budget and nearly one-third of the Environmental Protection Agency funding. Lawmakers appeared to ignore that budget request entirely when putting together a spending plan for the rest of fiscal 2017, which runs through September. Much of that spending plan had been in the works before the November election.
Congress has the power of the purse and could essentially ignore the more detailed budget request. Early reactions on both sides of the aisle have been generally unfavorable. One Republican lawmaker, Rep. Tom Cole of Oklahoma, flinched at the thought of cutting NIH and such programs as Meals on Wheels. Rep. Mark Meadows (R-N.C.), head of the ultra-conservative Freedom Caucus, said of Meals on Wheels, “I’ve delivered meals to a lot of people that perhaps it’s their only hot meal of the day.”
OMB director Mulvaney, briefing reporters, said the administration had produced a “taxpayer-first” budget, saying that compassion should be offered not only to the needy who receive government resources but also to the people who pay the taxes to fund such programs. “Compassion needs to be on both sides of that equation,” Mulvaney said.
The administration's detailed budget request calls the termination of many research-related programs, such as the Department of Energy's Advanced Research Project Agency - Energy (ARPA-E). The National Oceanic and Atmospheric Administration's grant and education program, which has $262 million in 2017 funding, would be zeroed out. “These grant and education programs generally support State, local, and/or industry interests, and these entities may choose to continue some of this work with their own funding,” the administration's budget document states.
Also terminated would be NASA's Office of Education, as well as five NASA Earth Science missions that the administration considers to be low-priority. The administration said killing those Earth Science missions would save $191 million. The Trump administration is also declining to put in money for a robotic probe to land on Jupiter's moon Europa, even though that it required under the NASA authorization act recently signed into law.
NASA acting administrator Robert Lightfoot, taking the stage in an auditorium at NASA headquarters, gave an upbeat assessment of OMB's budget request, which includes a modest cut to the agency's funding but keeps most major programs intact. “What this budget tells us to do is keep going,” Lightfoot said.
Among key health-care changes:
Planned Parenthood would be barred from receiving any HHS funding, according to a fact sheet accompanying the budget release — a prohibition that would apply not just to Medicaid but to all programs. The fact sheet notes that this move “follows through on a campaign promise” to block federal dollars from “certain entities that provide abortions, including Planned Parenthood.”
Funding for the Children’s Health Insurance Program (CHIP) would be slashed by at least 20 percent for the next two fiscal years. According to the budget document, the administrator favors a renewal of CHIP, a program created 20 years ago for the children of lower-working class families and which currently insures 5.6 million children.
The spending plan would, however, eliminate an element of the Affordable Care Act that increased by 23 percent the portion of the program’s costs that is paid for with federal money, leaving states to shoulder a larger share. It would also for the first time essentially limit states’ eligibility levels to qualify, saying that the government would no longer help cover children from families with incomes of more than 250 percent of the federal poverty level. Currently, 18 states plus the District of Columbia allow families with incomes higher than 300 percent of the poverty line to sign up their children for CHIP, according to data from the Kaiser Family Foundation.
The Trump budget cuts $1.2 billion from the Centers for Disease Control and Prevention, which responds to disease outbreaks in the United States and around the world, makes sure food and water are safe, and helps people avoid heart disease, cancer, stroke and other leading causes of death. The 17 percent cut is the lowest CDC budget in more than 20 years, Frieden said.
The president's budget seeks an $82 million cut at the center that works on vaccine-preventable and respiratory diseases, such as influenza and measles. It proposes a cut of $186 million from programs at CDC’s center on HIV/AIDS, viral hepatitis, sexually transmitted infections and tuberculosis prevention. One of the biggest cuts, $222 million, is to the agency’s chronic disease prevention programs, which are designed to help people prevent diabetes, heart disease and stroke, and obesity.
Some of those funds are being channeled into a new $500 million block grant program to states and territories to focus on “leading chronic disease challenges specific to each state.” Critics have said block grants allow states to plug holes in their budgets, without accountability that federal programs require.
The agency’s center on birth defects and developmental disabilities also gets a 26 percent cut to its budget at a time when researchers have yet to understand the full consequences of Zika infections in pregnant women and their babies and the underlying causes of autism.
The budget calls for a 17 percent cut to CDC’s global health programs that monitor and respond to disease outbreaks around the world. It also cuts about 10 percent from CDC’s office of public health preparedness and response.
The budget document highlights $35 million that the CDC spends on childhood lead poisoning prevention. But the overall spending on environmental health would under Trump's plan be cut by $60 million, down to $157 million, according the document.
Trump administration officials have also proposed the establishment of an Emergency Response Fund to respond quickly to emerging public health threats. In the wake of the Ebola and Zika epidemics, U.S. officials have repeatedly called for the need for such a fund. The budget does not provide a specific amount. It says HHS would have “department-wide transfer authority to support the Fund in the case of a natural or man-made disaster or threat.” The fund would be available to receive a transfer of up to one percent of any HHS account, without any limitation on the total, for use in emergency preparedness and response.
The Food and Drug Administration would see a cut in federal funding from $2.74 billion to $1.89 billion. To offset the reduction, user fees paid by manufacturers of drugs, devices and other medical products, which now total $1.2 billion and cover nearly half the cost of all medical-product activities, would be increased by more than $1.1 billion. As a result, the agency's overall funding would increase by more $400 million.
But hiking industry fees isn't likely to go anywhere on Capitol Hill. Republican Sen. Lamar Alexander of Tennessee, the chairman of the health committee, has said he does not want to reopen negotiations with the industry over fees that it pays to support FDA activities. His committee recently approved legislation that ignores the administration request for higher user fees.
The budget retains the Office of National Drug Control Policy, which had been threatened with virtual extinction, with a $368.5 million budget, a small decrease from its 2017 funding. In an email sent to full-time employee earlier this month, Richard Baum, the acting director of the office, said the administration’s proposal for the fiscal year that begins in October would reflect “a nearly 95 percent” cut in the agency’s budget. That appears to have been largely reversed.
