A budget proposal from the Trump administration would put limits on rental housing assistance for low-income families, among an avalanche of cuts that threaten public health.
Photo by Chriss_ns, courtesy iStockphoto
U.S. public health has been chronically underfunded for decades. But proposed deep cuts and program eliminations in the White House’s fiscal year 2026 budget request would put the country’s well-being on life support, experts say.
Potential cuts across the U.S. Department of Health and Human Services, Environmental Protection Agency and others could leave the country more vulnerable to infectious disease outbreaks, increase homelessness, reduce access to health care and threaten access to clean air and water, public health advocates warned after the Trump administration released its new budget proposal on May 2.
Under the plan, the Centers for Disease Control and Prevention and the National Institutes of Health would lose 40% of their funding, moves that fly in the face of the Trump administration’s call for making America healthy, said APHA Executive Director Georges Benjamin, MD.
The proposal is a “gut punch of cuts, reductions and nonsensical reorganizations” that continues administration actions “that harm the health of communities across the nation.”
— Georges Benjamin
The proposal is a “gut punch of cuts, reductions and nonsensical reorganizations” that continues the administration’s trend of actions “that harm the health of communities across the nation,” Benjamin said in a news release.
A proposed $3.5 billion in cuts to CDC would eliminate centers that focus on chronic disease, injury prevention and environmental health, suggesting that states shoulder that burden.
The cuts would also impact the country’s preparedness and surveillance capabilities while ignoring the fact that diseases with pandemic potential such as COVID-19 typically happen overseas due to interactions between animals and people, said Yuka Manabe, MD, an Infectious Diseases Society of America fellow and professor of medicine at the Johns Hopkins School of Medicine’s Division of Infectious Diseases.
Focusing on overall federal spending alone ignores the fact that prevention costs far less than treatment, she said.
“By isolating ourselves scientifically and decreasing money that goes overseas to try to study some of these types of things, including surveillance by the CDC, basic discovery of emerging and reemerging infections...we are hampering our ability to know what’s there,” Manabe told The Nation’s Health. “That’s fine until it’s not fine. Dismantling that system has huge consequences.”
The proposed budget calls for a nearly $18 billion cut to NIH — funded at over $47 billion in fiscal year 2025 — which would cut NIH research centers and institutes dedicated to minority and health disparities, nursing research and global health. The budget proposal also calls for reconfiguring existing NIH institutes into five new ones focused on body systems research, neuroscience and brain research, general medical sciences, behavioral health, and disabilities.
As of May, there was no clear strategy on how existing institutes would be restructured. And when clinical trials or longitudinal studies are paused indefinitely, studies can be compromised if the gap of time is too wide, said Robert Egge, chief public policy officer of the Alzheimer’s Association.
As of May, Egge said he had not heard of any major Alzheimer’s trials that were compromised from NIH staffing cuts that occurred this spring, but said he worries that the uncertainty will discourage emerging scientists from starting their own research careers.
“Already, it’s a big commitment for someone to make this their career choice, to go into research in any field,” Egge told The Nation’s Health. “We should be doing everything we can to make that inviting and a place where somebody believes they can build a strong career. Ultimately there are those people in research that make the difference in the long term.”
Several agencies would be consolidated under HHS Secretary Robert F. Kennedy Jr’s proposed Administration for a Healthy America, including the Health Resources and Services Administration. But that merger would come with a $1.7 billion cut to HRSA, eliminating most of its work, including maternal and child health programs, health workforce development initiatives and parts of the Ryan White HIV/AIDS program, which provides HIV treatment for low-income Americans.
The Substance Abuse and Mental Health Services Administration would also be consolidated under the Administration for a Healthy America. A funding cut of over $1 billion to SAMHSA could impact community-based programs that focus on issues such as suicide prevention, residential treatment and family counseling services for pregnant and postpartum women with substance use disorders.
There is also a concern about losing research from the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse through the proposed NIH cuts, said Robert Morrison, executive director and director of legislative affairs for the National Association of State Alcohol and Drug Agency Directors.
The association works to make sure information from the institutes flows to state alcohol and drug agencies, and they in turn relay observations about substance use disorders from states that warrant more research.
“It takes elbow grease to get them connected and make sure the communication is there on what these studies are finding,” Morrison told The Nation’s Health. “The budget could impact the institutes, their configuration. If that’s the case, how do we make sure that we as an association continue that work…in a way that continues to keep the information flow going in both directions and maintain the relationships at the state level with the universities?”
The Environmental Protection Agency is facing a nearly 55% cut to its overall budget, which includes a $2.4 billion cut to its Clean and Drinking Water State Revolving Loan Funds. The programs allow communities to apply for loans through their state for drinking water infrastructure projects that include wastewater treatment, stormwater management and recycled water use. The proposal would also eliminate EPA’s Office of Environmental Justice and External Civil Rights —a $100 million cut — which helps vulnerable communities access funding and technical support to protect themselves from toxic air and water pollution.
Losing the office could mean losing the ability to do regular air and water quality monitoring, leading to a trickle-down effect that harms health and drives health care costs up, according to KD Chavez, executive director of the Climate Justice Alliance. A proposed $254 million cut to EPA’s Superfund program would also delay responses to hazardous spills near fence line communities.
“For Indigenous folks, we’re seeing a lot of public lands and sacred lands that are being opened up for destruction with the expansion of oil and gas and mining,” Chavez told The Nation’s Health. “And a lot of the money that would have gone to just making sure things continue, like Superfund site cleanups, or affordable clean energy projects, heating and cooling centers during extreme weather events — especially for seniors and vulnerable neighborhoods and populations —a lot of these EPA funds were going to play a vital role and a critical part of funding.”
The U.S. Department of Housing and Urban Development could face a more than $26 billion cut for rental assistance programs for low-income people, older adults and people with disabilities. The money that went to the individual programs would be combined into one state housing assistance block grant, which would redesign federal housing assistance and put two-year limits on how long a household could receive assistance, said Kim Johnson, MPP, senior director of policy at the National Low Income Housing Coalition.
“It would be an absolutely disastrous proposal for the households that currently receive rental assistance and for the millions of people who are on a waiting list for rental assistance,” Johnson told The Nation’s Health.
As a result, states would be left with the daunting task of deciding who does and who does not get housing while losing a significant chunk of federal funding typically earmarked for rental assistance programs. Johnson said HUD overall typically gets $55 billion in annual funding.
“How are they supposed to patch the holes that are inevitably going to be in their budget?” Johnson said. “What programs and services are not going to be carried forward because you simply cannot afford to continue doing them? And who is going to lose assistance because there’s simply no longer funding to carry on rental assistance programs?”
For more information on the budget proposal, visit www.omb.gov/budget.
- Copyright The Nation’s Health, American Public Health Association
