House Bill Would Cut HHS Budget By 6%, CDC By 19% And Eliminate AHRQ

Will eliminating the Agency for Healthcare Research and Quality mean darker days for healthcare safety and quality? (Photo: Getty)

getty

Will this be the House of the setting sun for the Agency for Healthcare Research and Quality? The Trump Administration has been trying to eliminate AHRQ, the one federal agency responsible for research into healthcare safety and quality. And now it looks like the House Appropriations Committee is going along with that plan.

The House committee’s new proposed bill and budget doesn’t include AHRQ, calling it “duplicative” in a recently-released fact sheet without specifying how and why. This is part of the committee’s proposed 6% slash to the U.S. Department of Health and Human Services budget for this upcoming fiscal year that would mean $7 billion less for HHS. Also included is a 19% cut to the Centers for Disease Control and Prevention budget. The big Q, meaning question, then is how not having AHRQ around anymore will affect the safety and quality of the healthcare for you and your loved ones?

The Trump Administration Has Been Trying To Eliminate AHRQ

You know the saying if at first you don’t succeed try try again? Well, the Trump administration episode one had already tried to eliminate AHRQ during Donald Trump’s first term as President back in 2017 as I covered in Forbes at the time. But Congress didn’t really listen to Trump back then. So AHRQ survived. Ah, but it looks like things are oh-so-different in oh-so-many ways for this second coming of the Trump administration.

Once Trump became President on January 20, it didn’t take long for his administration working with Elon Musk heading the so-called Department of Government Efficiency known as DOGE to completely get rid of the U.S. Agency for International Development known as USAID. This happened fairly rapidly without Congress stepping in and saying we can’t go for that, no, no can do. So, on July 1, USAID, which had been around since 1961, was officially shut down with any remaining operations and programs being merged into the State Department.

The Trump administration hasn’t yet toppled the smaller AHRQ in quite the same manner. Instead, over the past several months, it’s been more a death by a thousand cuts with progressive layoffs and dismissals of personnel and cuts to funding and operations. I’ve been told by contacts at AHRQ that at this point empty chairs far outnumber people at meetings there. And the proposed budget from the Trump administration for the upcoming federal government fiscal year did not include AHRQ at all.

AHRQ Was Officially Established in 1999 By Bipartisan Efforts

Even though Congress doesn’t have to follow the proposed Trump administration budget because of all the checks and balances, separation of powers Constitution thing, it looks like House committee is doing so at least when it comes to AHRQ. The House bill would be eliminating an agency that’s officially been around since 1999 but can trace its roots all the way back to 1968. That was the year that the National Center for Health Services Research and Development got started. This Center went through it’s Diddy-like phase, where the Center’s name, configurations and oversight were changed multiple times. That was until the Omnibus Budget Reconciliation Act of 1989 designated what was a Center to become its own operating agency with the name the Agency for Health Care Policy and Research. It went by the acronym AHCPR, which looks a bit like saying, “Ah, CPR.”

The AHRQ as we know it today—at least as we knew it before the Trump Administration and DOGE began dismantling much of the agency over the past several months—officially began with the Healthcare Research and Quality Act of 1999. That was—guess what—a bipartisan effort with Senator Bill Frist (R-Tennessee) sponsoring the bill and Senator Ted Kennedy (D-Massachusetts), Representative Michael Bilirakis (R-Florida) and Representative Henry Waxman (D-California) providing the support. President Bill Clinton then signed everything into law. That established AHRQ as the lead Federal agency on healthcare quality and safety research.

How Eliminating AHRQ May Affect The Quality And Safety Of Your Healthcare

Through its subsequent two-and-a-half decades AHRQ has published a range of influential healthcare reports. For example, in 2001, there was the “Making Healthcare Safer: A Critical Analysis of Patient Safety Practices” that listed 73 evidence-based patient safety practices that were not routinely done in hospitals and nursing homes across the country. Then in 2003, AHRQ released The National Healthcare Quality Report and The National Healthcare Disparities Report, which were at the time the first attempts to provide a comprehensive view of the quality of healthcare and differences in people’s access to healthcare services across America.

Additionally, AHRQ has established different programs and toolkits to help patient safety. This has included ones to help doctors, nurses, hospital managers, patients and others reduce medical errors and healthcare associated infections as measure quality of care. It’s also established programs and tools to help with discharging patients from hospitals, arranging post-discharge care, preventing hospital readmissions and identifying preventive services.

AHRQ has also become an important—or actually the important—funder of researchers in universities, academic medical centers and other organizations working on issues related to healthcare quality and safety. For example, in 2009 alone, AHRQ awarded $17 million to fund projects aimed at fighting healthcare-associated infections. Without AHRQ around, it’s not clear who will support such research going forward. This could mean less science about how to make healthcare safer and better for everyone. That will end up hurting everyone including you, unless you happen to be something indestructible and never requiring healthcare like Superman, Supergirl or a fruitcake.

Without AHRQ, It’s Not Clear What Other Part Of HHS Will Oversee Healthcare Quality And Safety

Again even though the House committee fact sheet called AHRQ “duplicative,” it did not provide any facts supporting this statement. It did not list any other parts of the federal government that is currently doing AHRQ-like work. Other places in the federal government that may bear the words “healthcare” and “quality” like say the CDC’s Division of Healthcare Quality Promotion haven’t really done the same things that AHRQ has been doing. Plus, the CDC and other parts of HHS may get further cut as well.

An ongoing question is how much of these cuts of scientific programs and funding are being guided by, you know, science, scientists and people who actually understand the areas well enough to know the ramifications of such decisions. For example, scientific studies have shown how different AHRQ efforts and AHRQ-funded projects have been associated with or led to reductions in medical errors and healthcare associated infections over time. These in turn have saved lives and costs.

The House Bill Propses Various Cuts To CDC

As alluded to earlier, AHRQ wouldn’t be the only HHS victim of the House bill cuts. The HHS budget would drop by $7 billion from its fiscal year 2025 allocation down to $108 billion for the next fiscal year. Included among these cuts would be a 19% slash to the CDC budget. Yes, you heard that correctly. That would be nearly a fifth of CDC’s funding.

Why does the committee want to make this CDC cut? Well, the stated rationale on the House fact sheet is “focusing the Centers for Disease Control and Prevention (CDC) on communicable diseases rather than social engineering” by “streamlining 35 duplicative and controversial programs while increasing funding to combat emerging and zoonotic infectious diseases.” Again, the fact sheet doesn’t really detail how the programs are ”duplicative and controversial.”

Moreover, focusing the CDC on communicable diseases could overlook the heavy and complex interplay between communicable and non-communicable diseases and other aspects of society. For example, a range of different infectious pathogens and diseases can lead to different chronic medical conditions such as COVID-19 leading to long COVID, human papillomavirus to cervical cancer, Helicobacter pylori to stomach ulcers and cancer, Epstein-Barr Virus to lymphoma. hepatitis B or C viruses to liver disease and cancer and HIV to heart disease. Similarly, many chronic medical conditions can make you more susceptible to infectious diseases and more severe outcomes. Furthermore, numerous studies have shown how different aspects of society such as social interactions, the environment, access to healthcare and the presence and absence of various economic resources can affect the spread of infectious diseases.

What’s Next For The House Bill And AHRQ

The next step for the House bill is to get marked up by the House Appropriations Committee, which is scheduled to happen late Tuesday. Whatever eventually makes it out of the committee will then be reviewed, modified and voted on by the House of Representatives. Of course, the House is just one of two legislative bodies comprising Congress. I’ve already written in Forbes about the proposed Senate budget. At some point, whatever comes out of the House will have to be reconciled with whatever comes out of the Senate.

So, there are still chances that the AHRQ could get rescued at some point by the House of Representatives. But the proposed budget by the Appropriations Committee doesn’t look very House warming to AHRQ right now.