President Donald Trump was criticized for calling on Congress to provide nearly $300 million to fund his HIV/AIDS initiative, while proposing massive cuts to the U.S. National Institutes of Health — the agency that leads the nation's research efforts in combating the disease.
In his $4.7 trillion budget request for fiscal 2020, Trump told lawmakers that the NIH's spending should be decreased by about $5 billion, from about $39 billion to about $34 billion, despite his HIV/AIDS proposal.
Trump also wants to slash U.S. spending on the global response to HIV/AIDS — calling for a 22% cut in funds for the President's Emergency Plan for AIDS Relief, or PEPFAR, program, which targets 15 of the hardest-hit countries.
PEPFAR was started in 2003 by President George W. Bush with a $15 billion initial investment from American taxpayers. Congress allocated $3.85 billion for PEPFAR in fiscal 2019. But Trump requested dropping that to $3.4 billion for fiscal 2020.
Since entering the White House, Trump has sought to wind PEPFAR down. In his fiscal 2018 budget request, he proposed cutting the program by $1 billion.
'A cold day in hell'
Trump's budget request is expected to be dead on arrival on Capitol Hill since lawmakers have been giving the NIH significant boosts in its spending levels in the past few years — making up for the previous decade in flat budgets for the agency.
"Congress will forget this budget by Friday, but the signal it sends to the world's poorest will be remembered," said Tom Hart, North America executive director for The ONE Campaign, an HIV/AIDS advocacy group.
House Energy and Commerce Committee Chairman Frank Pallone, D-N.J., called Trump's budget request a "sham and has absolutely no chance at ever becoming a reality."
Health and Human Services Secretary Alex Azar, whose spending Trump wants to cut by 12%, is slated to go before the Energy and Commerce Health Subcommittee on March 12 to explain his boss's fiscal 2020 request.
"It would be a cold day in hell before I helped pass a budget like this," said Rep. Rosa DeLauro, D-Conn., who chairs the House appropriations subcommittee for which Azar is set to testify March 13.
In his Feb. 5 State of the Union address, Trump said his administration planned to launch a new initiative focused on ending HIV/AIDS.
The plan, first proposed by Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Diseases, is aimed at bringing critical agencies involved in HIV/AIDS work together in a more collaborative way.
Fauci acknowledged the planned initiative is an extension of programs that have already been in the works since the Obama administration.
The NIH would share the $300 million Trump is proposing for HIV/AIDS with other federal agencies. But losing $5 billion would have a deep impact on the agency's overall research efforts, lawmakers said.
Fauci's agency would lose about $800 million if Congress accepted Trump's fiscal 2020 proposal.
And while the Centers for Disease Control and Prevention would get $140 million from Trump's HIV/AIDs initiative, the agency would lose millions of dollars more under the administration's proposed spending cuts.
In addition, Azar revealed last week that he was stripping the NIH, CDC and other HHS programs of $385 million in fiscal 2019 funds so he could use the money to respond to the growing number of migrant children his agency is charged with caring for under the Trump administration's border policy.
Block-granting Medicaid, requiring work
In his budget request, Trump again proposed turning Medicaid into a block-grant program and capping the amount of money the federal government provides to states. Block-granting the program would mean states would be given a fixed lump sum of federal funding they could use as they see fit.
In addition, the administration wants to impose a federal work requirement for all able-bodied adults 18 to 64 years old who receive Medicaid and food stamp benefits. The White House estimated the U.S. could save $130.4 billion over 10 years under such a mandate.
Slight FDA boost
The U.S. Food and Drug Administration would get a slight increase of $643 million under Trump's proposal.
The $6.1 billion total the agency would get, however, was not enough to entice departing FDA Commissioner Scott Gottlieb to stay. He resigned March 5.
In the budget request, the Trump administration also highlighted a number of ideas officials have previously discussed to lower drug prices. Some of these strategies have relied on FDA actions, such as reforming the 180-day exclusivity period granted to the first generic-drug maker that files an application. The administration also called for capping out-of-pocket costs for participants in the Medicare Part D drug program for seniors and disabled Americans.
Trump's fiscal 2020 budget also calls for $4.8 billion to support activities mandated under legislation enacted in 2018 to address the U.S. opioid crisis.