Trump’s Proposed 2019 Budget Again Slashes ONC Funding by $22M

President Donald Trump’s fiscal year 2019 budget proposal calls for a $22 million reduction in funding for the government’s health IT branch, the Office of the National Coordinator for Health IT (ONC).

The $4.4 trillion budget proposal, which was released on Feb. 12, originally requested $68.4 billion for the Department of Health and Human Services (HHS), which would have been a $17.9 billion, or 21-percent decrease from the 2017 enacted level.

Update: after further review, despite the administration’s initial budget request to cut HHS funding by $18 billion, an addendum to the proposal from the Office of Management and Budget (OMB), following a very recent agreement from Congress to raise the defense and non-defense discretionary spending caps in 2018 and 2019, revealed that an additional $27 billion would be given to HHS. In sum, per HHS’ budget in brief document, this brings the new total amount of 2019 HHS funding in Trump’s proposal up to $95.4 billion in discretionary budget authority and $1.12 billion in mandatory funding. This new total represents a $9.57 billion increase from 2018 for HHS.

According to the budget document, “An American Budget,” the funding level includes additional funds for “program integrity and implementing the 21st Century Cures Act and the 2017 enacted funding levels do not include actual fee collections and contract support costs. The budget proposes $295 billion in mandatory savings, helping to put federal spending on a sustainable path.”

As it relates to health IT and related agencies within HHS, according to the department’s own budget planning document, the fiscal year 2019 proposed budget for ONC is $38 million, which is $22 million below the fiscal year 2018 Continuing Resolution. Meanwhile, the Office for Civil Rights (OCR) would receive an $8 million cut to its budget, from $39 million down to $31 million.

And once again, just like last year, the Trump administration proposes to essentially eliminate the Agency for Healthcare Research and Quality (AHRQ) and consolidate it into the National Institute for Health as the National Institute for Research on Safety and Quality (NIRSQ). Within NIH, the 2019 budget includes $256 million in budget authority for NIRSQ—down from its current $322 million allocation.

Indeed, many of these proposals look quite similar to what the President requested last year, when Trump’s administration called for a $22 million cut to ONC’s funding as well as a reduction of 26 staff members. In last year’s budget request, Trump proposed a $6 million cut for OCR while also merging AHRQ into NIH. At that time, health IT stakeholders pointed out that ONC needs sufficient funding to carry out the health IT provisions in the Cures Act.

As such, it’s important to note that this budget proposal is not a law and that a certain number of Senate Democrats would have to vote for these cuts to be enacted. According to many reports, that’s extremely unlikely to happen. For example, Trump’s $22 million proposed cut to ONC funding never actually went through last year; the health IT agency’s budget has remained at $60 million since federal agencies are still working under the Continuing Resolution. However, it’s possible that Trump’s proposed cuts for fiscal year 2018 could be enacted and take effect sometime this year.

Meanwhile, healthcare organizations have repeatedly stepped up in their defense of AHRQ. Nonetheless, in HHS’ planning document, it says that the NIH/AHRQ consolidation “will combine two agencies that both support health services research, and create an entity within NIH that can better coordinate and ensure a continued focus on research to improve health care quality and patient safety,” adding that the new NIRSQ will continue to select “unique, systemically-important activities formerly funded by AHRQ that have demonstrated effectiveness in improving healthcare quality.”

Overall, however, the proposed budget would give NIH $33.8 billion, or a $747 million increase from last year. This is inclusive of $750 million as part of the HHS-wide $10 billion investment to fight the opioid crisis and address serious mental illness.

Meanwhile, the budget proposal calls for an $8.7 billion or nearly 12-percent increase, in Department of Veterans Affairs’ (VA) funding. As the budget states, “In addition to the amount requested for enterprise-wide IT infrastructure enhancements [$4.2 billion], $1.2 billion [for the first year] is included in a separate budget account for the acquisition of a replacement electronic health records (EHR) system.”

In a statement on the 2019 budget proposal, HHS Secretary Alex Azar said, “The President’s budget makes investments and reforms that are vital to making our health and human services programs work for Americans and to sustaining them for future generations. In particular, it supports our four priorities here at HHS: addressing the opioid crisis, bringing down the high price of prescription drugs, increasing the affordability and accessibility of health insurance, and improving Medicare in ways that push our health system toward paying for value rather than volume.”