This edition of AcademyHealth’s Situation Report highlights the release of the FY26 “skinny budget,” which proposes deep cuts to HHS, NIH, and AHRQ—including the elimination of vital research institutes and funding streams—while also attempting to reorganize federal health agencies without congressional approval. At the same time, new restrictions on foreign subawards threaten global collaboration in NIH-funded research, and an Urban Institute analysis projects millions could lose Medicaid coverage under expanded work requirements. Federal rollbacks are also dismantling inclusive data infrastructure, undermining efforts to track and address health disparities. AcademyHealth urges researchers to speak out—use tools like the Stand with AHRQ toolkit and interactive Medicaid data maps to demonstrate the real-world impact of these proposals and defend evidence-informed policy.
In today’s issue:
- “Skinny Budget” Proposes Tens of Billions in Cuts to HHS
- Amid Further HHS/NIH Impacts, Lawmakers & Coalitions Push Back
- New Analysis Reveals Coverage Losses Caused by Medicaid Work Requirements
- Federal Rollbacks Threaten Inclusive Data Infrastructure
- Inside Washington: April Advocacy Highlights for Members
- Other News We’re Tracking
“Skinny Budget” Proposes Tens of Billions in Cuts to HHS
The White House released a so-called “skinny budget” as part of President Trump’s budget request for FY26, where he proposed cutting the Department of Health and Human Services discretionary accounts by 26 percent. The President’s Budget Request is a proposal, but Congress must still pass legislation to fund every specific account. This request would seek to solidify the likely unlawful HHS reorganization that was announced last month, which sought to close hundreds of programs throughout the Department. The skinny budget also calls for cutting:
- nearly 40 percent of the NIH budget, including the elimination of the National Institute on Minority and Health Disparities and the National Institute for Nursing Research,
- CDC funding nearly in half, and
- Substance Abuse and Mental Health Services Administration by $1 billion.
In all, this proposal would cut $119 billion from non-defense discretionary accounts while boosting defense discretionary by the same amount.
For AHRQ, the proposed budget calls for ending the Patient Centered Outcomes Research (PCOR) and the $125 million in mandatory funding from the PCOR Trust Fund, cuts an additional $130 million in discretionary funding, the elimination of the digital health portfolio, ends new research, workforce development, capacity building, and convening grants. s, and offloads contracts and interagency agreements not associated with “statistical activities,” which the budget does not define. The proposal includes a statement that AHRQ no longer exists apart from the new HHS Office of Strategy, which Congress has not agreed to yet.
The proposed budget has drawn criticism from both sides of the aisle, with opponents to the proposal saying it would further degrade America’s scientific and health investments, and will leave Americans sicker, poorer, and dying earlier from preventable diseases. Senate Appropriations Committee Chair Susan Collins (R-ME) said a day before this budget was released that the cuts to health research has "put our leadership in biomedical innovation at real risk and must be reversed."
Congress is still early in its deliberations on FY26, and is looking for information from stakeholders. You can find out more on how to stand up for AHRQ with our toolkit.
Amid Further HHS/NIH Impacts, Lawmakers & Coalitions Push Back
The NIH announced that it will no longer allow subawards to foreign institutions, citing national security concerns and new guidance for their grant structure. Issuing subawards to collaborators in other countries is a common practice among scientists; the change, set to go into effect by September 30, will likely cause immediate disruptions to research. A further 26 percent cut to HHS’ discretionary budget was proposed in President Trump’s recent 2026 budget request, which targets NIH with the largest cuts of the proposal, reorganizes several NIH programs, and eliminates funding for numerous centers/institutes within NIH.
Coalitions continue to push back against these changes. A group including labor unions, city governments, and nonprofits has sued a handful of federal agencies and DOGE for previous reductions in force. The lawsuit claims that actions taken by agencies, like HHS, to follow a February executive order and issue mass firings of government employees unlawfully bypassed Congress, exceeded presidential authority, and violated the separation of powers under the Constitution.
In addition, Congressional lawmakers introduced twin resolutions calling on HHS Secretary, RFK, Jr., to reverse his decision to end public to comment on HHS’ policy and regulation changes. These public comment periods offer opportunities for researchers and organizations who may be impacted to voice their perspectives, suggest changes, or identify problems. A variety of patient advocacy groups, hospital associations, labor groups, and health advocates have since endorsed the Congressional resolution, including the National Rural Health Association and United Steelworkers. Experts believe that changes to Medicare are likely to continue to require public notice and comment under current statute, although laws codifying Medicaid and CHIP do not have independent notice-and-comment rulemaking requirements, which may allow HHS to forgo such options.
What researchers can do: Researchers can contact their Senators and Representatives to convey the importance of public input on health regulations and policy changes, as well as the importance of global collaboration among researchers on NIH grants.
New Analysis Reveals Coverage Losses Caused by Medicaid Work Requirements
A recent analysis from the Urban Institute reveals that expanding federal work requirements for Medicaid expansion coverage to age 64 would increase coverage losses. Building on two previous releases, one of which estimates national Medicaid coverage losses if work requirements were enforced for expansion enrollees ages 19 to 55, and the other of which estimates the geographic distribution of these coverage losses across the 40 expansion states and DC, this third analysis approximates that an additional 1 million adults would lose federally funded Medicaid coverage in 2026. This estimate includes many with high health care needs and is in addition to the 4.6 to 5.2 million estimated expansion enrollees ages 19 to 55 who would lose eligibility for federal Medicaid funding in 2026 under the implementation of work requirements.
Moreover, findings from these three analyses reveal that most expansion enrollees who would be subject to work requirements, regardless of whether the extension caps at age 55 or 64, are already either engaged in work activities or would be considered exempted. These Medicaid coverage losses would mean losses to essential health care including disruptions to chronic condition management, substance use disorder treatment, and preventative care.
What researchers can do: These findings add to the mounting estimated impacts of implementing federal work requirements in Medicaid. Researchers can elevate the concerning impacts to health care access and coverage by applying findings from these three analyses in their work and utilizing the interactive map to assess how proposed changes will impact specific states.
Federal Rollbacks Threaten Inclusive Data Infrastructure
A new Milbank Quarterly commentary by AcademyHealth Board Member Ninez Ponce along with authors Tara Becker, Riti Shimkhada, AJ Scheitler, and Susan Babey, details how recent executive actions by the Trump administration have stalled or reversed long-planned federal efforts to improve data collection on race, ethnicity, sexual orientation, and gender identity (SOGI). Despite significant investments in updating federal standards—most notably the 2024 revision of Statistical Policy Directive 15 (SPD 15) and national testing of SOGI measures—the administration’s recent directives have led to the removal of key datasets, halted ongoing analyses, and cast uncertainty over future implementation timelines. These shifts jeopardize evidence-based policymaking and health equity research, particularly for transgender and other marginalized populations, including Pregnancy Risk Assessment Monitoring System (PRAMS) data.
As part of AcademyHealth’s data series, AcademyHealth policy fellow Madison Haiman and Emma Mairson highlighted how states can fill in the gaps left this data is not restored. Read the full Milbank Quarterly commentary here.
Inside Washington: April Advocacy Highlights for Members
AcademyHealth's April Read on Washington—a members-only column—covers the latest developments reshaping the federal health landscape, including HHS layoffs and funding cuts, the Braidwood Supreme Court case, proposed changes to civil service protections, and more. This monthly update tracks policy shifts that impact health services research and is made possible through member support. Not yet a member? Join AcademyHealth today to access exclusive content and support our advocacy for evidence-informed policy.
Other News We’re Tracking
NSF Freezes Grant Awards, Begins Terminating Hundreds of Projects
The National Science Foundation has halted all new funding actions—including new awards and supplemental funding for existing grants—until further notice, already terminating over 1,400 grants. NSF is also implementing a new policy to screen proposals for alignment with undisclosed agency priorities, raising concerns about erosion of the peer-review process. For health services researchers, this freeze introduces significant uncertainty for current and future NSF-supported projects, especially those spanning interdisciplinary and public-interest domains.
Trump Executive Order Targets Medical School Accreditors Over DEI Standards
A new executive order from the Trump administration threatens federal recognition of medical education accreditors that include diversity-related standards, raising alarms among health professionals. The order could disrupt accreditation for medical schools and residency programs, potentially opening the door to new, less-regulated accrediting bodies. For health services researchers, this move signals a broader effort to reshape institutional standards in health care education — with possible downstream effects on workforce diversity, training quality, and access to care.
Previous Updates
This is the latest in a series of Situation Report updates from AcademyHealth. You can find prior issues here.
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