Internists deeply concerned by administration’s fiscal year 2018 ‘skinny’ budget proposal
Washington (March 16, 2017) — The American College of Physicians (ACP) today said it is deeply concerned about the fiscal year 2018 budget outline or "skinny" budget released this morning by the Trump administration because it proposes deep cuts to medical and health services research, primary care training programs, and many other essential health-care programs and research. "The United States has long been recognized as a world leader in medical research and education," said Nitin S. Damle, MD, MS, MACP, ACP's president. "This budget, were it to be adopted by Congress, would greatly weaken critical programs that are essential to maintaining our leadership in biomedical and health-services research, public-health programs, and medical education."
Specifically, ACP is concerned by noted proposed reductions in funding and changes in policy:
- The proposal significantly reduces the budget for the Department of Health and Human Services (HHS) funding by $15.1 billion, or 17.9 percent. HHS is the principal federal agency charged with protecting the health of all Americans and for providing essential human services. "A cut of this magnitude threatens all facets of the health-care system," Dr. Damle said, "including the operation of the Medicare and Medicaid programs."
- The proposal reduces the budget of the National Institutes of Health (NIH), by $5.8 billion, or almost 20 percent. "NIH is the nation's premier medical research agency, making important discoveries that improve health and save lives," Dr. Damle noted. "A cut this large would threaten the U.S. standing as the world leader in medical and biomedical research."
- The proposal moves or consolidates the Agency for Healthcare Research and Quality (AHRQ) into NIH without any specific details about how that change would be structured or whether NIH would receive any additional funding to carry out AHRQ's mission. "Through vigorous health-services research–which differs greatly from biomedical research–this agency is responsible for improving the quality, safety, efficiency and effectiveness of care and ultimately helps physicians help their patients by making evidence-informed decisions, funding research that serves as the evidence engine for much of the private sector's work to keep patients safe, making the healthcare market place more efficient through establishing quality measures," Dr. Damle emphasized. "Simply folding AHRQ into NIH could harm the vital work that AHRQ performs."
- The proposal eliminates $403 million from unspecified health and nursing training programs, which the Trump administration claims do not enhance the nation's health workforce. "ACP is troubled that this cut could come from the Title VII Health Professions program," Dr. Damle said, "which is critical because it is the only federal program dedicated to funding and improving training of primary-care physicians."
ACP is also concerned about deep cuts to funding for climate change. Without support for the research on climate change conducted by federal agencies – including NASA, National Oceanic and Atmospheric Administration (NORA), the EPA, the State Department and the Department of Energy – the warming of the planet will continue, bringing with it devastating consequences to human health.
While ACP is encouraged by an increase of $500 million for expanding prevention efforts for opioid substance use disorder, more details are needed to evaluate this expansion fully, particularly since other budget cuts and policies proposed by the administration could undermine this goal.
"ACP is keenly aware of the fiscal pressures facing the Trump administration and Congress at this time, but it strongly believes the U.S. must invest robustly in biomedical and health services research, workforce and delivery system initiatives that support primary care and public health, including programs that have a proven track record of effectiveness but also those that demonstrate the kind of innovation required in any high-performing health-care system," Dr. Damle concluded. "Unfortunately, this budget proposal fails to make those investments and would make America less great by undermining our commitment to science, medical and health services research, medical education, and research on climate change."
The American College of Physicians is the largest medical specialty organization in the United States. ACP members include 148,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.