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Former Congressman Dr. Phil Gingrey provides public policy and government relations counsel to clients on a variety of issues. Here at Phil on the Hill, Phil draws upon his long career in public service to provide perspective and context on policy topics such as health care, the federal budget, annual appropriations, regulatory reform, and life sciences.

The “Paper Cuts” in the President’s Budget

Tuesday, June 20, 2017

Last week, the Trump Administration delivered its first fully fleshed out federal budget proposal to Congress with recommendations that amount to what OMB director Mick Mulvaney calls a “taxpayer first budget.”

Many in medical science and biomedical research, however, could be forgiven for thinking it is a health care last budget.

The National Institutes of Health, which Sen. Lindsey Graham rightly calls “a national treasure,”would be cut from $31.8 billion to $26 billion. The National Cancer Institute would receive $1 billion less in 2018 than this year.

The National Science Foundation would lose $776 million, an 11 percent decrease.

Overall, experts estimate that federal research would be reduced by an estimated 17 percent.

Why is the Trump Administration doing this? This document is known on Capitol Hill as “Mick Mulvaney’s budget.” Mick was a colleague of mine in Congress who co-founded the House Freedom Caucus and was active in the Republican Study Committee, the policymaking arm of conservative members. I remember Mick for his outspoken and principled desire to reduce the scale and scope of the federal government.

President Trump and Mick Mulvaney demonstrate a commendable desire to balance the budget within a ten-year window, reducing a federal debt now larger than our current annual Gross Domestic Product.

Mick will tell you cuts to health budgets justify what Congress calls the pay fors, reductions needed not just to reduce the size of government but to also offset the administration’s planned increases in defense spending. Here, too, there is a reasonable argument to be made. After all, North Korea and other global flashpoints are not getting any calmer.

But the fact remains that this administration’s first budget proposal would shrink research and public efforts to prevent and cure some of the deadliest diseases.

Human services that promote health are also on the chopping block.

Social Security Disability Insurance would be cut by about 2 percent over the next decade. SNAP, the Supplemental Nutrition Assistance Program, would be cut by 28.8 percent. Medicaid would shrink by 16.5 percent over the next decade. Even Rep. Mark Meadows, the current chairman of the House Freedom Caucus, was publicly taken aback by proposed cuts to the Meals on Wheels program.

As jarring as some of these reductions may seem, it is important to keep in mind the adage that under our Constitution “the President proposes and Congress disposes.”

There is no reason for the health care community to despair. Many Republicans in the House and many more in the Senate will never go along with these decreases as I heard from them recently at FY 2018 budget hearings on the Hill as well as in private conversations I have had with former colleagues over the past few weeks. They are aware that the costs of preventing and treating disease will not only save lives but will reduce medical costs, public health expenditures, deficits and debts.

The administration’s budget proposals are important because they signal that after years of increases, there is renewed pressure on the federal budget.

If those who care about health care stay engaged in the process, these Draconian reductions will remain simply cuts on paper, and nothing more.