Doctor groups fear Trump’s ‘unprecedented’ proposed budget cuts

President Donald Trump’s proposed 2018 federal budget includes major spending cuts for medical education programs and National Institutes of Health (NIH) funding, each of which could have negative impacts on doctors, according to organizations like the American College of Physicians (ACP) and the Association of American Medical Colleges (AAMC).

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Backers of the budget counter that the proposed cuts still leave healthcare funding at adequate levels.

The proposed budget in its present form is unlikely to be approved by Congress, but that doesn’t mean doctors can breathe a sigh of relief. The proposal demonstrates the administration’s desire to aggressively cut non-defense discretionary government spending. That could continue to put healthcare spending in the crosshairs as budget negotiations pick up steam this spring.

Chris Sloan, manager at Avalere Health, a Washington, D.C.-based healthcare consulting firm, said Congress is unlikely to keep all of Trump’s budget parameters intact. But the proposed budget “indicates the fiscal challenges we’re going to have for 2018,” says Karen Fisher, JD, AAMC’s chief public policy officer.

In March, the White House released what it’s calling its “America First” budget for fiscal year 2018. The document, which focuses only on discretionary spending and excludes entitlement and mandatory spending programs, calls for $54 billion in increased defense spending, to be offset by cuts to other programs.

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Among the proposed cuts are $5.8 billion in NIH funding and a $403 million reduction in medical education programs. The overall budget for the U.S. Department of Health and Human Services, which oversees most healthcare spending, would be trimmed by $15.1 billion. The budget also calls for the Agency for Healthcare Research and Quality (AHRQ) to be folded into NIH but has no details on whether NIH would get any additional funding to continue the AHRQ’s research mission.

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The NIH funding cut “is unprecedented,” and would take NIH funding back to levels not seen since 2002-2003, says AAMC’s Fisher. But Chris Edwards, an economist at the conservative Cato Institute, counters that NIH funding in real dollars is still above levels seen in 1990 and that little evidence exists that NIH research leads to major breakthroughs in new medical treatments.

The proposed cuts come less than a year after Congress approved a $4.8 billion increase in NIH funding over 10 years as part of the 21^st Century Cures Act. That funding was not guaranteed, however, and needs to be authorized each year by Congress.

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The bipartisan support for that increase leads Fisher and Sloan to predict little support on Capitol Hill for the proposed budget’s NIH cuts. “I think there is no chance that they are able to get significant cuts to NIH through Congress,” says Sloan.

The $403 million in medical education cuts would impact what are known as Title VII and Title VIII education programs for nurses and other medical professionals, Fisher says. Those are aimed at promoting diversity, inter-profession cooperation and a team-oriented approach to treatment and increasing the healthcare workforce in underserved areas, she explains. With projections of looming healthcare workforce shortages, now is not the time to cut such educational funding, she argues.

Cato’s Edwards counters that medical education should not be singled out for government support that other professional education does not receive.

The AHRQ works to create clinical guidelines and undertakes effectiveness research, explains Jared Frost, JD, ACP senior associate for legislative affairs. “[Creating clinical guidelines] is a difficult and specialized skills set within this agency and they do a wonderful job,” Frost says.

Healthcare groups will likely lobby hard on Capitol Hill against these cuts between now and when the full budget proposal is announced in May. The proposed budget presents an “opportunity to educate about the vital importance of [medical] research,” Fisher says.