T

he Trump administration’s proposed budget for 2018 would make sweeping cuts to Medicaid as well as to the agencies and programs that are the nation’s engines of science and biomedical research.

The administration released a “skinny budget” in March that included sharp proposed cuts to biomedical and science funding. That blueprint prompted harsh blowback from scientists and public health professionals alarmed by the potential long-lasting damage of such dramatic reductions in funding. It also received a cool reception from Republican lawmakers.

But the administration’s fleshed-out budget, which was posted online prematurely on Monday and then quickly taken down, indicates the White House is determined to stay the course. In a nod at that austerity, the document says the budget “focuses resources on direct services and proven investments while streamlining or eliminating programs that are duplicative or have limited impact.”

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Some of the most significant cuts:

  • Medicaid would face a cut of $610 billion over the next decade, on top of the $839 billion that would already be cut under the proposed American Health Care Act that passed in the House earlier this month. It wasn’t immediately clear exactly where the $610 billion reduction would come from, though the document pointed to per capita caps, block grants, and new forms of flexibility for states.
  • The National Institutes of Health’s budget would be reduced by 18 percent from 2017 spending levels to $26 billion.
    • The National Cancer Institute would receive $4.47 billion, down 19 percent.
    • As with the skinny budget, the new proposed budget eliminates an NIH program, known as the Fogarty International Center, that promotes medical research overseas.
  • The Centers for Disease Control and Prevention would get $6.3 billion, down 17 percent.
    • $934 million would be spent on HIV/AIDS, viral hepatitis, sexually transmitted infections, and tuberculosis prevention, down 17 percent.
    • The CDC’s global health program, tasked with combating disease outbreaks overseas, would get $350 million, down 18 percent.
    • $157 million would be spent on environmental health, down 28 percent. Spared in that cut is $35 million to prevent lead poisoning in children, an allocation spurred in part by the water quality crisis in Flint, Mich.
  • The FDA would get $1.89 billion in direct government funding, a decrease of 31 percent, or $854 million. But that loss would be offset with an increase of $1.3 billion in user fees, paid by drug and device makers seeking approval for their products.
  • $403 million would be cut from physician training programs. When this cut was proposed in the skinny budget, critics feared it would impact programs for students pursuing joint MD and PhD degrees.

The deep cuts to the NIH drew immediate condemnation from advocates for biomedical research.

The proposed budget “would be a travesty for patients and the future of personalized medicine if enacted,” said Edward Abrahams, president of the Personalized Medicine Coalition, which represents patients, insurers, health care providers, and others.

Dr. Ross McKinney, chief scientific officer of the Association of American Medical Colleges, said by email late Monday that “some parts of this budget proposal do not make sense.” He said more NIH research funding is essential.

On Capitol Hill, Tom Cole, a Republican congressman from Oklahoma, called the proposed cut to NIH “penny-wise and pound-foolish” and the cut to the CDC “a really bad mistake.” Cole chairs the House health appropriations subcommittee.

“It’s a good place to start the discussion from, but I don’t think it’s likely to occur,” Cole said of the proposed cuts to the NIH budget. “I don’t think it could be passed, honestly, through the House, and I’m certain it can’t be passed through the Senate.”

Andy Harris, a Republican congressman from Maryland and a doctor who has conducted NIH research, said he supported a provision to cap the level of indirect costs as funded by NIH grants, but that he would oppose an NIH cut of this magnitude if the provision was not included.

It’s possible the budget proposal briefly posted on Monday could still change. Alleigh Marre, a spokeswoman for the Department of Health and Human Services, said on Twitter that the official version would be released on Tuesday morning.

Lev Facher in Washington and Meghana Keshavan contributed reporting.

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