Hello,

The six-week government shutdown is dramatic, but the Trump administration has been exerting extraordinary control over spending since Donald Trump took office. In my latest article, I delve into the details of the administration’s budget disruptions and the toll they’ve taken on public health programs. 

No matter what budget Congress ultimately passes for next year, the Trump administration may continue to thwart financial support in ways that will harm people’s health.

“This is boring but crazy-high stakes,” said Joe Carlile, a former associate director of the White House’s Office of Management and Budget. “A one-branch veto of spending neuters the power of the purse in the Constitution that Madison said was the fundamental check on the executive branch.”

Trump’s pick to lead OMB, Russell Vought, outlined the budgetary strategies deployed this year in Project 2025, the Heritage Foundation’s conservative blueprint. Vought and spokespeople at the White House did not respond to queries from KFF Health News.

However, in a Sept. 3 speech, Vought explained his motives, saying that federal agencies and Congress had become “woke and weaponized” under Presidents Barack Obama and Joe Biden.

“Thankfully, President Trump won,” he said. “And we have now been embarked on deconstructing this administrative state.”

Together with the Department of Government Efficiency, Vought’s OMB has canceled grants, placed extraordinary constraints on how funds can be spent, and added excessive layers of review, agency officials said. 

Since most federal money for public health flows to states, communities feel the impact of slashed and delayed funds. In West Texas, Centers for Disease Control and Prevention funds to stem a measles outbreak weren’t available until after the crisis had subsided and two children had died. A project to protect Alabamans from raw sewage and hookworm was abandoned. People with HIV have had to delay medical care as clinics scale back hours. Time-dependent surveys on HIV and maternal mortality were halted. Food banks have canceled events. Tobacco prevention programs lapsed. Initiatives to protect older adults at risk of falling have been harried.

Government employees have described budget disruptions to members of Congress, said Abigail Tighe, executive director of the National Public Health Coalition, a group that includes current and former staffers at the CDC. But Republicans in Congress have largely failed to act.  

“This is preventing states and communities from doing critical public health work to keep our country safe,” Tighe said. “If they don’t have capacity, we all collectively suffer.”

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