Entitlement Reform and a Year of Austerity

Full access

Keep an eye out in 2018 for Congress and the Administration to once again target research and health funding for FY 2019 with deep cuts proposed at both the discretionary and mandatory level. A year ago, President Trump set the tone of federal budget negotiations for FY 2018 with the introduction of his “skinny budget.” In a measure strongly condemned by then-ASN President Eleanor Lederer, MD, FASN, shortly after its introduction, the administration proposed deep cuts to funding for the National Institutes of Health, as well several other health programs.

In 2017, Congress listened to ASN’s strong stance against the proposed cuts, providing for a $2 billion increase to the budget, and stopping a number of other harmful proposals from becoming law. However, the Republican tax reform package passed at the end of 2017 has been estimated by non-partisan sources to increase the federal deficit by as much as $1.5 trillion. This massive increase will likely be paid for by decreasing spending on mandatory funding programs, such as Medicare and welfare spending programs. Long a target of Speaker of the House Paul Ryan, these mandatory programs are already being eyed for a coordinated, systematic overhaul under reconciliation procedures—the same mechanism used to alter the Affordable Care Act and the tax code—by Congress and the White House, according to a recent Politico report.

Also, discretionary spending, a broad category of funding for agencies and programs ranging from the military to health research, will be targeted for cuts. In a July 7, 2017, memo to the heads of federal agencies, Office of Management and Budget Director Mick Mulvaney promised that the FY19 budget would “build on the ambitious plans laid out in the President’s first budget” and instructed that FY19 budget requests only include proposals in line with the “President’s commitment to reprioritize spending and redefine the proper role of the Federal Government.” If the President’s FY18 budget is an indication of the administration’s spending priorities, health and research may bear the brunt of this reprioritization effort. Rumors on Capitol Hill corroborate this intelligence, with both Democrats and Republicans hinting that in FY19, programs and agencies will be lucky just to keep their funding steady.