Trump Budget Proposes Deep Cuts to Health and Science Agencies

Medicaid, the NIH, and the CDC would face major reductions.

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The health and science community is reeling after the release of President Trump’s proposed 2018 budget, which contains deep cuts to Medicaid, the NIH, the CDC, and more.

The plan, an expansion of March’s “skinny budget,” would over the next decade slash more than $610 billion from Medicaid, on top of the massive rollbacks that would come from an Affordable Care Act (ACA) repeal. Cuts to Medicaid and the Children’s Health Insurance Program, which operates in conjunction with Medicaid, would amount to $616 billion in total.

That belt-tightening would affect the entire country, but Massachusetts would feel the squeeze acutely.

Massachusetts was among the 31 states, plus Washington, DC, that expanded Medicaid under the ACA, and MassHealth, Massachusetts’ Medicaid program, covers approximately 1.9 million people. The kind of austerity proposed in the budget would have a drastic impact on the state’s healthcare system—an effect compounded by the multi-billion-dollar Medicaid waiver the Commonwealth received in 2016, and the already-tight state budget.

In March, Brian Rosman, director of policy and government relations at Health Care for All, a local healthcare advocacy group, told Boston that Medicaid cuts would put Massachusetts in a tough spot.

“[If cuts happen] the state Medicaid officials are going to be faced with this awful choice,” Rosman said. “Do we cut benefits, restrict eligibility, or do we start paying hospitals less?”

The decision would be especially difficult, Rosman added, because Massachusetts has a disproportionate number of top-rated hospitals, which are more expensive than average providers.

Those top-rated hospitals would also feel the sting of cuts to the NIH, which in the proposed plan would amount to 18 percent of its operating budget. The National Cancer Institute (NCI), which is part of the NIH, would also lose 19 percent of its operating budget.

“A lot of institutions can’t support a basic scientist unless they receive NCI and NIH funding,” explains Ursula Matulonis, director of gynecologic oncology at Dana-Farber Cancer Institute. “That funding is really the foundation of science. It’s not something that you can reverse quickly. If the funding goes away, the repercussions will be significant.”

The proposed budget also imperils other health and science organizations. If passed as written, the CDC would lose 17 percent of its funding, the FDA would lose 31 percent of its budget, and the Agency for Healthcare Research and Quality would be combined with the NIH.

That said, lawmakers are unlikely to accept the budget without significant changes.

“It’s a good place to start the discussion from, but I don’t think it’s likely to occur,” Oklahoma Republican Congressman Tom Cole told STAT. “I don’t think it could be passed, honestly, through the House, and I’m certain it can’t be passed through the Senate.”