Trump Administration Releases 2020 Budget, Proposes Significant Cuts to Health, Social Program Spending

On Monday, President Donald Trump released his Administration’s proposed FY 2020 budget, amounting to a record $4.75 trillion plan that increases military and defense spending while significantly cutting health, environmental, and education spending. Notably, spending on the U.S. Department of Health and Human Services is slated for a 12 percent cut, which includes a $750 million decrease to the U.S. Centers for Disease Control and Prevention (CDC), a $5.4 billion decrease to the National Institutes of Health (NIH), a $1 billion decrease to the Health Resources and Services Administration (HRSA), a $200 million decrease to the Agency for Healthcare Research and Quality (AHRQ), and a $62 million decrease to the Substance Abuse and Mental Health Services Administration (SAMHSA).

The budget proposes to cut $845 billion from Medicare over the next 10 years, largely by modifying payments to hospitals and providers and strengthening fraud and abuse enforcement activities. The budget also proposes to cut $1.5 trillion for Medicaid over the next 10 years and instead provide $1.2 trillion for block grants or per-person caps starting in 2021. Under this arrangement, states would be granted far greater authority to determine coverage for low-income residents. Further, the budget proposes to eliminate funding for Medicaid expansion provided under the Affordable Care Act (ACA).

In other areas, the Trump Administration proposes to cut $220 billion from the Supplemental Nutrition Assistance Program (SNAP) over the next 10 years, implement mandatory work requirements for able-bodied adults receiving SNAP benefits, and provide SNAP beneficiaries with food box deliveries in lieu of cash benefits. The Office of National Drug Control Policy (ONDCP) is proposed to be cut by more than 95 percent, shifting the bulk of duties and responsibilities into other federal agencies. The budget proposes to cut the U.S. Environmental Protection Agency (EPA) budget by 31 percent, largely eliminating climate change-related programs and research.

The Trump Administration does propose several areas of new spending in areas related to health and social programs. For example, the budget proposes to set aside $750 million to establish a paid parental leave program and a $1 billion one-time fund for underserved populations and company investments in childcare. A $643 million increase is proposed for the U.S. Food and Drug Administration (FDA) and includes a proposal for a new user fee to help evaluate electronic cigarettes. The Administration also proposes to spend $291 million in ending the spread of HIV in the United States within a decade. However, the budget also calls for significant cuts to global HIV investments, including a $1 billion decrease in spending on the President’s Emergency Plan for AIDS Relief (PEPFAR) and reductions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

The budget proposal largely mirrors the same increases in military and defense spending and decreases in domestic spending as presented to Congress by President Trump last fiscal year. With a divided Congress, the Trump Administration’s budget proposal is certain to face significant scrutiny and largely serves as a symbolic blueprint to the Administration’s campaign promises.

The full FY 2020 budget proposal, along with fact sheets and other materials, is available from the White House here.