Published on February 14, 2020
Updated on April 17, 2023
February 14, 2020
President Trump released his proposed $4.5 trillion budget this week, which includes significant cuts to several health programs. In the proposal, defense spending would see an increase of 0.3% ($750 billion), while non-defense spending would see a decrease of 5% ($590 billion) for fiscal year 2021 – which starts on October 1. The cuts are below the level Congress and the president agreed to in a deal last summer. However, any major decisions will likely not be made until after the election in November.
Of that $590 billion in cuts, the biggest reductions are in health and safety-net programs, including $130 billion in Medicare prescription drug programs, $292 billion from Medicaid work requirements and food stamps, and $70 billion through restrictions on access to disability benefits. Several agencies are slated for cuts, including the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI).
Given Democrats control the House, it is unlikely the president’s budget will have the momentum to pass through the chamber, especially with the cuts proposed on health care spending. Hearings and mark-ups are slated to begin over the next few weeks in the House; the Senate has not yet indicated it will hold hearings.
Despite the fact it will likely not pass, the president’s budget does provide some insight into his policy priorities should he be reelected. This is a developing story, and we will provide updates as they occur.
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Another component of the president’s proposal would impact tobacco regulation. Under the budget, he suggests removing the Center for Tobacco Products (CTP) from the FDA to create a new independent agency under the Department of Health and Human Services (HHS). The FDA was given the authority to regulate tobacco products (including vaping) in 2009 after the passage of the Family Smoking Prevention and Tobacco Control Act. The CTP currently exists as the arm of the FDA that manages its tobacco control initiatives; however, should the budget pass, it would formally establish it as an independent entity and remove FDA oversight.
The accompanying justification released with the budget read, “A new agency with the singular mission on tobacco and its impact on public health would have greater capacity to respond strategically to the growing complexity of new tobacco products.”
The administration has had a complicated relationship with tobacco and vaping products over the past several months. At one point, the president called for the ban of all flavored tobacco products, before walking that back and allowing several products to remain on the market.
Joe Grogan, the head of the White House Domestic Policy Council, voiced his opposition to FDA oversight late last year, referring to it as a “huge distraction.” He also said, “Tobacco has no redeeming qualities and it should not be regulated by a health agency like this.”
Former FDA Commissioner Scott Gottlieb even expressed his opposition at the time, saying, “The regulation of tobacco products was one of the most productive uses of my time as FDA Commissioner.”
Anti-smoking advocates have expressed criticism of the budget request. The president of the Campaign for Tobacco-Free Kids, Matthew Myers, said, “This proposal is yet another giveaway to the tobacco and e-cigarette industry from an Administration that recently sided with the industry over kids by leaving thousands of flavored e-cigarettes on the market.”
The president’s budget is far from passing in its current iteration, and we will provide updates as the story develops.