President Trump Releases FY 2019 Budget

This week, President Donald Trump released his proposed FY 2019 Federal Budget. The $4.4 trillion budget calls for increases in military and defense spending, limits to federal funds for infrastructure improvements, stronger border protections, and an infusion of funds to address the opioid crisis. While the budget proposal offers an insight into the Trump Administration’s priorities, it virtually has no chance of being enacted into law. Recall last week, Congress agreed to a two-year budget deal that increases military and domestic program spending by nearly $300 billion over the next two years.

Trump’s budget proposal includes a number of health- and public health-related provisions. These include:

  • Assumes the passage of the Graham-Cassidy Proposal to repeal-and-replace the Affordable Care Act (ACA), which would largely convert all ACA funds to state-based block grants and implement per-capita spending caps
  • Cuts $878 million from the Centers for Disease Control and Prevention (CDC) discretionary budget; significant program cuts include Immunization and Respiratory Diseases (-$44m), Emerging and Zoonotic Infectious Diseases (-$60m), Chronic Disease and Health Promotion (-$138m), Birth Defects and Disabilities (-$26m), Injury Prevention and Control (-$18m), Public Health Scientific Services (-$26m), and Environmental Health (-$21m)
  • Eliminates the Preventative Health and Human Services Block Grant (funded solely with Prevention and Public Health Fund (PPHF))
  • Transfers the Strategic National Stockpile from the CDC to the Health and Human Services (HHS) Assistant Secretary of Preparedness and Response; transfers the National Institute for Occupational Safety and Health (NIOSH) from CDC to the National Institutes for Health (NIH)
  • Modifies Medicare prescription drug benefits to lower drug costs to beneficiaries and creates an out-of-pocket maximum
  • Provides $10 billion in funds to address the ongoing opioid crisis through prevention and treatment services
  • Cuts $688 million from the Substance Abuse and Mental Health Services Administration (SAMHSA); eliminates the Screening and Brief Intervention, and Referral to Treatment (SBIRT) program, cuts other related prevention programs, increases the Substance Abuse and Prevention Block Grant by $13 million
  • Eliminates the Agency for Healthcare Research and Quality (AHRQ) which is tasked with researching and improving the effectiveness of health services; eliminates various health care training and workforce programs
  • Reduces Supplemental Nutrition Assistance Program (SNAP) vouchers and introduces “USDA food packages” that would include shelf-stable food products and canned goods
  • Eliminates the Community Services Block Grant which provides $700 million in grants for various state-based health care, food, and workforce programs

The U.S. Department of Health and Human Services (HHS) FY 2019 Budget Brief is available here, the HHS budget tables are available here, and the CDC’s budget detail document is available here. The full White House budget proposal is available here.

Despite President Trump releasing his budget proposal, these figures and actions are highly unlikely to be enacted. As Congress continues to finalize the details of its two-year budget deal that will need to be enacted by mid-March, specifics to the FY 2019 federal budget will begin to emerge.