The partial budget unveiled by the Trump administration this week would eliminate or slash many safety net programs, cutting funding for WIC (nutrition assistance for mothers and young children) by $200 million over the budget period, ending all federal funding for civil legal assistance, cut job training programs, zeroing out the Community Services Block Grant that funds community-level anti-poverty efforts (e.g., Meals on Wheels, which feeds home-bound seniors), cutting heating assistance for poor families, eliminating several affordable housing programs as well as the US Interagency Council on Homelessness, defunding AmeriCorps, and eliminating the Economic Development Administration, which provides grants to low-income communities. The Education budget cuts $3.7 billion that currently funds teacher training, after-school and summer school programs, and programs that assist low-income and immigrant students (such as ending the 21st Century Community Learning Centers that funds academic and cultural enrichment opportunities for students in high-poverty schools); and reduces financial aid to low-income college students. ThinkProgress reports that the Environmental Protection Agency faces a $26 billion cut (31 percent lower budget than 2016) and that "more than 50 EPA programs will be cut entirely... The budget discontinues funding for the Clean Power Plan, international climate change programs, climate change research and partnership programs, and related efforts ." The proposed EPA budget also cuts funding for enforcement of environmental regulations and clean up of Superfund and brownfield sites. The Department of Health and Human Services faces a 17% cut. Vox reports that this includes a $5.8 billion cut to the National Institutes of Health (20% of its budget), which will “decimate the basic and clinical scientific infrastructure in the United States,” potentially affecting up to “300,000 outside researchers, so a very broad community of researchers would feel the effects of a budget reduction of this size. “Our [research] showed that publicly funded science conducted at academic research institutions and government labs is the source of the most important innovations and products that become transformative therapeutics,” said Aaron Kesselheim, an associate professor of medicine at Harvard Medical School. “Deep cuts like this will turn off the discovery of the important new therapies of tomorrow.” A CDC block grant to fund state-level public health activities like disease monitoring may mean deep cuts – but it’s too early to tell. The budget eliminates existing grants to help nonprofits and public agencies train employees on health and safety. The budget adds $1.5 billion to speed up immigrant deportation proceedings (including detention facilities and transportation) and $2.6 billion to fund construction of a border wall. The Corporation for Public Broadcasting, the National Endowment for the Humanities, and the National Endowment for the Arts would all be eliminated entirely. The budget would affect global health by eliminating several climate change prevention programs and slashing funds for programs related to climate change mitigation, peacekeeping, health, and development. Colorlines combed through the budget department-by-department to highlight the budget’s likely impacts on communities of color (e.g., the role of school choice programs in hurting academic achievement of students of color and exacerbating school segregation, or and a provision that would “reduce funding and services that support tribal governments by unspecified amount, which the budget says will support “tribal sovereignty and self-determination across Indian Country”).
Earlier this year, two new bills (H.R. 482 and S. 103) were introduced in Congress to limit collection of Census and American Community Survey data concerning the racial composition of communities and the race/ethnicity of those struggling to afford housing. SPUR weighs the potential effects of this legislation, including “jeopardizing progress on racial equity. The most obvious problem is that they would effectively blot out our ability to measure racial disparities across neighborhoods. And that would mean we could no longer track institutional racism — or measure our progress to reverse it. For example, without housing and community data tabulated by race, we would not have recently learned that gains in black homeownership since the passage of the Fair Housing Act of 1968 were completely eroded between 2000 and 2015. (See the Urban Institute’s figure below). The disproportionate impact of the housing bubble and Great Recession on the wealth of black Americans would be less visible and measurable, and perhaps vulnerable to dismissal, without quantitative proof.”
While President Trump’s new budget calls for broad cuts to Health and Human Services, it preserves funding for veterans’ health care programs, including the Veteran’s Choice Program, which provides options for veterans to receive care outside the Veterans Administration. The New York Times lays out winners and losers. Meanwhile, Vox reports that claims that the proposed budget adds $500 million to fight opioid misuse may be misleading—those funds may instead be an allocation that’s part of the 21st Century Cures Act passed under the Obama administration.
Boston Globe reporter Billy Baker explores how middle-aged men let their friendships lapse and the consequences to their health and wellbeing. “Men need an activity together to make and keep a bond,” he writes. “Women can maintain friendships over the phone.” He cites studies finding that social isolation brings a range of health consequences, from increased risk of stroke to progression of Alzheimer’s.
A study published in JAMA Psychiatry found higher rates of anxiety in high-income countries than in low-income countries. The study, conducted by members of the WHO World Mental Health Survey Consortium, was based on data from interviews with nearly 150,000 people in 26 countries over 12 years, according to STAT. STAT’s report notes that the study’s findings do not contradict findings that within a country, people with lower incomes are more likely to report anxiety than people with higher incomes. The report also notes that the different rates among lower and higher income countries may reflect cultural differences in defining and reporting anxiety.
In a post in the Health Affairs blog, Arthur Robin Williams, Edward Nunes, and Mark Olfson advocate for addressing opioid misuse with a “Cascade of Care” model used successfully in the diagnosis and treatment of HIV. The model includes the use of patient navigators who connect people to longterm community-based recovery services.
The Washington Post reports that many immigrants are withdrawing from the Supplemental Nutrition Assistance Program: "In the two months since President Trump’s inauguration, food banks and hunger advocates around the country have noted a decline in the number of eligible immigrants applying for SNAP — and an uptick in immigrants seeking to withdraw from the program."
Gavin Newsom, with DHS’ Mitch Katz in Los Angeles, intends to use universal care as his platform for the 2018 governor’s race. An article in the Sacramento Bee says Newsom and others are examining whether the “Healthy San Francisco” universal care model might work for the whole state. Currently the SF program covers undocumented San Francisco residents and poor people who don’t qualify for Medi-Cal. It also provides financial assistance for those who qualify for subsidies through Covered California but still can’t afford to purchase health insurance on their own. At SF General, “through focusing on regular checkups and preventative care… overall health care costs have ticked down over the past decade….Healthy San Francisco, created in 2007, has not only endured but has been strengthened under Obamacare.”
Maternal mortality – especially among black women – has spiked since 2010 (the overall maternal mortality rate has doubled since 2010, with black women – making up only 11% of mothers giving birth in the time period studied accounting for 29% of maternal deaths). As Rewire reports, this spike in maternal deaths has coincided with “Texas lawmakers [slashing] the state’s family planning budget by $73.6 million during the 2011 legislative session, leading to a 77 percent reduction in the number of clients served by family planning providers contracted by the state.”
Trump’s proposed budget would cut 18% of the DHHS, the Washington Post reports. The NIH would be cut by nearly $6 billion, about a fifth of its budget.
The big news this week was the CBO score for the AHCA, which found the bill would leave 24 million people uninsured over ten years, raise costs for older and poorer people, and raise deductibles for those who buy on the exchange, Huffpo, the New York Times, and others reported. Rural Trump voters would be most likely to suffer, the Boston Globe reported. A McClatchy survey of House Republicans found most don’t support the plan, and at least 15 GOP governors have said they oppose the repeal bill, Politico reports. Some Repubs are considering removing the provision that insurers must give a 30% surcharge to people who drop coverage for more than 63 days. A Kaiser Health Tracking Poll found that the majority of the public expects the AHCA will cause people to lose coverage unwillingly, and to pay more for coverage if they retain it.
Meanwhile, Seema Verma was sworn in as the new head of CMS, and one of her first actions was to send a letter to the nation’s governors urging them to charge Medicaid recipients premiums, as well as make them pay part of their ER bills and get jobs, the Washington Post reported. Conservative Republicans are also latching on to the job requirement for Medicaid, The Hill reports.
Nonprofit hospitals have been focusing more on community needs and SDOH under the ACA, but that’s now in jeopardy with repeal, the Washington Post reports. It cites as an example a violence prevention program run out of Brigham and Women’s hospital that aims to “address broader, community-based health issues and social problems that make people ill or expose them to injury.” In Tennessee, 11 state Republicans sent a letter to the TN congressional delegation demanding they keep in mind the impact to rural community hospitals in their ACA repeal efforts. Rural hospitals may have to pick up $88B in care in 2019 if a flood of people go back to being uninsured, the Nashville Tennessean notes.
Kaiser Health News did a roundup of news on how the AHCA would affect states:
- Washington state would lose $2.5 billion a year in Medicaid coverage, and 600,000 Washingtonians would lose coverage. (Seattle Times)
- Arizona could lose $46.8 million in federal public health funding over the next five years (Arizona Republic)
- At least half a million Massachusetts residents would lose health insurance by 2026 (WBUR)
- Florida's health care future will look a lot like its past — Florida would revert to pre-ACA status, with one of the nation's highest uninsured rates and an underfunded safety net system. (Tampa Bay Times)