President Trump used his budget blueprint on Friday to forge ahead with his assault on the nation’s public health and biomedical research enterprise, proposing draconian cuts to the National Institutes of Health and the Centers for Disease Control and Prevention that experts warned would upend decades of progress in advancing human health, well-being and longevity.
In hard numbers and biting words, the budget wipes out a string of programs, including one that helps low-income people living in cold climates pay heating bills. It eliminates C.D.C. programs devoted to preventing chronic disease and injuries, including gun violence injuries, dismissing those programs as “duplicative” and “unnecessary.”
It calls the N.I.H., the world’s premier biomedical research agency, “too big and unfocused.” The document argues that the institutes have “broken the trust of the American people,” while effectively accusing the agency of funding research that led to the coronavirus pandemic. It says the Centers for Medicare and Medicaid Services, the federal agency that provides health care to more than 160 million Americans, has carried out “wasteful and woke activities.”
In some respects, the plan is not surprising; Health Secretary Robert F. Kennedy Jr. has already announced that he is shrinking the federal Department of Health and Human Services, which oversees the N.I.H. and the C.D.C., by 20,000 people. The blueprint proposes $500 million for Mr. Kennedy’s Make America Healthy Again initiative.
Yet the budget proposal takes aim at some initiatives that Mr. Kennedy might seem to favor. It eliminates the National Center for Complementary and Integrative Health, which focuses on alternative therapies. And Mr. Kennedy often says he wants to improve the health of Native Americans, many of whom rely on the home heating program Mr. Trump wants to cut.
The plan would slash $18 billion out of the N.I.H. budget, shrinking it to $27 billion — a stark contrast from its heyday in the 1990s, when a bipartisan Congress voted to double its budget within five years because Republicans argued biomedical research was an engine for economic growth.
The proposed budget is only a blueprint — a statement of Mr. Trump’s priorities. It will now go to Congress, where it is already facing hurdles.
Senator Susan Collins, Republican of Maine and the chairwoman of the Appropriations Committee, said Friday that she had “serious objections” to cuts to the home heating program, which helps many of her constituents survive the cold New England winters, and to programs “that support biomedical research.”
Mr. Trump also proposes shutting down the National Institute for Minority and Health Disparities, a branch of the N.I.H. devoted to studying ways to improve the health of minorities, including Native Americans, who often suffer higher rates of chronic disease than white people.
The budget said the institute was “replete with D.E.I. expenditures” — a reference to diversity, equity and inclusion initiatives, which the president has systematically moved to dismantle within the government.
“Eliminating these efforts would reverse decades of progress,” said Dr. Thomas R. Frieden, who ran the C.D.C. under President Barack Obama. “You don’t improve things by destroying them. You improve them by improving them.”
The budget blueprint does not talk about the Food and Drug Administration. Dr. David A. Kessler, who ran the F.D.A. under both Republican and Democratic administrations, has argued that deep cuts to biomedical research funding will put the United States at a competitive disadvantage with China.
At a recent hearing on Capitol Hill, he reminded lawmakers of the Cold War era, when the federal government ramped up its investment in research after the Soviet Union became the first nation to launch a space satellite.
“Whatever needs to be fixed, let’s fix it, but we need to make a marked increase in our investment,” Dr. Kessler said. ”This is Sputnik 2.0, but with China.
While chronic disease and injuries are now major causes of death in the United States, the C.D.C.’s scope would be narrowed and would return to its original mission of protecting Americans against infectious disease. The agency’s budget would be cut nearly in half; it would lose $3.5 billion in funding, leaving it with “more than $4 billion,” the proposal said.
Mary Woolley, the longtime chief executive officer of Research America, an advocacy group that promotes biomedical research, said the effects of Mr. Trump’s proposal would be felt over the long term by slowing studies that could lead to treatments for a range of diseases, including childhood cancer, Alzheimer’s disease and Lupus, the chronic autoimmune disease.
But she also said there would be short-term effects. Patients are already losing access to experimental drugs because clinical trials have been shut down as a result of recent budget cuts, she said. She worried that young researchers would conclude that “they have no future in this country and should look elsewhere.” Some are already being recruited by countries, including China, she said, adding, “If you don’t have the next generation, you have nothing.”
Polls show that most Americans support biomedical research. A recent survey by KFF found that a majority of the public, 61 percent, opposed major cuts to staff and spending at federal health agencies. There were stark differences along party lines, with 9 out of 10 Democrats opposing the cuts, and 72 percent of Republicans supporting them.
Ms. Woolley cited a recent report by United for Medical Research, a coalition of patients, advocacy groups, industry and academic medical institutions, that found N.I.H.-funded research is an economic engine, returning $2.56 for every $1 invested.
The budget also proposes cutting more than $1 billion from the Substance Abuse and Mental Health Services Administration, which directs funds and support nationwide to address two of the country’s biggest public health crises.
While Mr. Kennedy, a recovering heroin addict, has said he is concerned in particular about the opioid epidemic, the budget rails against the public health strategy known as “harm reduction,” which was supported by the Biden administration and involves decreasing the risk of deaths and overdoses by ensuring that people who use illicit substances can do so safely.
It specifically criticizes “safe smoking kits” and “syringes.”
The heating program, called the Low Income Home Energy Assistance Program was labeled “unnecessary.” The document justified eliminating it by citing Mr. Trump’s promises to increase domestic oil and gas production and reduce energy prices.
The Government Accountability Office has raised significant integrity concerns related to fraud and abuse in the program, but it currently helps 6.2 million Americans from Texas to Maine offset their high utility bills. Last month, the administration fired everyone working in the office that administers the program.
Jan Hoffman and Brad Plumer contributed reporting.
