Today's Situation Report focuses on two key developments. House Republicans have pushed forward a budget framework closely aligned with President Donald Trump’s domestic policy vision, proposing significant reductions in Medicaid funding by $880 billion over the next decade. Meanwhile, the NIH funding freeze continues to cause delays in grant reviews and threatens the stability of biomedical research, compounding the uncertainty and upheaval in the field. 

In today’s issue: 

  • House GOP Budget Advances, Threatening Deep Medicaid Cuts with Policy Implications 
  • Trump's Funding and Communication Freeze Disrupts NIH Grants, Spurs Legal Battles 
  • Deadline Tomorrow! Support AHRQ by Signing a Letter of Support  

House GOP Budget Advances, Threatening Deep Medicaid Cuts with Policy Implications  

House Republicans narrowly approved a budget framework late Tuesday, including a proposed $880 billion cut over the next decade, with Medicaid bearing the brunt of those reductions.  

For health services and policy researchers, the implications are significant. Medicaid provides health coverage to millions of low-income individuals, and such deep funding reductions could lead to widespread coverage losses, strain on state budgets, and shifts in healthcare access and outcomes. The proposed cuts may also force states to reconsider eligibility criteria, benefits, and provider payments, reshaping the health care landscape for vulnerable populations and creating new challenges for policymakers. 

The plan faces a tough road ahead. The Senate, which recently approved a competing budget will now need to negotiate with the House. AcademyHealth has met with dozens of targeted congressional offices and committees to provide educational briefings by members who are top Medicaid experts in the country. The meetings are an opportunity to inform staffers about the overwhelming evidence showing that the proposed reforms are likely to hurt beneficiaries, rural hospitals, and states. We will have more to share soon.  

For those in the community engaging in similar education efforts around the importance of Medicaid, new qualitative message research with Trump voters conducted by the Cost & Coverage Collaborative, an initiative of the Robert Wood Johnson Foundation (RWJF), recommends this core message when educating others about the impact of Medicaid cuts: “You can’t cut [$880 billion] from Medicaid without taking healthcare away from millions of seniors living in long-term care, children, and people with disabilities. Rushing these cuts will hurt those who can least afford care – and won’t do anything to lower our healthcare costs.”  

This month's "Read on Washington," available only to AcademyHealth members, includes additional updates on risks to Medicaid in the budget reconciliation process, the latest on FY25 appropriations, as well as updates on childhood vaccines, CMMI data collection, and NIH grants. 

Trump's Funding and Communication Freeze Disrupts NIH Grants, Spurs Legal Battles 

Recent executive orders from the Trump administration caused significant disruption to federal agencies, particularly in health and research funding. On January 21st, the administration ordered a pause on external communications by the Department of Health and Human Services (HHS) until February 1, requiring approval from a “presidential employee” for public documents, communication, and Federal Register postings, which disrupted agency operations, including NIH funding decisions. On January 27th, the administration froze all federal grants and loans to review spending, causing the NIH to halt grant payments and cancel research funding panels. On January 29th, the administration issued a memo rescinding the funding freeze, but White House press secretary Karoline Leavitt clarified that this was not a cancellation, causing widespread confusion.  

A group of state attorney’s general filed suit, and on January 31 a federal judge issued a temporary restraining order temporarily blocking the federal funding freeze. The following Monday, NIH staff were reportedly told by agency leadership that review councils would resume, and on Tuesday, February 4th, a study section scheduled prior to Trump’s inauguration was hosted. However, later that day cancellations of scheduled review councils continued.  

After receiving evidence that the Trump administration was evading that order, a judge issued an additional, broader order requiring the administration to “immediately take every step necessary” to restore frozen funding and end any federal funding pause, “including clearing any administrative, operational, or technical hurdles.” 

Despite these rulings and recent claims that funding has been unfrozen, NIH study sections have remained unable to meet because the Trump administration continues to block the agency’s ability to announce meetings in the Federal Register. There have been no publications on the Federal Register since the start of the federal communications freeze on January 21st. Without the required meetings, funding for research grants cannot move forward, resulting in a defacto freeze. 

What are NIH Study Sections and What is their Role in NIH Grant Review? 

Proposals for research funding from the NIH go through an intensive review process. Upon submission of a funding application, the Division of Receipt and Referral (DRR) within the Center for Scientific Review (CSR) checks the application for administrative and formatting requirements and determines which NIH Institute or Center it should be assigned to for funding consideration. The DRR then assigns applications to a specific study section, where the application undergoes peer review to evaluate the scientific and technical merit of the proposed research.  

The study sections—panels composed of non-federal scientists, mostly from academia, who have expertise in relevant scientific disciplines and research areas—provide critical peer review to determine potential impact, scientific merit, and feasibility. To convene a study section meeting, by law, notice of the meeting must be posted to the Federal Register at least 15 days prior to the meeting. A subset of reviewers assess each application and assign a preliminary Overall Impact score. At the study section meeting, the primary reviewer presents the application and the full panel discuss and provide a final Overall Impact score.  

After study section review, applications with fundable scores undergo a second level of peer review—called advisory council review—conducted by the funding Institute or Center’s (IC) National Advisory Council. Advisory councils are composed of scientists from the extramural research community and public representatives appointed by the IC. The advisory council considers the study section’s results and determines the relevance of applications to the council’s priorities, as well as reviewing applications for potential barriers to funding such as human subjects or animal concerns. Advisory councils make recommendations as to whether applications should be funded—decided whether each application is recommended for funding, not recommended for funding, or deferred for re-review by the study section. Applications recommended for funding are then reviewed by the IC, which makes the final decision.  

What might this mean?  

Roughly 2,600 study section and advisory council meetings involving nearly 30,000 expert reviewers are held each year to determine NIH funding disbursements. Decisions made by the NIH grant review process collectively determine the flow of NIH funding affecting more than 300,000 researchers located at more than 2,500 research institutions, including universities and medical schools, nationwide. In 2024, the NIH awarded nearly $38 billion worth of grants to support research projects, institutional programs at research centers, and training for scientists nationwide.  

Each study section meeting can include more than 30 researchers, clinicians, administrators, and other expert reviewers. Simply scheduling study sections is a labor in itself, with some scheduled up to a year in advance, making rescheduling difficult and time consuming.  

The initial funding freeze and ongoing delay of study section meetings has already had a significant impact on research institutions. Roughly 16,000 grant applications have been stalled thus far, and 42 study sections and advisory council panels were cancelled last week alone. As a result, NIH funding disbursed to outside researchers between January 20th and February 14th is roughly $1 billion behind grants disbursed over the same period in 2024. Nearly 2,000 fewer grants were awarded in the first two weeks of Trump’s presidency compared to the same time period in 2024 (see figures in this Nature article ).  

Even short-term, temporary interruptions to the NIH grant-making process can lead to substantial, long-term scientific and economic implications nationwide. Short interruptions in the NIH grant review process can lead to months-long backlogs and result in delayed research for things like clinical trials for cancer treatments. Federal funding from the NIH supports thousands of research labs, many within universities and medical schools that rely heavily on grants to operate. Funding uncertainty impacts hiring and admissions decisions at universities, with many institutions making decisions to defer graduate students, reduce class sizes, rescind offers to graduate students, and institute hiring freezes. Several universities, including the University of Washington, UNC Chapel Hill, the University of Pittsburgh, and the University of Pennsylvania, have paused or reduced doctoral admissions and faculty hiring due to uncertainty in research funding.  

These decisions can have lasting ripple effects on future and early career scientists, and on both national and local economies. NIH-funded research is conducted in every state and the District of Columbia and significantly impacts local economies. In 2023, funding from the NIH supported more than 410,000 jobs across states, and NIH-funded research fueled a total of almost $93 billion in economic spending, with 47 states experiencing more than $100 million in new economic activity.  

What questions remain? 

According to news reports, while employees within the NIH Office of the Director were told this week that Federal Register notices for study sections will start being permitted again, notices of advisory council meetings, which provide additional review and make the final funding recommendations, will not. The continued blocking of advisory council meetings contradicts Judge John McConnell’s most recent order to clear any “administrative, operational, or technical hurdles,” raising the potential for additional legal action. Judges could issue more specific orders directed towards individuals responsible for violations or hold individuals in contempt of court.  

Deadline Tomorrow! Support AHRQ by Signing a Letter of Support 

As mentioned in previous updates, the Friends of the AHRQ have released an opportunity for organizations to sign on to a letter to Congress calling on the Agency to be fully funded in FY26. You can read the letter and have your organization sign it here. The deadline is February 27. AcademyHealth is planning to promote the letter widely and the more signatories we collect, the more powerful the letter will be. If you want to join the Friends listserv, email us at Advocacy@academyhealth.org. 

Previous Updates 

This is the sixth in a series of Situation Report updates from AcademyHealth. You can find prior issues below:  

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