The White House recently released the President's proposed budget for the U.S. Government for Fiscal Year 2019 (FY19), titled Efficient, Effective, Accountable: An American Budget. The budget emphasizes defense spending and border security and proposes significant cuts affecting agencies across-the-board, including many federal health agencies and programs. The release of the budget is an annual exercise that serves as a starting point for the federal budget process before Congress begins to draft FY19 appropriations bills. The President's budget is meant to communicate the Administration’s policy priorities and holds no binding power over the budget process, which lies entirely within the purview of Congress.

The budget includes a proposed $17.9 billion, or 21 percent funding decrease to the U.S. Department of Health and Human Services. The budget proposes a$1.4 billion funding increase to the National Institutes of Health (NIH), including $750 million from a broader agency-wide opioid and mental illness initiative and a significant funding increase for the Office of the Director. This funding level includes a $73 million cut to the National Heart, Lung and Blood Institute, a $46 million cut to the National Institute on Aging and a $31 million cut to the Eunice K. Shriver National Institute of Child Health and Human Development. The National Institute of Neurological Disorders and Stroke would receive an increase of $67 million.

The U.S. Food and Drug Administration (FDA) would receive a funding increase of $473 million, with $10 million allocated from the opioid initiative. The increase also assumes $190 million in new user-fee funding, a highly unlikely scenario, as new agreements were just renegotiated this summer. It would also eliminate the Agency for Healthcare Research and Quality (AHRQ), folding it into the NIH as the National Institute for Research on Safety and Quality. Congress rejected the proposed transfer of AHRQ to NIH in both the House and Senate FY 2018 spending bills. The Office of the National Coordinator for Health Information Technology (ONC) faces a proposed cut of $22 million, with administrative restructuring and the elimination of the Health Information Technology Adoption portfolio.

The Centers for Disease Control (CDC) would face a cut of $703 million, largely affecting chronic disease prevention and health promotion. The budget also changes how prevention programs, including tobacco use cessation and heart disease prevention, are funded and does not require the newly created state block grants to be spent on these prevention programs.

The budget supports repeal of the Affordable Care Act and advocates for more state flexibility as well as Medicaid and Medicare program reforms. Proposed reforms include establishing equal Medicare reimbursement at the physician office rate for all hospital-owned physician practices and off-campus facilities currently paid at the hospital outpatient rate, including those grandfathered by the Bipartisan Budget Act of 2015. The budget proposes the elimination of 14 health professions training programs, a cut of $451 million, and consolidates graduate medical education (GME) programs into a mandatory GME capped grant program targeted to benefit medically underserved communities. Additional proposals include a targeted prior authorization program for certain services prone to self-referral and overutilization and self-referral reform to better align with alternative payment models. The document also proposes to repeal the Independent Payment Advisory Board, an aim already accomplished by the recently-passed Bipartisan Budget Act of 2018. Certain medical liability reforms are also cited as a source of savings.

Keywords: National Institute of Child Health and Human Development (U.S.), Medicaid, Patient Protection and Affordable Care Act, National Institute on Aging (U.S.), National Institute of Neurological Disorders and Stroke (U.S.), Tobacco Use Cessation, Physicians' Offices, Outpatients, Medically Underserved Area, United States Food and Drug Administration, National Institutes of Health (U.S.), Medicare, United States Dept. of Health and Human Services, Centers for Disease Control and Prevention, U.S., Health Promotion, Chronic Disease, Education, Medical, Graduate, Medical Informatics, Health Occupations, Referral and Consultation, Health Services Research, Heart Diseases, ACC Advocacy

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