The newly announced budget for fiscal year 2018 presented by President Trump calls for huge disruptions in government-funded medical and scientific research, the extent of which go well beyond what was expected for federal health-related agencies that usually receive broad support from both Republicans and Democrats. The cuts to the National Institutes of Health (NIH) would fund the agency at a 15-year low—NIH would see its budget cut by approximately 20% (nearly $6 billion) and the Department of Health and Human Services, or HHS, would be cut by $15.1 billion, slashing spending by NIH on agencies including the FDA, CMS, and Indian Health Service.
Trump’s budget blueprint, “America First: A Budget Blueprint to Make American Great Again,” calls for a major NIH reorganization to focus on “highest priority research” but fails to explain all the changes involved in reorganizing it, except for abolishing 1 program dedicated to building partnerships between health research institutions in the United States and other countries, and consolidating the Agency for Healthcare Research and Quality into NIH. The cuts to HHS, NIH, and other health agencies comes on the heels of a pledge made during Trump’s first joint address to Congress on February 28, 2017, to help fight and stop more diseases.
The budget document also states that FDA user fees will rise as pharma and biopharma should “pay for their share” in a constrained budget environment, calling for FDA medical product user fees to nearly double to “over $2 billion in 2018, approximately $1 billion over the 2017 annualized continuing resolution level.” According to the Regulatory Affairs Professionals Society (RAPS), the administration is “presumably looking to renegotiate the user fee programs, which expire in September 2017, forcing companies to fork over an additional $600 million.” The drug and device industries had, in fact, recently completed user fee agreements negotiations with FDA, agreeing upon an appropriate amount of industry fees to support needed FDA improvements.
Researchers and medical experts are alarmed about the potentially disastrous effects a $6 billion budget cut to NIH would have on biomedical and other research. Investment in research and development has been widely regarded since World War II as critical to national prosperity and security. Scientific and medical research in the United States depends heavily on grants from federal agencies that would face dramatic budget cuts. NIH uses only approximately 10% of its $30 billion budget for NIH’s own in-house studies; more than 80% goes to 300,000 outside researchers. “President Donald Trump’s fiscal year 2018 spending plan erases years’ worth of bipartisan support for NIH, and the American biomedical research enterprise, which has long been the global leader for biomedical innovation,” said Benjamin Corb, of the American Society for Biochemistry and Molecular Biology, in an interview with Science. “Cuts this deep threaten American’s ability to remain a leader.”
UsAgainstAlzheimer’s chairman George Vradenburg said the cuts to NIH and medical research threaten to undo years of gains made in the fight against Alzheimer’s disease. He pointed out that the most direct path to healthcare cost savings is investing in research to achieve treatments and cures. The group reminded Trump that Alzheimer’s researchers have stated that the minimum level of annual funding to achieve the national goal of stopping Alzheimer’s by 2025 is $2 billion a year at NIH.
The budget eliminates $403 million in funding to train health professionals and nurses, calling the program ineffective. The budget does not provide specifics for the CDC beyond the creation of a $500 million block grant fund to help states respond to their specific public health challenges, but the source of the funds is not clear—whether this would be new funding or a reallocation.
Mention is also made of unspecified investment in mental health activities such as suicide prevention and a $500 million increase in substance abuse services funding aimed at addressing the opioid addiction epidemic.
The 2018 budget must be negotiated and approved by Congress.