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MEMO: Trump Administration FY 2018 Budget Proposed

Thursday, May 25, 2017   (0 Comments)
Posted by: Blake Goodman
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May 25, 2017

MEMORANDUM

TO:     Coalition for Clinical and Translational Science

FR:     Dale Dirks and Dane Christiansen

RE:     Trump Administration FY 2018 Budget Proposal

Following completion of the Fiscal Year (FY) 2017 appropriations bills a few weeks ago, the Trump Administration issued its official budget proposal for FY 2018 this week. The budget proposal is being issued later than usual due to the changeover in administrations and the protracted FY 2017 process.

The budget proposal issued this week is very similar to the FY 2018 outline that was provided by the White House in March. However, there is much more detail accompanying this latest offering by the President, the Office of Management and Budget, and federal agencies.

The budget proposal represents a significant shift in priorities from the previous administration and marks the current President’s stated goal to increase spending on defense and security programs while decreasing spending on non-defense discretionary programs. Public health, medical research, health professions training, education, environmental, and foreign assistance programs are all cut dramatically in the President’s budget proposal.

The budget proposal also tracks some of the changes included in the House of Representatives-passed American Health Care Act. For example, it recommends significant cuts to—and a restructuring of—the Medicaid program.

Congress will now begin the process of deliberations on the budget proposal. Although the funding levels and policy changes in the proposal seem daunting, many of the programs recommended for cuts have bipartisan support in Congress, and are likely to receive better treatment during the congressional budget/appropriations process.

Below, please find the FY 2018 budget proposal’s top-line numbers for various agencies:

  • $69.81 billion in discretionary budget authority for the Department of Health and Human Services, a cut of $14.5 billion below FY 2017.
    • $5.12 billion for the Food and Drug Administration program level, an increase of $456 million over FY 2017. The budget proposal recommends that the bulk of FDA’s budget come from industry user fees rather than the existing combination of discretionary budget authority and user fees.
    • $5.55 billion for the Health Resources and Services Administration, a cut of $913 million below FY 2017.
    • $5.975 billion for the Centers for Disease Control and Prevention program level, a cut of $1.2 billion below FY 2017.
    • $26.9 billion for the National Institutes of Health program level, a cut of $7.2 billion below FY 2017. The budget proposal recommends cuts for each NIH institute and center, and recommends capping NIH payments of indirect costs.
    • $3.8 billion for the Substance Abuse and Mental Health Services Administration, an increase of about a $25 million over FY 2017.
    • $0 for the Agency for Healthcare Research and Quality, a cut of $324 million. The budget proposal recommends consolidating the functions of AHRQ into NIH.
  • $59 billion in discretionary funding for the Department of Education, a cut of $12 billion below FY 2017.
  • $5.6 billion for the Environmental Protection Agency, a cut of $2.4 billion below FY 2017.
  • $82.1 billion in discretionary funding for the Department of Veterans Affairs, an increase of $4.3 billion over FY 2017.
  • $37.61 billion for the State Department, a cut of $19.92 billion below FY 2017.
  • $639.1 billion for the Department of Defense, an increase of $26 billion over FY 2017

Of specific interest to CCTS, the budget proposal recommends:

  • $5.975 billion for the Centers for Disease Control and Prevention program level, a cut of $1.2 billion below FY 2017.
    • $952 million for Chronic Disease Prevention and Health Promotion at CDC, a proposed decrease of $168 million from FY 2017, including $500 million from the Prevention and Public Health Fund (an increase of $112 million over in PPHF funding FY 2017).
      • Line item (often disease-specific) CDC programs are eliminated and replaced with a new $500 million “America’s Health Block Grant Program” for states and tribal organizations [please see language below].
  • $26.9 billion for the National Institutes of Health program level, a cut of $7.2 billion below FY 2017. The budget proposal recommends cuts for each NIH institute and center, and recommends capping NIH payments of indirect costs.
    • $4.47 billion for the National Cancer Institute at NIH, a proposed decrease of $920 million from FY 2017.
    • $2.54 billion for the National Heart, Lung, and Blood Institute at NIH, a proposed decrease of $670 million from FY 2017.
    • $1.66 billion for the National Institute of Diabetes, and Digestive and Kidney Diseases at NIH, a proposed decrease of $360 million from FY 2017.
    • $1.36 billion for the National Institute of Neurological Disorders and Stroke at NIH, a proposed decrease of $420 million from FY 2017.
    • $3.78 billion for the National Institute of Allergy and Infectious Diseases at NIH, a proposed decrease of $1.13 billion from FY 2017.
    • $2.19 billion for the National Institute of General Medical Sciences at NIH, a proposed decrease of $460 million from FY 2017.
    • $1.3 billion for the National Institute on Aging at NIH, a proposed decrease of $705 million from FY 2017.
    • $418 million for the National Institute of Arthritis and Musculoskeletal and Skin Diseases at NIH, a proposed decrease of $139.9 million from FY 2017.
    • $215 million for the National Institute on Minority Health and Health Disparities at NIH, a proposed decrease of $74.1 million from FY 2017.
    • $557 million for the National Institute for Advancing Translational Sciences at NIH, a proposed decrease of $148.9 million from FY 2017.
    • $1.45 billion for the Office of the Director at NIH, a proposed decrease of $21 million from FY 2017.
  • $0 for the Agency for Healthcare Research and Quality, a cut of $324 million. The budget proposal recommends consolidating the functions of AHRQ into NIH.
  • $640 million for the VA Medical and Prosthetic Research Program, a proposed decrease of $35 million from FY 2017.
  • $34.6 billion for the Defense Health Program, a proposed decrease of $560 million from FY 2017.
    • Congressionally directed medical research programs at the Department of Defense, including the Peer-Reviewed Medical Research Program, are traditionally not included in the administration’s budget request.
  • Roughly $880 million in cuts to Medicaid and $72.5 billion in cuts to Social Security Disability Insurance (over the next 10 years), which would effectively cut the programs in half in terms of resources available.

Additional Detail and Responses to Committee Recommendations

America's Health Block Grant Program ($500.0 million)

The FY 2018 budget request includes a new $500 million America's Health Block Grant to increase State, Tribal, and territorial flexibility on the leading chronic disease challenges specific to each State, which could include preventing and better managing heart disease and diabetes - two of the most common and costly chronic diseases - as well as arthritis, the leading cause of disability in the United States. The newly-established America's Health Block Grant will provide flexibility in FY 2018 for each state to implement specific interventions that address leading causes of death and disability, including interventions to spur improvements in physical activity and the nutrition of children and adolescents, and other leading causes of death such as heart disease.

CDC Response: CDC will provide a response to Congress for this Significant Item in a supplemental package.

“National Institutes of Health – This Report is Pending”

  • In addition to responses to Committee Recommendations, the NIH report traditionally also includes funding levels for various programs and activities at Institutes and Centers.