NIH, Medicaid Hit Hard in Federal Budget

Zachary D. Kribs
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On May 23, 2017, the Trump administration released its full budget request to Congress. The budget provides for a $1.7 trillion cut to domestic programs over the next 10 years, while drastically increasing defense spending. The budget, titled “A Foundation for American Greatness” by the White House, provides recommendations to Congress regarding both mandatory spending (entitlements like Medicaid) and discretionary spending (budgets funded yearly by Congress such as the Department of Defense and the National Institutes of Health. Relying on predictions of economic growth of nearly twice the level projected by the non-partisan Congressional Budget Office (CBO), the budget would significantly decrease the federal deficit from current levels by slashing domestic programs, despite a massive increase in military spending and a reduction in revenue from tax breaks to high-income earners.

The American Society of Nephrology (ASN) and peer societies expressed grave concern for the more than $7 billion proposed cuts to the NIH budget. Distributed nearly evenly over all the institutes, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) would receive an allocation of $1.45 billion, a cut of over $429 million from enacted FY 2017 levels and far short of the $2 billion increase ASN is currently advocating for.

Other major changes to the NIH budget include the elimination of the John E. Fogarty International Center, which studies the global impact of climate change on health outcomes, and the creation of a $272 million National Institute of Research on Safety and Quality, which would replace the $324 million Agency for Healthcare Research and Quality (AHRQ) eliminated by the budget.

Altogether, the budget proposal cuts of $12.4 billion from the Department of Health and Human Services (HHS), which, if enacted, would severely inhibit the operation of all affiliated agencies. A number of these cuts are of particular concern to ASN, including a $1.3 billion cut to the Centers for Disease Control (CDC), and a one-third reduction of the HHS General Departmental Management Fund, a cut that could potentially affect key ASN initiatives.

In a first for any presidential budget proposal, the Trump administration also proposes a massive $610 billion cut to Medicaid over the next 10 years. It is unclear if these cuts stand in addition to or replacement of the $839 billion in cuts proposed by the House Affordable Care Act replacement bill, but if enacted would leave the program only able to offer a fraction of its current services.

In response to the budget release, ASN President Eleanor Lederer, MD, FASN, issued a statement “denouncing” the drastic cuts. ASN has also coordinated responses regarding the budget with numerous peer societies, and continues to advocate for a $2 billion increase in funding for the NIH.