President Donald Trump’s proposed budget for 2018, unveiled to the public on May 23, includes significant cuts to various departments that touch health IT, including the Office of the National Coordinator for Health IT (ONC) and the National Institutes of Health (NIH).
The president’s budget request, “A New Foundation for American Greatness,” includes $1.4 trillion in Medicaid cuts over the course of a decade in two large chunks. As reported in The Hill, the budget “assumes full passage of the House-passed version of the American Health Care Act (AHCA) to repeal and replace ObamaCare, which cuts $839 billion from Medicaid and pulls funding from Planned Parenthood.” And also, in addition to that, “the budget would make another $610 billion in cuts to Medicaid over 10 years by transitioning the program from a traditional entitlement to either a block grant program or a per-capita program that puts a ceiling on federal Medicaid funding to states,” per The Hill’s report. However, the budget doesn’t touch Medicare, something that Trump promised to leave alone on the campaign trail.
Meanwhile, the budget request to Congress cuts of billions of dollars from several other healthcare programs across various federal healthcare agencies. The ONC, which is the health IT arm of the government, and resides within the Department of Health and Human Services (HHS), alongside the Centers for Medicare & Medicaid Services (CMS), would be in line to have its $60 million budget slashed to $38 million. The $60 million figure for ONC has held steady for the last few years under the Obama Administration. In the budget request, ONC’s staff would also be in line to lose 26 members of its staff next year, from 188 down to 162. The staff increased by 14 from 2016 to 2017.
In a document that was briefly released on May 22, but then taken down quickly, under the ONC section, it stated: “ONC’s budget focuses on two key priorities: interoperability of health information, and the usability of electronic health records. The interoperability of health information is central to the core mission of the Department of Health and Human Services to enhance and protect the health and well-being of all Americans. ONC’s FY 2018 Budget emphasizes ONC’s continued policy coordination work, utilizing ONC’s new Health IT Advisory Committee, as required by the 21st Century Cures Act. ONC will also focus on thwarting information blocking and prioritize its work on standards coordination, implementation, testing, and pilots to accelerate industry progress towards interoperability.”
Indeed, the Cures Act, passed last year with bipartisan support, calls for the combination of two federal advisory committees into a single Health Information Technology Advisory Committee. What’s more, ONC will work with HHS’ Office of Inspector General to investigate and issue penalties for developers, networks, and exchanges engaged in information blocking.
The budget proposal also calls for the Agency for Healthcare Quality and Research (AHRQ) to essentially be eliminated, with the majority of its 2017 budget folded into NIH for next year. It should be noted, however, that NIH would receive $272 to perform many of the same initiatives that AHRQ has in the past, although that figure is still down about 18 percent. Overall, NIH would sustain cuts across the board of nearly $6 billion, from $31.8 billion down to $26 billion.
According to The Hill report, “Congress is expected to reject many of the proposals as it takes up the budget in the coming weeks and months. It is being released, unusually, with President Trump out of town on his first foreign trip in office.”
Not even a month ago, Congress passed a funding package for FY2017 that included a $2 billion increase to NIH’s budget, $120 million of which will go toward the agency’s work on the Precision Medicine Initiative. This means that Congress could certainly be against Trump’s desire to cut NIH funding.
Further of note, HHS’ Office of Civil Rights (OCR), a key department in the industry’s ongoing cybersecurity battle, is in line for a $6 million cut, from $39 million to $33 million. Also, as reported by Politico eHealth, funding for HHS’ Health Resources and Services Administration (HRSA) is in line to be down by 10 percent, with its telehealth funding reduced from $17 million to $10 million.
In a statement from Thomas H. Payne, M.D., president of Bethesda, Md.-based American Medical Informatics Association (AMIA), and medical director, information technology services, UW Medicine at the University of Washington, said, “The impact of these cuts, if they are realized, will reverberate across our nation’s hospitals, universities, and other important sectors of the economy. The ecosystem that entices young scientists and clinicians to pursue their passion to help patients will be severely damaged, resulting in a downward spiral of innovation, delayed or forgone investment in new treatments, and a stagnant patchwork of IT-enabled patient care.”
Dr. Payne’s statement continued, “At a time when we should be acting on bipartisan agreements, such as passage of the 21st Century Cures Act or the Precision Medicine Initiative, and building on our nationwide investment in EHR adoption, this budget request stops progress in its tracks. Worse, this budget will imperil long-standing and important activities at the NIH, FDA and ONC intended to deliver new cures, safer treatments, and higher quality care for all Americans.”
Also adding a statement was Ben Moscovitch, manager of health IT at The Pew Charitable Trusts, noting that the President’s budget emphasizes the importance of enhancements in both interoperability and IT usability, and that it follows the 21st Century Cures Act. But, Moscovitch said, “To meet that commitment, however, ONC needs sufficient funding to improve the usability and interoperability of EHRs. The President’s proposed budget may not give ONC the resources it needs to carry out this vision and meet its responsibilities in the Cures Act. Congressional appropriators will now work to craft a budget; as they do so, we hope they will ensure that ONC has adequate funding to improve patient safety, including through the health IT provisions in the 21st Century Cures Act, and advancing reforms to reduce preventable harm.”
