What's inside the budget document

The preliminary budget document was first posted by Inside Medicine and then reported by the Washington Post, and is what's known as a "passback," which is an official reply by the Office of Management and Budget to an agency's budget proposal.

In fiscal year 2024, HHS had a discretionary budget of around $121 billion, which the new proposal would cut to $80 billion. Specifically, the proposal aims to reduce NIH's budget from more than $47 billion to $27 billion, representing a roughly 40% cut, and CDC's budget from $9.2 billion to $5.2 billion, representing a roughly 44% cut.

In addition, the proposal would eliminate some of NIH's institutes and centers, including the National Institute on Minority Health and Health Disparities and the National Institute of Nursing Research while also fusing many of NIH's other institutes. For example, a new National Institute on Body Systems would absorb three separate institutes within NIH — the institute focused on heart and lung diseases, the institute focused on diabetes, kidney, and digestive disorders, and the institute focused on muscle, skeletal, and skin diseases.

Several programs at CDC would also be eliminated, including all the agency's chronic disease programs and domestic HIV work.

The proposed budget would also create a $20 billion agency called the Administration for a Healthy America that would include pieces of other agencies that are being consolidated, including those focused on primary care, environmental health, and HIV.

The Administration for a Healthy America would have $500 million in policy, research, and evaluation funding allocated to support any "Make America Healthy Again" initiatives, including a focus on chronic childhood diseases. However, many specific programs, like those focused on preventing childhood lead poisoning, bolstering the healthcare workforce, and advancing rural health initiatives, would be eliminated.

The budget proposal would also:

• Fund  FDA to a level that allows it to keep collecting drug and medical device fees from the industries it regulates. FDA would also no longer have a "direct role in routine inspections of food facilities."
• Eliminate rural hospital flexibility grants, state offices of rural health, rural residency development program grants, and at-risk rural hospitals program grants.
• Eliminate money for the Head Start program, which provides early childcare and education for low-income families and is funded by HHS' Administration for Children and Families (ACF).
• Eliminate the Health Resources Services Administration (many former offices would be housed within Administration for a Healthy America), the Administration for Community Living, the Substance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality, and the Administration for Strategic Preparedness and Response.
• Eliminate grants and contracts at ACF that "promote abortions and high-risk sexual behavior, inflict radical gender ideology on already vulnerable children, and facilitate discriminatory practices in service delivery."
• Create a new Office of the Chief Technology Officer, which would house both the Assistant Secretary for Technology Policy and the "Office of Chief Information."

Reaction

Many experts and industry stakeholders were critical of the proposed cuts.

Stefano Bertuzzi, CEO of the American Society for Microbiology, said the proposed cuts would be a "bloodbath," adding that he hopes the version of the draft sent to Congress will look significantly different than the document that was leaked.

Bertuzzi added that a 40% budget cut to NIH would likely mean the institute wouldn't award new grants for a long time if it plans to honor obligations to fund existing grants.

Anand Parekh, chief medical advisor at the Bipartisan Policy Center, said the proposed cuts are aimed at some of the prevention-focused healthcare efforts that HHS Secretary Robert F. Kennedy, Jr. has said he wants to prioritize.

"These are the efforts that try to get ahead of healthcare problems," Parekh said. "You can expect the costs of the Medicare and Medicaid program just to go up. That's the shortsightedness of reducing the sliver of the budget that is discretionary when that is the main opportunity you have to reduce health burden in America and get ahead of health problems."

"Short-term, this is going to be a really big deal," said Jason Owen-Smith, executive director of the Institute for Research on Innovation and Science. "Long-term, it represents, conservatively, a fundamental change in the national aspirations of the U.S. in the field of biomedicine. I don't think there's another way to think about a change of this magnitude."

Jeremy Berg, an associate dean and professor at the University of Pittsburgh who previously led the National Institute of General Medical Sciences at NIH, said he didn't understand the point of reorganizing HHS in the way the budget proposes.

"I'm fundamentally not sure what the point is, what they're trying to accomplish," Berg said. "All that you're going to have is a bunch of divisions within these larger organizations that will probably look an awful lot like the existing institutes."

Berg added that there are consolidations that could make sense at NIH, like combining the alcohol and drug abuse institutes, but making changes on the scale outlined in the proposal "is going to completely consume NIH for a year or two."

Tommy Sheridan, deputy director of the National Head Start Association, said the proposed elimination of Head Start funding "would be catastrophic."

"More than a million parents wouldn't be able to go to work from all those children, or they would have to scramble to find some other type of option," he said. "In a lot of communities, Head Start is the only early childhood provider in the community — especially rural America."

Alan Morgan, CEO of the National Rural Health Association, also noted that rural residents would suffer if health initiatives were cut.

"Those are essential to ensuring access to care for rural Americans and critical to keeping rural hospitals open," he said. "If that would come to fruition it would be absolute shocking news, because these programs have had such bipartisan support," he added.