Editorial note: The Read on Washington is a monthly column on happenings in DC that affect the field of health services research. In addition, AcademyHealth recently began offering ad hoc updates via the Situation Report series. The Situation Report can be found on our blog and is also emailed directly to our members. All of AcademyHealth’s advocacy work is supported by member dues.
Day by day on how the Administration is roiling science and health
Stat News has published a day by day accounting of the first 100 days of the Trump Administration and how it has impacted science and health. There is a lot.
Proposed Trump budget leaked, devastating future cuts to HHS planned
An internal budget document sent from the White House Office of Management and Budget to the Department of Health and Human Services was leaked, previewing massive cuts to the Department. If finalized, this proposal would cut funding by tens of billions of dollars, in addition to consolidating agencies into new entities. The CDC would see more than 40 percent of its budget cut and NIH more than 40 percent. AHRQ would see a full elimination of the patient-centered outcomes research (PCORTF) and digital health portfolios, 50 percent cut to patient safety grants, 40 percent cuts to HSR grants, and deep cuts to staffing.
Supreme Court hears Braidwood and the future of the USPSTF
The Supreme Court heard Kennedy v Braidwood, which will determine the constitutionality of the United States Preventative Service Taskforce and the no-cost preventative care under the ACA that it recommends. Over an hour and a half of in-the-weeds arguments, the justices seemed to favor the administration’s position — that Obamacare’s coverage mandates are constitutional because the task force that recommends them is made up of members who can be ignored or fired at will by the health secretary. You can learn more about the case and AcademyHealth’s work on it here.
House and Senate agree to budget resolution, formally starting reconciliation
The House of Representatives narrowly voted to support the Senate budget resolution, kicking off budget reconciliation as the primary vehicle for Republican legislative priorities. Reconciliation is a budget tool that sidesteps the 60 vote filibuster, allowing them to pass their legislation on a party-line vote. At this stage, committees are working to meet the instructions set out for them to change revenue, deficits, spending, or the debt limit by specific amounts. Eventually, the budget committee will assemble all the drafted legislation from committees into one large legislative package that both chambers will vote on. A key point of contention is that the extension of the tax cuts from the first Trump Administration would be in large part paid for by deep cuts to Medicaid, which has drawn serious concern from moderate Republicans in both chambers. AcademyHealth has been active in educating Congress about the evidence showing that the proposals being considered would harm beneficiaries, rural hospitals, and state budgets.
Trump Administration moves on Schedule F, opportunity to provide comments
The Trump Administration proposed a new rule that would reclassify tens of thousands of career civil servants as "at-will" employees in a process call Schedule F. President Trump and his allies, including billionaire Elon Musk, have said they want to "dismantle government bureaucracy," which they criticize as a "deep state," and root out what Trump has called "rogue bureaucrats." They've claimed, without presenting evidence, that the government is rife with corrupt employees and non-existent workers. This new designation would allow the Administration to increase pressure on workers and fire those that they see as insufficiently loyal. Comments on this rule must be received by May 23, 2025.
DOGE requiring manual review and approval of health grants, bottlenecking systems
The U.S. DOGE Service is putting new curbs on billions of dollars in federal health-care grants, requiring government officials to manually review and approve previously routine payments — and paralyzing grant awards to tens of thousands of organizations, according to 12 people familiar with the new arrangements. The effort, which DOGE has dubbed “Defend the Spend,” has left thousands of payments backed up, including funding for doctors’ and nurses’ salaries at federal health centers for the poor. Some grantees are waiting on payments they expected last week. Typically, an organization that has been awarded a grant does not receive the funding up front. The money is held in a secure account managed by the government, and an organization will request “drawdowns” — tranches of money periodically throughout the year — to cover expenses such as salaries or research costs. Under Defend the Spend, organizations must now include a justification for each transaction. Federal officials then review the justification before deciding whether to approve the payment.
CMS rolls back Biden-era health equity efforts
The Trump administration is changing how the federal government rewards doctors and hospitals: Fighting racism and improving care for LGBTQ+ is out. Nutrition and well-being are in. The strategy has come into focus in recent weeks as the Centers for Medicare and Medicaid Services signaled it will roll back incentives and requirements for doctors and hospitals to tackle disparities in health. It marks the end of one of the Biden administration’s signature initiatives and comes as the Trump administration stamps out diversity, equity and inclusion policies across the federal government.
NIH has cut at least $2.3 billion in grants this year
The National Institutes of Health has scaled back its awards of new grants by at least $2.3 billion since the beginning of the year, with the biggest shortfalls hitting the study of infectious diseases, heart and lung ailments, and basic research into fundamental biological systems, a new STAT analysis has found. This roughly 28% contraction in funding comes on top of threats to freeze billions of dollars of NIH funding to specific universities as well as abrupt terminations to hundreds of research projects on Covid-19, HIV/AIDS, health disparities, vaccine hesitancy, and other areas targeted by President Trump’s political agenda.
NIH will prohibit funding to universities with DEI programs
The NIH has announced that research universities must certify that they do not operate any diversity, equity, or inclusion programs or lose funding and access to future grants, effective immediately. The NIH announcement does not attempt to define what diversity, equity, and inclusion means, leaving colleges to try and interpret it and potentially providing little accountability to the Administration labeling a college in violation. The announcement also requires grant recipients to certify that their institutions do not engage in a "discriminatory prohibited boycott" of Israeli companies or companies doing business in Israel.
Office for Reproductive Health in CDC mostly eliminated
One of the casualties of Tuesday’s massive purge of workers from the Department of Health and Human Services (HHS) is an office dedicated to promoting healthy pregnancies. Most of the more than 100 employees at the Division of Reproductive Health lost their jobs this week, including some who conduct work mandated by federal law. Experts and former staff say the latest firings will halt the IVF and family planning work Trump campaigned on. The CDC’s reproductive health division functioned as “a key source of support for maternal and child health programs nationwide,” Elizabeth Kielb, director of maternal and infant health at March of Dimes, a nonprofit organization focused on maternal and infant health, said.
NSF Director Panchanathan resigns amid grant termination and job cuts
National Science Foundation Director Sethuraman Panchanathan resigned amid demands from the new Trump administration and DOGE to cancel billions of dollars in research grants. “I believe I have done all I can to advance the critical mission of the agency and feel that it is time for me to pass the baton to new leadership,” Panchanathan said in parting remarks.
Newborn screening advisory panel eliminated
As cuts sweep across federal health agencies, the Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC) has been terminated. Notably, the ACHDNC, which sits under the Health Resources and Services Administration, is responsible for the Recommended Uniform Screening Panel (RUSP), a standardized list of dozens of conditions the HHS secretary recommends states screen for as part of their universal newborn screening programs.
What we’re reading
The Washington Post reports that 38 of the 43 experts cut last month from the boards that review the science and research that happens in laboratories at the National Institutes of Health are female, Black or Hispanic, according to an analysis by the chairs of a dozen of the boards. Six percent of White males who serve on boards were fired, compared with half of Black and Hispanic females and a quarter of all females, according to the analysis. Of 36 Black and Hispanic board members, close to 40 percent were fired, compared with 16 percent of White board members. The chairs’ analysis calculated the likelihood that this would have happened by chance as 1 in 300.
The Government Accountability Office released a report on Generative AI’s environmental and human effects, including identifying areas that Congress can consider legislation. GAO identifies five risks and challenges that could result in negative human effects on society, culture, and people from generative AI: lack of accountability; lack of data privacy; cybersecurity concerns; unsafe systems; and unintentional bias.
Nature reported on the results of a huge reproducibility project in Brazilian biomedical studies, with concerning results. A coalition of more than 50 research teams surveyed a swathe of studies to double-check their findings, and were able to replicate the results in less than half of the tested experiments.