President Donald Trump is proposing big cuts in federal spending on biomedical research and the elimination of subsidies that help poor people heat their homes as part of a budget that would reduce discretionary spending at the Department of Health and Human Services by 23 percent.

The cuts are sure to provoke an outcry from Democrats and Republicans who have long backed a robust budget for the National Institutes of Health, as well as from research universities, advocates for cancer patients, victims of heart disease and other conditions, and lawmakers from northern states dependent on the Low Income Home Energy Assistance Program.

“The budget includes a major reorganization of NIH’s institutes and centers to help focus resources on the highest priority research and training activities,” according to a document prepared by the Office of Management and Budget. It calls the heating-assistance program “a lower-impact program” that “is unable to demonstrate strong performance outcomes.”

The administration is requesting $65.1 billion for HHS for the 2018 fiscal year, according to the document, down from $84.6 billion in 2016. The budget is a request made by the administration, and spending levels are ultimately set by Congress.

Mandatory Spending

Trump’s budget proposal doesn’t touch on major issues like changes to the Affordable Care Act or tax-reform plans. The summary doesn’t mention giving the Medicare program for the elderly the authority to negotiate drug prices, which Obama had unsuccessfully proposed in past budgets. Trump has said that drugmakers should have to bid for government business, although he hasn’t elaborated. The document doesn’t include the vast majority of spending by the health department, which is mandatory outlays for Medicare and the Medicaid program for the poor.

The document from the Trump administration titled “America First: A Budget Blueprint to Make America Great Again,” is a broad statement of the administration’s priorities. Overall, it bolsters funding for the military by $54 billion, as Trump has promised, while cutting the same amount from other departments.

At HHS, the White House wants to fully fund health programs and efforts to combat prescription-drug overdoses and limit fraud and waste. The administration would reduce what it considers less important programs, including funds to universities that collaborate on projects with scientists mainly in the developing world, according to the document.

Among the biggest changes is a $5.8 billion cut to funding for the health institutes, to $25.9 billion, compared with fiscal 2017. It’s not clear where all the money would come from, and the budget cites “consolidations and structural changes” as well as cutting administrative costs and a “rebalance” of government funding for research.

Research Funding

The administration also proposes eliminating the Fogarty International Center, and moving the Agency for Healthcare Research and Quality under the NIH. The Fogarty center, NIH’s global health research arm, was created more than 40 years ago and was appropriated about $70 million in fiscal 2016. It funds about 400 research and training projects involving more than 100 universities that work on projects such as polio eradication and the effects of climate change and disease outbreaks around the world, according to its website. 

Fogarty scientists are responsible for modeling infectious disease outbreaks, such as the Ebola virus epidemic that began in 2013 and killed more than 11,000 people in Africa. The center’s work helps control the spread of pathogens and provides data to guide the development of bioterrorism countermeasures.

Anti-Poverty Programs

The other big reduction comes from funding for programs at the Office of Community Services that aid low-income people. The budget proposes saving $4.2 billion from 2017 levels by ending the Low Income Home Energy Assistance Program and the Community Services Block Grant, which provides funds to fight poverty in states and communities.

The budget also would increase the user fees that the Food and Drug Administration collects from pharmaceutical companies and medical-device makers to review their products -- doubling the total to more than $2 billion. New drug fees are currently more than $2 million per application, and any change will need to be confirmed by Congress. In exchange, drug and device makers will get “administrative actions designed to achieve regulatory efficiency and speed the development of safe and effective medical products,” according to the blueprint.

Other changes include:

• A $500 million increase in funding for opioid abuse prevention efforts, above the 2016 enacted level.
• An increase in funds for the Health Care Fraud and Abuse Control program to $751 million, $70 million more than 2017.
• A new $500 million block grant designed to “focus on the leading public health challenges specific to each state.”
• Ending some training programs for nurses and health professionals, saving $403 million, while continuing to fund other programs that encourage health-care providers to work in underserved areas.