June 2017

On May 23, 2017 President Trump released his full proposed budget outline for fiscal year 2018 which proposes radical funding cuts to federal research and health programs. As reported in March, when a partial fiscal year 2018 budget was released, the administration proposes a 19 percent funding reduction to the NIH. The proposed cut would be across all institutes. The budget proposes the following for the institutes that the ATS monitors:

• A $575 million or 18 percent funding cut for the National Heart, Lung and Blood Institute
• An $838 million or 18 percent funding cut for the National Institute of Allergy and Infectious Disease
• A $323 million or 12 percent funding cut to the National Institute of General Medical Sciences
• A $159 million or 23 percent funding cut to the National Institute of Environmental Health Sciences
• A $305 million or 22 percent funding cut to the National Institute for Child Health and Development
• A $33 million or 22 percent funding cut to the National Institute for Nursing Research

Another budget proposal that would impact U.S. biomedical health infrastructure significantly if enacted is a proposal to cap indirect costs for NIH grants at 10 percent of total research for all types of NIH grants. This proposal would have serious damaging effects to many institutions across the country and while we do not expect a 10 percent indirect cap to be enacted, the issue of capping indirect costs in some manner will be discussed in Congress. The ATS will monitor these discussions closely and keep members informed.

Notably, it proposes eliminating the Fogarty International Center, the NIH's global health research and training institute. The Fogarty Center supports research on tuberculosis, HIV/AIDS and other global health threats and activities to build research capacity in low and middle-income countries.

The administration's budget also proposes to eliminate the Agency for Health Research and Quality (AHRQ) and create a new National Institute for Research on Safety and Quality at NIH, to improve the efficiency and coordination of health services research, which would be funded at $272 million, an 18 percent reduction from AHRQ's FY2017 budget of $324 million. Previous administrations have proposed virtual elimination of AHRQ, so this proposal is not necessarily novel and the AHRQ is expected to be maintained.

The FY2018 budget proposes a radical $1.2 billion or 16.7 percent funding reduction to the Centers for Disease Control and Prevention and completely eliminating the CDC's Office of Smoking and Health (OSH). The administration proposes folding tobacco control activities into a new "America's Health" block grant funded at $500,000 million annually for state public health departments to address leading causes of death and disability such as heart disease, diabetes and tobacco use. The ATS is deeply concerned about this proposal to eliminate the CDC's national tobacco control program in favor of a state block grant from which states could choose public health priorities and fund them accordingly. This approach would severely erode tobacco use and prevention as a national public health priority and permit states to significantly cut back or even eliminate tobacco use cessation, prevention and education efforts. The successful Tips from Former Smokers national campaign would be eliminated under this proposal.

The FY2018 budget proposes funding reductions for the following other CDC programs that the ATS monitors:

• A $4 million or 13.8 percent funding reduction to CDC's asthma program
• A $12.2 million or 8.6 percent funding reduction to the CDC's domestic tuberculosis program
• A $135.2 million or 40 percent funding reduction to the CDC's National Institute of Occupational Safety and Research

The budget proposes to slash the EPA by 31 percent. Specifically for EPA programs, it proposes:

• Discontinuing funding for the clean power plan
• Eliminating funding for international climate change programs
• Eliminates funding for climate change research and partnership programs and "all related efforts"
• Proposes to "reorient the EPA's air program to protect the air we breathe without unduly burdening the American economy."
• Cuts the EPA Office of Research and Development by nearly 45 percent

Concerning international affairs and global health, the State Department would see a 28 percent funding cut overall under the proposed budget and the U.S. Agency for International Development's global tuberculosis program would be cut by 26.5 percent.

Finally, the Dept. of Veterans Affairs Medical Research program, which has seen funding increases over the past few years would be cut by $35.3 million or just over 5 percent.

While the President's budget contains a number of very problematic proposals such as the NIH indirect policy and elimination of the CDC's tobacco control program, it is important to note that this budget proposal, though of serious concern, is only the first step in the fiscal year 2018 funding and appropriations process. Annual government spending is determined by Congress. We expect that Congress will reject many of these proposed funding reductions and proposals, including the NIH indirect cap. The ATS is actively advocating with Congress and with our sister organizations to oppose President Trump's FY2018 budget. We will alert ATS members when action is needed to support NIH, CDC and other ATS priority programs.