On March 11, 2019, President Donald J. Trump released his Fiscal Year (FY) 2020 Budget Proposal, and presented it to Congress for its consideration. Overall, this Budget Blueprint includes $2.7 trillion in spending cuts—higher than any other Administration in history. As part of these cuts, the Budget meets the President’s directive to reduce non-Defense spending by 5 percent below 2019 levels, which were negotiated as part of a two-year budget deal in 2018.
The release of the President’s Budget is the first step in determining discretionary spending levels for federal government agencies and programs. Congress holds the “power of the purse.” The President’s Budget proposal will be reviewed as part of the budget and appropriations processes 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.
Within the $87.1 billion budget request for the Department of Health and Human Services (HHS), is a 12 percent decrease from the 2019 level and proposes $1.25 billion in net mandatory health savings, which is expected to reduce longer-term deficits. The President’s Budget intends to address the Nation’s critical public health needs through investments that seek to combat the opioid epidemic by sustaining critical investments in surveillance, prevention, treatment, access to overdose reversal drugs, recovery support services, and research. For example, the Budget proposal includes $1.5 billion for State Opioid Response grants, which fund prevention, treatment, and recovery support services in all states and territories. In addition, the Budget maintains more than $1 billion in the National Institutes of Health (NIH) for opioid and pain research, including the continuation of the Helping to End Addiction Long-Term Initiative that began in 2018.
The Budget also includes $221 million to expand the behavioral health workforce, including an additional $4 million for a new effort authorized in the SUPPORT for Patients and Communities Act to increase the number of providers that are able to prescribe medication-assisted treatment. In addition, the Budget maintains $120 million to support treatment and prevention of substance use disorder, including opioid abuse, in rural communities at the highest risk. Moreover, the Budget enables states to more easily provide one year of post-partum Medicaid coverage for women with a substance use disorder, to improve health outcomes for mothers and their infants.
In addition, the President’s proposal supports mental health services, increase efforts to eliminate infectious diseases, supports high-priority biomedical research, speeds access to new innovative technology, and enhances emergency preparedness and health security. It also offers strategies to reduce drug-related costs, improve the health of older Americans, and strengthen Medicaid work requirements to promote self-sufficiency.
To help strengthen the healthcare provided to American Indians and Alaska Natives, the budget begins a multi-year effort to modernize the Indian Health Service’s electronic health record (EHR) system to promote interoperability between federal health systems, as the Department of Veterans Affairs transitions to a new EHR system. In FY 2020, the Budget invests $25 million to begin the transition to a new and modernized EHR system. This funding will lay the groundwork to improve the quality of care, reduce the cost of care, promote interoperability, simplify IT service management, increase the security of patient data, enhance cybersecurity, and update infrastructure across rural locations to enable a successful EHR transformation.
The Budget provides $6.1 billion in total resources for the Food and Drug Administration (FDA), $643 million more than the 2019 level. The Budget includes $55 million to strengthen FDA’s activities in response to the Nation’s opioid crisis, $55 million to advance digital technology, $13.5 million for ensure that compounded drugs are safe and effective, and $20 million for a pilot program to develop and test technology that could detect pathogens in the blood supply.
This budget request for the third straight year seeks cuts to Office of the National Coordinator for Health Information Technology (ONC) and HHS Office of Civil Rights (OCR), calling for a $17 million cut from ONC and a $9 million cut from OCR, but is not expected to result in any reduction of staff in either office. Additionally, this budget consolidates the highest priority activities of the Agency for Healthcare Research and Quality (AHRQ) into NIH as the National Institute for Research on Safety and Quality (NIRSQ), which is a similar request from the last two years. HIMSS continues to work as part of the Friends of AHRQ coalition to make sure this change does not occur.
Outside of HHS, in the Department of Veterans Affairs (VA) budget includes $1.6 billion as part of a multi-year effort to continue implementation of a new EHR system. The EHR is a high-priority initiative that is intended to ensure a seamlessly integrated healthcare record between the Department of Defense and VA, by bringing all patient data into one common system.
Similarly, the Department of Defense MHS Genesis program to modernize their EHR is continuing to be funded, with a re-phasing of their effort to ensure adequate time for deployment of the commercial solution. The re-phasing coincides with the Department’s stated goals of learning from each phase of the rollout before moving to the next phase.
The President’s National Cyber Strategy highlighted the Department of Homeland Security’s (DHS) role in securing and building cybersecurity resilience for the Nation’s most critical infrastructure, including Government networks and healthcare. The Budget includes more than $1 billion for DHS’s cybersecurity efforts.