Trump’s Budget Again Calls for Billions in NIH Cuts

Proposed cuts of $5 billion in NIH funding and $129 million to the Agency for Healthcare Research and Quality (AHRQ) were included in the Trump administration’s fiscal year 2027 budget.

In all, “the budget requests $111.1 billion in discretionary budget authority for HHS for 2027, a $15.8 billion or 12.5% decrease from the 2026 enacted level,” according to the Office of Management and Budget (OMB) document released Friday.

For the second year in a row, the administration is attempting to reorganize the department by consolidating several HHS agencies under a new umbrella sub-agency known as the Administration for a Healthy America (AHA).

“Within AHA, the budget includes $19 million to expand access to nutrition services at health centers by integrating nutritional care and expanding access to healthy food and nutrition education,” the OMB document noted. However, Congress rejected the AHA idea last year, and it is unclear whether it will be any more popular this time around. Congress turned away the Trump administration’s proposed cuts to the NIH last year as well.

As part of the reorganization to form the AHA, the proposed budget would eliminate the $287 million Title X family planning program, as well as Early Hearing Detection and Intervention Programs, Rural Hospital Flexibility Program grants, and Rural Hospital Provider Assistance Programs. It would also eliminate all chronic disease prevention and health promotion activities with the CDC except for programs related to cancer prevention and control and Alzheimer’s disease, according to a separate Budget in Brief document issued by HHS. Youth Violence Prevention and Firearm Injury and Mortality Prevention Research programs also would be eliminated.

All of these programs are being cut “to align with the administration’s priorities, streamline the bureaucracy, restore a clearer division of responsibilities between federal and state government, and save taxpayer funds,” the Budget in Brief document said.

The $5 billion proposed cut to NIH represents about 10% of the agency’s total budget, and includes the elimination of three sub-agencies noted in the OMB document:

• The National Institute on Minority Health and Health Disparities, which is “replete with DEI [diversity, equity, and inclusion] expenditures.”
• The Fogarty International Center, “which has funded Master’s degree programs in foreign countries, such as Serbia and India, at the expense of Americans.”
• The National Center for Complementary and Integrative Health, “which has funded research on ‘racial and ethnic disparities’ in back pain therapies and on ‘mindfulness-based intervention’ on HIV risk.”

The $129 million cut to AHRQ is needed because “much of AHRQ’s research on quality, safety, and affordability of healthcare delivery is wasteful or duplicative of research conducted at NIH,” according to the OMB document. “The budget reorganizes priority AHRQ statistical activities in the new HHS Office of Strategy and eliminates the harmful digital health portfolio,” which includes a “study on how Medicaid gender affirming care coverage policies impacted the use of hormones and sex change surgery among beneficiaries.”

The proposal also cuts $356 million from the Administration for Strategic Preparedness and Response (ASPR), which plans for pandemics and other climate- and health-related emergencies. “Overextended by additional responsibilities during the COVID-19 pandemic, ASPR moved away from its mission to coordinate the federal emergency response in the United States, leading to confusion regarding ASPR’s role in preparedness and response,” the OMB document noted.

Instead, “the budget refocuses ASPR” through developing medical countermeasures, maintaining critical supplies in the Strategic National Stockpile (SNS) for emergencies, and “strengthening domestic pharmaceutical resilience through the procurement and maintenance of the Strategic Active Pharmaceutical Ingredients Reserve.”

The OMB document criticizes ASPR for its distribution of emergency COVID supplies to states. “Federal policymakers never intended for the SNS to equip every state in the event of an extended pandemic,” it noted. “The SNS is the supplier of last resort to the federal government, state, local, and tribal governments.”

A large part of the ASPR cut — $240 million — comes from eliminating the Hospital Preparedness Program, “whose activities can be supported by CDC’s Public Health Emergency Preparedness Program in conjunction with stronger state efforts.”

The few increases included in the HHS budget proposal appear to be related to the administration’s Make America Healthy Again (MAHA) effort. In addition to the $19 million for health centers, another $57 million is added to “strengthen national nutritional and food safety by removing unsafe chemicals in America’s food supply, modernize and streamline the [FDA’s] regulatory capability by supporting artificial intelligence (AI) and machine learning, and develop alternatives to animal testing.”

An additional $55 million is included for “new Infection Prevention and Healthy and Safe Food initiatives” at CDC to address antimicrobial-resistant infections and “pervasive micro- and nano-plastics to ensure food and water is safe and clean for all Americans.”

Another $28 million is added for two telehealth-related programs, and $19 million is added for Native American tribes “to implement a new Prevention Innovation Program.”

One thing not included in the budget proposal is any mention of a pay raise for civilian employees at HHS and other federal agencies. The only pay raise mentioned was a 5% to 7% raise for members of the military.

Health groups were quick to weigh in against the proposal. Eliminating the Title X program “is a direct attack on the nation’s only federal program dedicated to family planning, and it threatens to dismantle a critical pathway to care,” Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, said in a statement. “Title X-funded services are often a patient’s only source of healthcare, and contraceptive and sexual health care is a pathway to accessing other needed preventive healthcare.”

Research!America, a health research advocacy group, called the proposal “a giant step backward for American health and innovation.”

“While the president’s budget request would bolster funding for AI and other technologies, it unfortunately would allow China and other competitors to do an end run around the U.S. as we abandon our lead in the sciences,” said Mary Woolley, the group’s president and CEO, in a statement. “From cutting biomedical research at NIH to slashing other STEM [science, technology, engineering, and mathematics] funding at NSF [the National Science Foundation], this budget would make our 250th year one of restricting, rather than realizing, our full potential.”

Kayla Hancock, director of Protect Our Care’s Public Health Project, noted that “Donald Trump’s budget plan is a roadmap to smashing virtually every public health safeguard and inviting deadly preventable diseases like measles to run wild.”

“Trump’s proposed cuts to the NIH alone will end up costing working people more than double that in lost economic activity, while the potential cost to our public health in lost scientific research and innovation is off the charts,” Hancock said in a statement.

Another set of cuts — amounting to more than $900 million for activities relating to ending the HIV/AIDS epidemic — drew sharp criticism from Anna Person, MD, chair of the HIV Medicine Association. “The president’s proposal to slash HIV public health programs is a dangerous one, at a time when states are already making unprecedented cuts to HIV services due to rising costs,” Person said. “Decimating the HIV prevention program that funds HIV surveillance and testing in every state would put lives at risk and leave communities more vulnerable to HIV outbreaks.”

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