Trump Releases Federal FY 2021 Budget Blueprint

This week, the Trump Administration released their federal fiscal year 2021 budget blueprint, which outlines the President’s policy priorities for the next budget year beginning on October 1, 2020. These documents define the Administration’s plans for the federal government, but also serve as the opening gambit to negotiations with Congress.

In a record-breaking $4.8 trillion budget plan, the Trump Administration delineates five key priorities for the coming fiscal year including new or renegotiated trade deals, rebuilding the nation’s military, addressing the opioid crisis, regulatory reform, and achieving American energy independence. However, the spending plan also outlines almost $2 trillion in domestic spending cuts particularly to safety net programs. Reductions would include new work requirements for Medicaid, federal housing assistance and food stamp recipients, which would reduce spending in these programs by nearly $300 billion.

Democrats in Congress were less than enthusiastic about the President’s 2021 Budget vision with House Speaker Nancy Pelosi noting “year after year, President Trump’s budgets have sought to inflict devastating cuts to critical lifelines that millions of Americans rely on.”  The President was also criticized from more conservative outlets for the budget blueprint relying on “optimistic projections for economic growth and unlikely budget cuts to illustrate deficit reduction.”

Perhaps one of the more worrisome proposals are proposed cuts to Medicaid and the Affordable Care Act (ACA) over ten years, totaling $844 billion, including eliminating the enhanced federal match for the ACA’s Medicaid expansion to low-income adults. Furthermore, the Administration proposes to require all states to remove adult Medicaid enrollees who do not meet new work requirements.

Notable provisions of interest to local health departments include:

• $1.6 billion, increased by $85 million from FY 2020, for State Opioid Response grants.
• A proposal to move the Center for Tobacco Products out of the Food and Drug Administration (FDA) and create a new agency within Health and Human Services to focus on tobacco regulation.
• $371 million, increased by $231 million from FY 2020, for the Ending the HIV Epidemic initiative, to support a ramp up of activities in 57 jurisdictions – 48 counties (in California, includes Alameda, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco counties), Washington DC, San Juan Puerto Rico, and 7 states with that have a substantial rural HIV burden (Alabama, Kentucky, Mississippi, Missouri, Oklahoma, Tennessee, and South Carolina).
• $58 million, increase of $48 million from FY 2020, for the Infectious Diseases and the Opioid Epidemic program. Funding would be directed to “select jurisdictions nationwide” to target the infectious diseases associated with the opioid epidemic including HIV, viral hepatitis, and bacterial and fungal infections.
• Eliminates $426 million from the CDC’s Chronic Disease Prevention and Health Promotion program area, including eliminating all program funding for tobacco; nutrition, physical activity and obesity; heart disease and stroke; diabetes; and oral health.
• Eliminates all funding ($160 million) for the Preventive Health and Health Services Block Grant program.
• Reduces funding for Emerging and Zoonotic Infectious Diseases by $85 million, including eliminating all funding for the Epi and Lab Capacity program and all funding for Healthcare-Associated Infections program.
• $182 billion cut to SNAP over ten years, including adding work requirements for able-bodied adults ages 18 to 65.
• Modifications to the Medicaid Institutions for Mental Diseases (IMDs) exclusion allowing for “targeted flexibility” to States to provide inpatient mental health services to Medicaid beneficiaries with serious mental illness.

The full FY 2021 budget proposal is available from the White House here. For a full list of proposed CDC appropriations including program cuts, click here.