The federal budget proposal that the Trump administration announced on March 16 includes major cuts to non-defense spending, including a $15.1 billion cut to the annual budget of the Department of Health and Human Services (HHS). It also includes a provision folding the Agency for Healthcare Quality and Research (AHRQ) into the National Institutes of Health (NIH). At the time of the publication of this news article, it was not known what the proposed budget would be for the Office of the National Coordinator for Health IT (ONC), which resides within HHS alongside the Centers for Medicare & Medicaid Services (CMS).
Released publicly early on Thursday morning, the Trump administration’s budget proposal carries the title “America First: A Budget Blueprint to Make America Great Again.” A qualitative title itself is a break from past practice. The budget proposal aims at increasing defense spending by $54 billion, to $639 billion in FY 2018 over $587 billion in FY 2017, while cutting the vast bulk of domestic spending, through $54 billion in cuts to non-defense spending. With regard to HHS, the 2018 budget proposal requests $69.0 billion for that department, which represents a $15.1 billion, or 17.9-percent, decrease from fiscal year 2017.
With regard to the 21st Century CURES Act, that program is excluded from cuts, and actually sees additional funding.
As the White House’s “Blueprint” notes, the administration’s proposal “[r]educes the National Institutes of Health’s (NIH) spending relative to the 2017 annualized CR level by $5.8 billion to $25.9 billion. The Budget includes a major reorganization of NIH’s Institutes and Centers to help focus resources on the highest priority research and training activities, including: eliminating the Fogarty International Center; consolidating the Agency for Healthcare Research and Quality [AHRQ] within NIH; and other consolidations and structural changes across NIH organizations and activities. The Budget also reduces administrative costs and rebalance federal contributions to research funding.”
The “Blueprint” includes no specific information regarding CMS or ONC, and it was not possible to obtain information on those agencies’ proposed budgets. One informational source who is not inside the federal government but who has extensive contacts with the government, told Healthcare Informatics that OMB officials had prepared the budget without any consultation with anyone within CMS or ONC. It was not possible to have that confirmed or denied by anyone in the federal government.
With regard to the $54 billion in proposed cuts to domestic spending that are intended to offset $54 billion in proposed increases in defense spending, President Donald J. Trump said in a statement, “The core of my first Budget Blueprint is the rebuilding of our Nation’s military without adding to our Federal deficit. There is a $54 billion increase in defense spending in 2018 that is offset by targeted reductions elsewhere. This defense spending is vital to rebuilding and preparing our Armed Forces for the future. We must ensure that our courageous servicemen and women have tools they need to deter war, and when called upon to fight, do only one thing: Win. In these dangerous times, this public safety and national security Budget Blueprint is a message to the world—a message of American strength, security, and resolve.”
Meanwhile, Mari Savickis, vice president of federal affairs at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), told Healthcare Informatics Thursday morning that “We are in the process of going through the just-released ‘skinny budget,’ but there isn’t anything about ONC in there, at first glance. The thing is, ONC has been given a tremendous amount of responsibility in the 21st Century Cures Act, so this ‘interoperability’ thing we are dealing with is something that’s needed to support the healthcare industry as a whole. So it’s hard to imagine ONC would just completely disappear; that seems fairly unlikely,” the Washington, D.C.-based Savickis said. “But it’s also hard to tell [what will happen], when you are seeing such sizable proposed cuts coming out of the administration. Right now, CHIME has cause for optimism. There are a lot of health IT provisions in the Cures Act, and it speaks to the larger issue—that the Administration wants to see savings. And in part, that’s driven by having a good technical infrastructure. It’s hard to see anyone disagreeing with that.”
But the Bethesda, Md.-based American Medical Informatics Association (AMIA) issued a statement by its vice president of public policy, Jeffrey Smith, that was more openly critical. “Specific to the HHS proposals, this budget would hinder our national capacity to advance discovery and deploy better cures for patients, faster,” Smith said in the statement. “The NIH cuts undermine the promises Congress made as part of the 21st Century Cures Act, and the dissolution of AHRQ severely hampers our collective ability to improve care delivery at a national level,” the AMIA statement continued. “It’s hard to see how programs like Precision Medicine, the Cancer Moonshot or the BRAIN Initiative can deliver on their potential with a 20 percent cut to NIH. Basic research done at the bench in universities across the country is interconnected to treatments delivered at the bedside. So, even targeted cuts at one end of the discovery spectrum will impact the whole.”