Internal budget document reveals extent of Trump’s proposed health cuts

The Trump administration is seeking to deeply slash budgets for federal health programs, a roughly one-third cut in discretionary spending by the Department of Health and Human Services, according to a preliminary budget document obtained by the Washington Post.

The HHS budget draft, known as a “passback,” offers the first full look at the health and social service priorities of President Donald Trump’s Office of Management and Budget as it prepares to send his 2026 fiscal year budget request to Congress. It shows how the Trump administration plans to reshape the federal health agencies that oversee food and drug safety, manage the nation’s response to infectious-disease threats and drive biomedical research.

The 64-page document calls not only for cuts, but a major shuffling and restructuring of health and human service agencies.

Agencies are allowed to appeal to HHS for changes, but have been told they cannot change the bottom line, according to a federal health official who spoke on the condition of anonymity because of the sensitivity of the negotiations.

While Congress often ignores the president’s budget request, this has not been a typical transition to a new administration. Trump and his allies in Congress have made clear they want to smash the status quo by drastically reducing the size of the federal government and scrubbing it of programs and research efforts seen as wasteful or contrary to administration priorities.

The administration already has downsized HHS by about one-fourth of its workforce, with about 20,000 imminent departures since Trump took office. The Centers for Disease Control and Prevention staff who worked on programs to prevent drowning and gun violence, improve worker safety and test for sexually transmitted illnesses and hepatitis were among those laid off.

National Institutes of Health staffers who specialize in managing scientific funding have been ordered to terminate contracts and cancel hundreds of grants that fund research on topics such as vaccine hesitancy, transgender health and covid.

HHS had a discretionary budget of about $121 billion in fiscal 2024, but under the Trump administration’s preliminary outline, it would see a decrease to $80 billion.

The proposed cuts are aimed at some of the prevention-focused health-care efforts HHS Secretary Robert F. Kennedy Jr. has said he wants to prioritize, said Anand Parekh, chief medical adviser at the Bipartisan Policy Center, a Washington, D.C., think tank.

“These are the efforts that try to get ahead of health-care problems,” he said. “You can expect the costs of the Medicare and Medicaid program just to go up. That’s the shortsightedness of reducing the sliver of the budget that is discretionary when that is the main opportunity you have to reduce health burden in America and get ahead of health problems.”

Spokespeople for the White House and HHS did not immediately respond to requests for comment.

“President Trump has committed to balancing the budget while providing adequate funding for critical nondefense discretionary priorities — securing our borders, caring for our veterans, and continued infrastructure investment,” the document states in an introduction.

“Reaching balance requires: resetting the proper balance between federal and state responsibilities with a renewed emphasis on federalism; eliminating the federal government’s support of woke ideology; protecting the American people by deconstructing a wasteful and weaponized bureaucracy; and identifying and eliminating wasteful spending.”

It is unclear which proposed cuts will stand in the budget proposal to Congress — and whether lawmakers will accept them. During the first Trump administration, Congress rejected some of the administration’s proposals, including a 20 percent cut to NIH.

But those who depend on this funding said the cuts would pose an existential threat to some programs.

“It would be catastrophic,” said Tommy Sheridan, deputy director of the National Head Start Association. “More than a million parents wouldn’t be able to go to work from all those children, or they would have to scramble to find some other type of option. In a lot of communities, Head Start is the only early childhood provider in the community — especially rural America.”

Alan Morgan, chief executive of the National Rural Health Association, said rural residents would suffer if the health initiatives proposed for elimination were cut.

“Those are essential to ensuring access to care for rural Americans and critical to keeping rural hospitals open,” he said. “If that would come to fruition it would be absolute shocking news, because these programs have had such bipartisan support,” he added, noting Kennedy himself had expressed support for the importance of rural hospitals.