President Donald J. Trump released his fiscal year (FY) 2018 Budget Proposal on Tuesday, May 23, and presented it to Congress. The President’s Budget totals $4.1 trillion, which is slightly more than what is budgeted for FY 2017. The budget proposes to spend more on defense, border security and infrastructure, while calling for reductions to many programs, education, the environment, scientific research, student loans, and healthcare, including health IT. The White House estimates that this budget will reduce overall spending by $3.6 trillion over the next ten years, and create a balanced budget by 2027.
The release of the President’s Budget marks only the first step in determining discretionary spending levels for federal government agencies and programs. Since Congress technically holds the “power of the purse,” the majority of the process will be the result of work by the relevant House and Senate Committees beginning with a series of hearings with Administration officials on their budget requests to better understand proposed cuts or increases. While the next step should be for Congress to pass a budget resolution to set the spending limits (or caps) for each area of federal funding (e.g., Labor-Health and Human Services), this often doesn’t happen and the previous year’s spending limits remain in effect. The House and Senate Appropriations Committees, using those limits, then develop the more specific and detailed individual spending bills. Over the last several years, the appropriations process has more commonly resulted in a larger spending package covering multiple appropriations bills, known as an “omnibus” or when negotiations fail to result in a bill that can pass both the House and Senate, a “continuing resolution” that retains the previous fiscal year’s spending levels.
Within the Department of Health and Human Services (HHS), the President’s Budget Request includes:
- An 18% decrease for HHS to $69 billion in discretionary spending, which excludes funding for the insurance provided by Medicare and Medicaid.
- Focuses resources on direct services and proven investments while streamlining or eliminating programs that are duplicative or have limited impact.
- Contributes $665 billion in mandatory savings by giving States new flexibilities to operate their Medicaid programs under per capita caps or block grants beginning in FY 2020.
For the Office of the National Coordinator for Health Information Technology (ONC), the President’s Budget Request includes:
- A proposed $38 million FY 2018, a decrease in from $60 million in FY 2017 and could result in a decrease in staff from 190 to 164 people.
- A focus on two key priorities: interoperability of health information, and the usability of electronic health records while reflecting ONC’s successful progress in increasing provider adoption rates, improving usability, and advancing interoperability in order to ensure the seamless and secure flow of health information.
- The 21st Century Cures Act directs ONC to implement activities that advance interoperability through continued work combating information blocking and building health IT exchanges. In FY 2018, ONC will continue to address and discourage information blocking by aggressively implementing ONC Certification Program rules, creating and promoting channels for reporting information blocking, and enforcing information blocking provisions required by the Cures Act
Budget Request Related to Telehealth Includes:
- The Health Resources and Services Administration (HRSA) Office of Rural Health Policy provides technical assistance, conducts research, and makes grants to enhance health care delivery in rural communities. The President’s Budget provides $74 million in FY 2018, which is $75 million below FY 2017. The focus is on targeting funding for critical rural health activities such as Rural Health Outreach Network and Quality Improvement Grants, Rural Health Policy Development, Black Lung Clinics, and Telehealth, and includes a $7 million decrease in Telehealth programs.
National Institutes of Health (NIH) Budget Includes:
- Under the 21st Century Cures Act, Congress authorized $4.8 billion over ten years in support of high priority NIH initiatives and research areas: the Precision Medicine Initiative; the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative; the Beau Biden Cancer Moonshot; and Regenerative Medicine. This budget includes $496 million for these initiatives.
- The FY 2018 Budget consolidates the Agency for Healthcare Research and Quality (AHRQ) within NIH as the National Institute for Research on Safety and Quality.
- The FY 2018 Budget also includes $272 million in budget authority within NIH to preserve key research activities previously carried out by AHRQ, including critical survey activities, support for the U.S. Preventive Services Task Force, evidence-based practice centers, patient safety, investigator-initiated grants, and researcher training grants.
- This reorganization within NIH would structure AHRQ as an institute and preserve links between many of the closely-related continuing activities, simplify administrative responsibilities for consolidating and continuing the programs, and maintain an entity that can serve as a center of excellence for improving the quality and safety of health care services.
Public Health and Social Services Emergency Fund Budget Includes:
- The FY 2018 Budget includes $72 million for the HHS cybersecurity program, which is $22 million above FY 2017 levels. The cybersecurity program will continue its operations to detect, manage, and remediate cybersecurity risks and has a unique Federal role in maintaining the security of information for other HHS entities. These activities range from FDA’s proprietary information, CMS’s financial records, and extensive personal health information across HHS.
- Much of the additional resources will be used to expand HHS’s capability to share cybersecurity threat indicators and information across the Federal and private health care spaces to better protect the security of such data.