The Office of Management and Budget published a sweeping proposed rule on May 29, 2026, that would fundamentally reshape how the federal government funds research, public health programs, and other evidence-based work. AcademyHealth has reviewed the proposal carefully. We are troubled, and we think you should be too.
The rule, framed as an effort to improve accountability and reduce bureaucratic burden, does something more consequential: it places political appointees between scientists and the work they do on behalf of the public. It rewrites the terms under which federally funded research can operate, in ways that would undermine the independence, integrity, and practical functioning of the health services research enterprise.
What the rule actually does
The most alarming provision establishes a new pre-issuance review process that requires senior political appointees, not scientific reviewers, to sign off on grants before they are awarded. The rule is explicit that these reviews must ensure proposals are consistent with "Federal agency priorities" and "the President's policy priorities." Peer review, which has governed the allocation of federal research funding for decades, is reduced to an advisory function. The rule states plainly that it "does not replace agency discretion."
Let us be direct about what that means. Federal agencies have always retained some discretion to decline a meritorious grant, and that backstop is not new. What this rule does is something categorically different: it mandates senior political appointee sign-off on every award, making ideological alignment an affirmative threshold that all grants must clear before funding. Under current practice, scientific merit is presumptively sufficient absent a specific reason to override it. Under this rule, political alignment becomes a universal pre-award gate. That is a structural inversion, not just an expansion of existing authority. The rule makes this explicit by reducing peer review from a decisional input to an advisory one.
The rule would also embed new ideological conditions throughout the grant lifecycle. Applicants and recipients must certify they are not engaged in what the rule defines as unlawful DEI activity, a definition broad enough and vague enough to create serious legal and operational uncertainty for universities, research hospitals, health systems, and nonprofits conducting federally funded work. The rule prohibits funding for activities the administration characterizes as "gender ideology," a term defined by executive order rather than statute. That distinction matters beyond the ideological content: because executive order definitions can be revised without rulemaking, grant conditions would effectively track political priorities in real time, faster than the regulatory process that governs them. Recipients would be expected to comply with a standard that can move without notice. That is not just ideological overreach. It is a structural accountability problem for any institution trying to plan, budget, and operate under a federal award.
The rule further gives agencies new authority to cancel or modify grants mid-award if recipients are found to be out of compliance with these evolving political standards, without the due process protections that researchers and institutions currently rely on.
This may be the most operationally consequential provision in the rule, and it deserves direct attention from anyone currently holding a federal award. The pre-issuance review affects what gets funded. This provision affects what stays funded. For the kinds of long-horizon work that define health services research, longitudinal studies, research networks, investigator pipelines, the ability to terminate or claw back a grant mid-stream as political standards shift is a threat of a different order than anything the prior grant management framework contemplated. A researcher three years into a five-year study, a network that has spent years building data infrastructure and community trust, an early-career investigator whose training is federally supported: all of these are now exposed to termination risk tied not to scientific performance but to political compliance. That exposure is new, and it is not theoretical.
Our position
AcademyHealth supports transparency and accountability in federal grantmaking. We have no objection to rigorous stewardship of taxpayer dollars, and we support efforts to reduce genuine administrative burden on researchers and institutions. But those goals do not require dismantling scientific independence.
This rule would not make federal research funding more accountable. It would make it more political. Those are not the same thing.
The federal grant system already has robust accountability mechanisms: single audit requirements, IRB oversight, programmatic reviews, suspension and debarment authority, and indirect cost controls. These tools exist precisely to ensure that funds are used as intended and that recipients meet scientific and programmatic standards. If wasteful spending or misaligned funding were the genuine problem this rule seeks to solve, those statutory remedies exist and can be strengthened. The rule's own preamble suggests a different motivation. Its primary evidence of a problem requiring regulatory remedy is not OIG findings, GAO audit results, or documented patterns of fraud in scientific grant programs. It is Heritage Foundation reports. When the evidentiary basis for a regulatory change is ideological rather than programmatic, the accountability framing is difficult to sustain.
There is also a structural difference between accountability and political alignment that has real consequences beyond values. Accountability is reviewable against an objective standard. Institutions can audit their own compliance, seek legal counsel, and plan accordingly. Political alignment is not reviewable in the same way. It shifts with executive priorities, offers no stable benchmark to plan against, and provides no meaningful basis for due process when a grant is modified or terminated. What the rule calls accountability is, in practice, a standard that only the current administration can define and apply. That is not oversight. It is control.
The comment period closes July 13, 2026. AcademyHealth will be submitting formal comments. We urge our members, partner organizations, and the broader health services research community to do the same, and to make their voices heard through their institutions and professional associations.
The stakes are high. Federal funding is the lifeblood of the evidence infrastructure that health policymakers, clinicians, and patients depend on. We cannot afford to lose it to a rule that mistakes political control for accountability.
Comments must be submitted electronically to www.regulations.gov, Docket OMB–2026–0034, by July 13, 2026.