Five questions about the new Trump budget and health issues

Five questions about the new Trump budget and health issues
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The White House is expected to release its fiscal 2019 budget request on Monday, and health advocates will be watching closely to see if this year’s proposal will contain deep cuts to the agencies charged with bolstering public health and finding cures for complex diseases.

Lawmakers from both parties are also waiting to see if the budget will propose major changes to the anti-drug office that have already sparked an outcry.

The release of President TrumpDonald John TrumpSasse: Trump shouldn't dignify Putin with Helsinki summit Top LGBT group projects message onto Presidential Palace in Helsinki ahead of Trump-Putin summit Hillary Clinton to Trump ahead of Putin summit: 'Do you know which team you play for?' MORE’s budget last year set off a firestorm of criticism in the health world from science and public health advocates — and even some disapproval from fellow Republicans.

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The president’s budget is ceremonial in many regards: Congress actually controls the federal government’s purse strings, and lawmakers are quick to rattle off tales of how both Republican and Democratic presidents never get their wishes. But the budget does provide a window into the White House’s priorities.

Will the budget propose major cuts to NIH again?

In an age of hyper partisanship, there’s one thing Democrats and Republicans agree on: They both love the National Institutes of Health (NIH).

Last year, Trump proposed slashing NIH’s budget by $5.8 billion, which would have brought the medical research agency’s budget down to the lowest level in 15 years.

But Republicans in charge of NIH’s purse strings quickly made it clear those cuts wouldn’t happen. Lawmakers have immense interest in preserving NIH, which is charged with projects like accelerating cancer research and culling health data from a 1-million-person research cohort.

Congress already plans to boost NIH’s upcoming budgets with the inclusion of $2 billion over two years in the budget deal passed early Friday morning.

Rep. Tom ColeThomas (Tom) Jeffrey ColeGOP centrists face decision day on Dreamer petition Bipartisan support for medical research is good news for all Trump on collision course with Congress on ZTE MORE  (R-Okla.), chairman of the House Appropriations health subcommittee, made clear Congress’s commitment to NIH on Thursday, saying increasing its research dollars amounts to “really vital investments.”

Congress is “going to do this anyway, you might as well take credit for it,” Cole said, referencing what he’s told Office of Management and Budget (OMB) Director Mick MulvaneyJohn (Mick) Michael MulvaneyFive GOP lawmakers mulling bid to lead conservative caucus On The Money — Sponsored by Prudential — Trump suggests China is easing pressure on North Korea because of trade fight | Mulvaney taps top aide as No. 2 at consumer bureau | House Republican to offer bill to curtail Trump's trade powers Mulvaney appoints top aide as consumer bureau acting No. 2 MORE. “You don’t make friends saying, ‘I want to cut the premier biomedical research institution in the world that's helping us find cures and is a vital element in defense everywhere from bioterrorism to just the biosphere.’ ”

Cutting funding for science agencies would be “shooting ourselves in the foot if we go in that direction,” said Ellie Dehoney, policy and advocacy vice president at Research America. “All the competitor nations that we think about are investing hand over fist in [research and development].”

Will CDC take a major hit?

The country is in the midst of a worse-than-expected flu season. And that’s just one example of why cutting funding for the Centers for Disease Control and Prevention (CDC) would be detrimental to the country’s ability to respond to public health crises, advocates say.

Last year, the Trump administration proposed a 17 percent cut to CDC. Tom Frieden, the agency’s director under President Obama, lambasted the cuts, noting it would bring the funding to its lowest level in more than 20 years.

“That was quite a devastating cut that would have crippled the agency’s core activities that are effective in reducing injury, illness and death,” said John Auerbach, the president and CEO of Trust for America’s Health and a former CDC official.

Auerbach is preparing to see significant cuts for the agency.

If that’s the case, it’s unlikely Congress will play along.

“I can guarantee you that in this president's term there will be some sort of equivalent to Ebola or SARS,” Cole said. “The biosphere is just going to produce these sorts of things, and you do not want to be the party that cut America's front line of defense against infectious disease.

“Because whether you could have stopped it or not, I guarantee you, you'll be blamed for it.”

What will happen to the anti-drug office?

A reported proposal that would significantly alter the Office of National Drug Control Policy (ONDCP) has already faced major backlash, and it remains to be seen if the budget will reverse course.  

In mid-January, Politico reported that OMB was planning to move two of ONDCP’s major grants into different departments, which would result in a 95 percent budget reduction to the anti-drug office.

More than 150 addiction advocacy organizations have already made their positions well known. The move would jeopardize the programs, which help reduce substance abuse in youth and coordinate efforts to curb drug trafficking. And it would hamper ONDCP in the midst of an opioid epidemic.

A bipartisan group of senators agreed, and told Mulvaney so in a letter sent Feb. 1.

Last year, OMB’s proposal to cut ONDCP’s budget by 95 percent was leaked. It also sparked backlash from advocates and lawmakers from both parties, and wound up not being included in the budget.

How will the drug industry and lawmakers respond to President Trump’s drug pricing proposal?

Trump’s budget will lay out several proposals aimed at making medications more affordable, Health and Human Services (HHS) Secretary Alex Azar told Bloomberg, which was one of a small number of news outlets invited to an on-the-record briefing Thursday previewing the proposals.

The proposals including ensuring seniors on Medicare get discounts that pharmacy-benefit managers negotiate with drug companies, creating an out-of-pocket spending cap, possibly making generic drugs available to low-income seniors at no cost, and more, Bloomberg reported. A 28-page document released Friday by the White House Council of Economic Advisers also laid out a range of policies to lower drug prices.

Trump has repeatedly said drug companies “are getting away with murder.” He has vowed to fight the increasing prices hitting Americans in their pocketbooks, but has taken little action to lower prices so far.

Azar has echoed this vow, saying in hearings that “drug prices are too high.” Azar is a former pharmaceutical executive who Democrats criticized as serving as a high-ranking official at Eli Lilly at a time when the company more than doubled the price of several drugs.

Lawmakers have also said they want to tackle the rising costs of medicines, and Trump’s proposals would have to be approved by Congress. 

How will Azar handle the pressure?

Azar was sworn in as HHS secretary just weeks ago. 

This week, he’ll be tasked with defending the department’s budget, and possible steep cuts to NIH and CDC. He’ll likely face a rash of questioning from lawmakers in three hearings: at the House Energy and Commerce Committee, the House Ways and Means Committee and the Senate Finance Committee.