President Trump's budget proposal for the 2019 fiscal year prioritizes funding for key administration goals like combating the opioid epidemic.
Trump's budget, as outlined in The Office of Management and Budget's initial proposal (PDF), allocated $68.4 billion to the Department of Health and Human Services, a $17.9 billion decrease from 2017 that represents a 21% cut. The document includes savings from a presumed repeal of the Affordable Care Act in its overall projections.
However, after Congress passed a two-year spending deal last week, OMB on Monday issued an addendum (PDF) that provides an additional $27 billion for HHS, as the bipartisan deal boosted spending above levels favored by the administration. The updated figures include an additional $9.5 billion in discretionary funding for HHS.
Though HHS got a funding hike under the addendum, the administration is still looking to cut spending on Medicare and Medicaid, and proposes significant cuts while maintaining the expectation of an ACA repeal. The budget specifically looks toward an ACA solution in the style of the Graham-Cassidy bill.
One of the main goals of the White House's budget proposal is to highlight policy priorities, and the Trump administration is putting focus on the opioid epidemic and mental health. It initially wrote into its budget $5 billion in additional funding for the opioid crisis over the next five years, with $1 billion to be paid in 2019. It upped that amount to $10 billion in the addendum.
The original budget document also outlines some of the administration's plans to combat the epidemic, which include a national media campaign that would promote alternative pain management therapies and continued work to develop new pain treatments.
Trump's budget also accounts for policies designed to reduce drug prices, which were outlined by the administration ahead of the full budget's release. This includes significant changes to the 340B drug discount program, adjustments to how Medicare reimburses doctors under Part D and access to more free generics for seniors.
HHS Secretary Alex Azar praised the updated budget in a statement, saying it "supports the hard work the men and women of HHS are already doing toward these goals." He spotlighted the drug pricing reforms in particular.
"The president's budget makes investments and reforms that are vital to making our health and human services programs work for Americans and to sustaining them for future generations," Azar said.
HHS provided a more detailed breakdown (PDF) of how its allocation will be distributed, based on the addendum figures. HHS will allocate additional funding to some of its public health programs, like the National Health Services Corps. and its HIV/AIDS program, but others will see a decrease, including the maternal and child health block grant and rural health outreach grants.
This year's budget sidesteps the controversy around cuts to the National Institutes of Health, which will see a $747 million boost in fiscal year 2019, mostly thanks to the additional opioid funding. The Centers for Disease Control and Prevention, however, will see a $703 million cut as HHS reduces funding to the Prevention and Public Health Fund.
Though the original budget document is largely ceremonial because of the two-year spending agreement, it does show likely ways that Trump and his staff would suggest federal agencies allocate funds in the future. Following its release, healthcare industry groups warned that steep cuts to programs like Medicare and Medicaid could have major consequences.
"The administration's proposed cuts would be devastating to patients, current and future providers, the healthcare safety net and, ultimately, our nation's health security," Darrell G. Kirch, M.D., CEO of the Association of American Medical Colleges, said in a statement.
National Nurses United also criticized the cuts proposed in the original budget. Jean Ross, R.N., co-president of NNU, said that the cuts are especially appalling in light of the Republicans' tax reform, which cut taxes on the wealthy.
"Without Medicaid and Medicare, millions of our patients could lose their access to healthcare," Ross said in a statement. "Nurses will see the impact of this in their emergency rooms, which are already crowded with patients whose health problems could have been prevented if they had access to healthcare services earlier."