Weekly Spotlight

Trump Administration’s Science Cuts Threaten America’s Research Dominance – Federal agencies face unprecedented budget reductions, mass layoffs as experts warn of long-term consequences for public health and innovation

The Trump administration is systematically dismantling America’s federal scientific infrastructure through sweeping budget cuts, mass layoffs, and unprecedented political interference in research, according to an analysis of recent developments across major science agencies.

From the National Institutes of Health to the Environmental Protection Agency, federal science programs that have underpinned American innovation for eight decades are facing their most severe reductions in modern history. The cuts are so extensive that some 2,000 scientists, including dozens of Nobel Prize winners, have signed an open letter warning that the U.S. lead in science is being “decimated” by the Trump administration’s cuts to research.

A Pattern of Systematic Reduction

The scope of the reductions is staggering. At the EPA alone, total staffing will be reduced to 12,448 — a nearly 23% decline in the workforce from January when President Donald Trump began his second term. Similar cuts are rippling across federal science agencies, with roughly 3,500 FDA staffers, or about 15 percent of the workforce, laid off or having quit their jobs in recent months.

Perhaps most significantly, the EPA officially confirmed that it is eliminating its research division – the Office of Research and Development that produced the science underpinning regulations on everything from PFAS to pesticides to lead. The office, with approximately 1,115 employees, played an outsized role in helping the agency fulfill its legal mandate to use the “best available science.”

“Without a research arm, it will be very difficult for EPA to issue new standards for air or water pollutants, toxic chemicals, pesticides, or other hazards,” said Michael Gerrard, faculty director of Columbia University’s Sabin Center for Climate Change Law.

Pioneer Scientist Sounds Alarm

The warnings are coming from the highest levels of American science. Robert Gallo, the renowned researcher who co-discovered HIV and developed the first HIV blood test, issued a stark warning about the implications of reduced scientific funding. “Significant cutbacks in medical science funding, especially in global health, research, and surveillance, leave us vulnerable as new threats emerge,” Gallo wrote. He emphasized that while science has given society the tools to detect and mitigate threats like HIV and COVID-19, “science can’t do it alone. It needs support, investment, and trust.”

The cuts are already showing measurable effects on scientific output. The number of basic science papers published by recipients of National Institutes of Health grants has been falling since 2013, the year the agency’s budget was cut by 5%, according to a new analysis by former NIH official Michael Lauer.

Political Interference in Scientific Publishing

Beyond budget cuts, the administration has taken unprecedented steps to control scientific communications. “The MMWR has lost its autonomy,” one health official told CBS News, referring to the CDC’s flagship medical journal that went unpublished for the first time in its more than 60-year history due to communications restrictions.

The Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report has long been considered “the voice of the CDC” and a respected source for public health information. But Trump administration political appointees now dictate what research can be published, including withholding studies on the growing bird flu outbreak while ordering scientists to produce research about wildfires after President Trump criticized California’s governor. Scientists report that researchers are “removing their names from publications, abandoning studies, and rewriting grant proposals and papers to remove scientifically accurate terms (such as ‘climate change’) that agencies are flagging as objectionable.”

Advisory Panels Under Fire

The administration’s reach extends to expert advisory committees that have guided American health policy for decades. Health Secretary Robert F. Kennedy Jr. is considering removing all 16 members of a highly influential advisory committee that offers guidance about preventive health services, such as cancer screenings – the U.S. Preventive Services Task Force.

Kennedy reportedly views the panel members as “woke,” according to sources familiar with the matter. The task force determines which preventive services insurers must cover without cost-sharing under the Affordable Care Act, affecting about 100 million Americans who receive no-cost cancer screenings and other preventive care.

Economic Impact on Drug Development

The consequences extend far beyond government operations. The nonpartisan Congressional Budget Office warned that proposed cuts could significantly reduce the number of new medications reaching Americans. CBO estimated that a reduction in the NIH’s funding of external preclinical research would ultimately decrease the number of new drugs coming to market by roughly 4.5 percent, or about 2 drugs per year. The effects would compound over time, with an estimated 53 drugs not coming to market over three decades under the administration’s proposed budget cuts and FDA staffing reductions.

Bipartisan Concerns Emerge

The severity of the cuts has prompted unusual bipartisan pushback. Republican Sen. Katie Britt of Alabama led a letter with thirteen GOP colleagues to White House Budget Chief Russ Vought, warning that “suspension of these appropriated funds — whether formally withheld or functionally delayed — could threaten Americans’ ability to access better treatments and limit our nation’s leadership in biomedical science.” The letter represents a rare instance of Republican lawmakers challenging their own administration’s policies, suggesting the scientific community’s concerns are resonating across party lines.

Long-Term Implications

Scientists emphasize that the full impact of these changes won’t be felt immediately. As Gallo noted, “innovation doesn’t appear overnight. It comes from years of basic science, sometimes decades before a breakthrough reaches the clinic or the pharmacy.” The cuts represent a fundamental challenge to the post-World War II model of federal investment in science that has made the United States the global leader in research and innovation. Federally funded research into seemingly obscure topics – like Gila monster venom in the 1980s and 1990s – laid the groundwork for today’s weight-loss drugs such as Ozempic.

“This will basically change science as we know it in the U.S.,” warned Dr. Richard Huganir, professor and chairman of the department of neuroscience at Johns Hopkins University School of Medicine, calling the situation “the apocalypse of American science.” The question now facing Congress and the American public is whether these represent temporary policy adjustments or a permanent restructuring of how the nation approaches scientific research and evidence-based governance. The answer will determine not just the next few budget cycles, but America’s scientific capacity for generations to come.

(See below for the list of articles consulted)

Other Regulatory News

Centers for Medicare and Medicaid Services (CMS)

10M people will lose their health coverage by 2034, CBO predicts

The Congressional Budget Office (CBO) has projected that up to 10 million individuals may lose their health coverage by 2034 due to Medicaid cuts and new work requirements stemming from the One Big, Beautiful Bill Act. This analysis highlights the potential impact of legislative changes on healthcare access for vulnerable populations, raising concerns about the future of Medicaid under the current administration’s policies.

#All

Opinion: How states can mitigate Trump’s Medicaid cuts – and set their health care systems on a better path

Following significant federal Medicaid cuts, states can adopt strategies to maintain healthcare access and affordability. The One Big Beautiful Bill Act projects nearly $1 trillion in federal Medicaid spending cuts over the next decade. States are encouraged to implement price controls in private insurance markets to safeguard Medicaid funding and improve healthcare systems.

#All

Q&A: What Medicare’s TriClip coverage means for heart patients with leaky tricuspid valves

Medicare has expanded coverage to include both transcatheter tricuspid valve edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR) procedures using FDA-approved devices. This policy shift regarding tricuspid valve treatment is expected to improve patient care for those suffering from leaky tricuspid valves.

#Device, #Patient, #Provider

CMS claims 2.8 million Americans enrolled in duplicate plans

Centers for Medicare & Medicaid Services has identified approximately 2.8 million Americans enrolled in duplicate health insurance plans. This duplication may complicate healthcare access and billing processes, highlighting potential system inefficiencies.

#Patient

Humana refiles Medicare Advantage ratings lawsuit against federal governmen

Humana has refiled a lawsuit against the federal government regarding downgraded ratings of its Medicare Advantage plans after initial dismissal due to procedural issues. The company argues the government failed to follow its own grading rules, seeking to contest ratings that could lead to significant financial losses.

#Payer

Health insurers are struggling, big time

Health insurance companies face declining profitability following initial Affordable Care Act gains. Recent financial results indicate struggles particularly related to Medicare payments and operational costs, potentially impacting the overall healthcare market and companies’ future performance.

#Payer

Optum increased its physician practice market share: What to know

Optum’s expansion in physician practice market share indicates growing influence in the healthcare sector. These strategic moves reflect broader changes in healthcare service organization and delivery across payer, provider, and patient segments.

#Payer, #Provider, #Patient

Physicians Leaving Medicare Remains High After the Pandemic, Raising Concerns About Workforce Stability

Increasing numbers of physicians, particularly in primary care, are exiting the Medicare program post-pandemic. This trend points to rising dissatisfaction due to administrative burdens and systemic Medicare issues, raising concerns about future healthcare access for beneficiaries.

#Provider, #Patient

Medicare Advantage Under the Microscope

Legislators renewed focus on Medicare Advantage, examining fairness in reimbursement, health insurer investigations, and evolving Medicare policies. A joint Ways and Means Health and Oversight Subcommittee hearing addressed prior authorization practices criticized for inappropriate care denials, though a clear reform path remains elusive. Check out my blog for more on the hearing)

The American Medicare system is facing unprecedented challenges as federal investigators probe potential fraud and lawmakers struggle with growing market consolidation that has left just two companies controlling nearly 60% of the privatized Medicare market. UnitedHealth Group, the nation’s largest health insurer, confirmed Thursday that it is cooperating with a Department of Justice investigation into its Medicare billing practices, marking a sharp reversal from the company’s previous denials. The company revealed in an SEC filing that it has “started complying with formal criminal and civil requests from the Department of Justice.”

The investigation coincides with alarming new data on market concentration. According to a KFF analysis, UnitedHealthcare (41%) or Humana (25%) had the highest enrollment in two-thirds of counties, comprising 59% of all Medicare Advantage enrollment in 2024. In 44% of counties, a single insurer controls at least half of all Medicare Advantage enrollees. This consolidation has created what critics describe as regional monopolies that may be limiting competition rather than enhancing it, contradicting Medicare Advantage’s original promise to leverage private sector competition to improve care and reduce costs.

Congress Pushes for Payment Parity

Responding to provider complaints, Congress has introduced bipartisan legislation requiring Medicare Advantage plans to pay providers at least as much as traditional Medicare. The Prompt and Fair Pay Act, sponsored by Reps. Lloyd Doggett (D-TX) and Greg Murphy (R-NC), comes as 27 healthcare organizations have abandoned Medicare Advantage over the past year due to reimbursement challenges. “Doctors who see MA beneficiaries not only experience major delays in reimbursement and senseless prior authorization denials, but often receive less compensation for services rendered than they earn through traditional Medicare,” Murphy noted.

However, in a controversial move, the Centers for Medicare and Medicaid Services announced it will implement prior authorization requirements for certain traditional Medicare services starting in 2026 in six states. The “Wasteful and Inappropriate Service Reduction” (WISeR) model has drawn criticism for introducing bureaucratic barriers that traditional Medicare has historically avoided.

“For both patients and clinicians, one of the advantages of traditional Medicare is that it almost entirely lacks the onerous preauthorization reviews that plague the program’s privately administered Medicare Advantage option,” wrote former CMS Administrator Don Berwick. “But under a new demonstration program recently announced by the Centers for Medicare and Medicaid Services, that’s about to change.”

While traditional Medicare adds prior authorization requirements, some insurers are moving in the opposite direction. Humana announced it will eliminate approximately one-third of prior authorizations for outpatient services by January 2026 and launch a “gold card” program waiving requirements for high-performing providers. However, the scope of the problem remains massive. Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023, with 3.2 million (6.4%) denied, creating significant administrative burdens for providers and potential delays for patients.

System at a Crossroads

The convergence of federal investigations, market consolidation, and expanding bureaucratic requirements has created what experts describe as a system in crisis. Medicare Advantage, which now covers more than half of all Medicare beneficiaries, appears to be consolidating into regional monopolies while potentially restricting access through prior authorization requirements and limiting provider payments.

With Medicare Advantage enrollment exceeding 33 million Americans, the decisions made in the coming months could determine whether the program evolves into a more competitive marketplace or continues toward greater consolidation. The question is whether policymakers can act swiftly enough to address these mounting challenges before they become permanent features of American healthcare.

#ALL

(See below for the list of articles consulted)

More from the Payment Rules Published Last Week

PFS – Proposed Medicare physician fee schedule changes could significantly impact specialist physicians. The efficiency adjustment and primary care add-on codes affect payment structures and may diminish AMA influence within the healthcare system by impacting financial incentives for specialists and shifting power dynamics in medical associations.

OPPS – Hospitals are trying to understand the implications of the accelerated timeline for a $7.8 billion clawback to align outpatient payments more closely with actual services rendered as well as enhanced hospital price transparency guidelines that aim to empower patients with cost knowledge, fostering competition and reducing healthcare prices, though critics cite extremely difficult implementation requirements. Perhaps most daunting are the various proposals related to site neutral payments.

(See below for the list of articles consulted)

Food and Drug Administration (FDA)

FDA reverses course on Juul

The FDA reversed its stance on Juul’s e-cigarettes after previously imposing restrictions. This decision indicates a regulatory shift potentially impacting the vaping market and public health discussions surrounding e-cigarettes.

#All

The FDA must be modernized for the era of personalized medicine

The FDA requires updated regulations and processes to accommodate personalized medicine advancements. Current frameworks may hinder innovation and accessibility as treatments become increasingly tailored to individual patients, necessitating more agile responses to new therapies and technologies.

#All

FDA ‘Expert Panels’ Raise Concerns of Evading Regulations, Ethics

Recent FDA expert panels have drawn criticism for bypassing standard procedures and ethical guidelines. Critics argue these panels may compromise regulatory process integrity, leading to potential decision-making biases and calling for greater transparency and adherence to established protocols.

#All

Health and Human Services (HHS)

HHS Announces Major Organ Transplant System Reform

HHS announced a major initiative reforming the organ transplant system following investigation of the Network for Hope, a Kentucky-based organ procurement organization. The investigation revealed that of 351 transplant cases, 73 patients exhibited signs of consciousness when organ procurement was halted, raising ethical concerns about employed practices. Congressional members expressed fears that public trust in organ donation could diminish due to these ethical breaches.

(See below for the list of articles consulted)

Why rural hospitals are preparing for a $50B funding race

Rural hospitals are preparing for competitive access to $50 billion in funding to address ongoing challenges including financial pressures and staffing shortages. Federal funding opportunities require strategic positioning to secure resources for enhanced services and operational maintenance in rural healthcare infrastructure.

#All

Senate Committee Advances HHS Assistant Secretary Nomination

The Senate Health, Education, Labor & Pensions Committee voted along party lines to recommend Brian Christine, MD, for Assistant Secretary for Health at HHS. This nomination reflects contentious health policy discussions in the current political climate as part of broader efforts to fill key department positions.

#All

Federal move away from animal testing draws mixed reactions

The Trump administration advocates shifting from animal testing toward alternative methodologies in federal agencies including NIH and FDA. While some view this as ethical advancement, others express concerns about rushing new approaches without adequate validation, highlighting

#All

Chinese hackers breach HHS, NIH in Microsoft SharePoint cyberattack: Report

Chinese hackers exploited Microsoft SharePoint vulnerabilities to breach HHS and NIH among other government agencies. Microsoft confirmed attacks and is working with affected agencies to address vulnerabilities, underscoring ongoing cybersecurity threats facing government institutions.

#All

PBM Reform Could Save Almost $100 Billion in U.S. Drug Spending

Health policy research suggests reforming pharmacy benefit managers (PBMs) could save nearly $100 billion in U.S. drug spending. Separating PBM compensation from drug list prices is essential to reduce overall healthcare costs and significantly impact healthcare affordability.

#Drug

Lawmakers introduce bill to end drugmaker limits on 340B discounts

Bipartisan lawmakers introduced the Pharmaceutical Access to Invest in Essential, Needed Treatments & Support Act to prohibit pharmaceutical companies from restricting 340B drug pricing discount access. The legislation would require drugmakers to provide discounts to eligible hospitals using contract pharmacies and establish civil penalties for violations.

#Drug, #Hospital

Heard on the Hill

More on the Big Beautiful Bill

Recent healthcare and tax reform legislation has sparked significant debate regarding rural healthcare impact and health insurance coverage implications. The tax law includes a substantial $50 billion fund supporting rural healthcare providers, serving as a critical lifeline for financially struggling hospitals and clinics following recent Medicaid cuts. Senator Thom Tillis suggested addressing rural hospital challenges could enable bipartisan health deals, potentially involving Affordable Care Act tax credit extensions. However, CBO estimates indicate the new tax law could result in approximately 10 million individuals losing health insurance by 2034 due to significant federal health spending cuts.

However, proposed Medicaid changes are projected to result in 1,500 excess deaths and $135 billion in economic losses annually. The legislation’s complexity, including replacement of familiar terms like GILTI with new acronyms, has created confusion among tax professionals regarding provisions and compliance requirements.

The combination of a substantial fund for rural healthcare, potential bipartisan efforts to enhance healthcare access, and dire projections regarding health insurance losses paints a complex picture of the current legislative landscape. As rural providers face unprecedented challenges, the intersection of tax reforms and healthcare policy will be critical in determining the future of healthcare access in the United States. The implications of these changes will be felt across the nation, particularly among the most vulnerable populations, necessitating ongoing scrutiny and advocacy.

(See below for the list of articles consulted)

Notable Notes

Why federal retirements are spiking this year

Federal retirement applications have surged 40% compared to the previous year, driven by concerns over potential benefit changes and workforce reductions. Many federal employees are retiring early in anticipation of these changes, creating significant implications for federal agencies and employees.

#All

What Happened to Our Brains During the Pandemic?

Research indicates people’s brains aged more rapidly during the COVID-19 pandemic regardless of infection status, according to U.K. Biobank serial imaging data. These findings highlight significant neurological impacts on mental health and cognitive function with potential long-term population implications.

#All

VA redirects $800M to upgrade EHR systems, infrastructure

The Department of Veterans Affairs reallocated $800 million to enhance electronic health record systems and infrastructure through cost-saving measures including staff reductions and call center consolidations. This investment aims to improve veteran healthcare delivery.

#All

Edwards Lifesciences loses TAVR leader to robotics firm, announces replacement

Edwards Lifesciences announced departure of its TAVR technology leader to a robotics firm shortly after FDA granted historic approval for TAVR to treat asymptomatic severe aortic stenosis. This leadership transition may impact strategic direction of their TAVR offerings during a pivotal company moment.

#Device

Stroke risk after TAVR still much higher for female patients

Clinical studies involving nearly 380,000 patients reveal women face significantly higher in-hospital disabling stroke risks after TAVR compared to men. This finding raises concerns about need for gender-specific approaches to mitigate complications and highlights importance of gender-specific cardiovascular research.

#Device, #Patient, #Provider

How pairing SAVR with additional heart surgeries affects mortality risk

Older patients undergoing surgical aortic valve replacement combined with other procedures face increased mortality risks. This raises questions about whether healthcare teams should consider alternative treatments, such as transcatheter options, suggesting need for treatment strategy reevaluation in older populations.

#Device, #Patient, #Provider

‘This trend is encouraging’: Radial access for PCI now preferred in US

Over 55% of percutaneous coronary intervention cases in 2022 utilized radial access, representing a significant trend closely monitored by cardiologists. This growing preference suggests potential changes in standard practices within interventional cardiology and positive implications for patient outcomes.

#Device, #Patient,#Provider

AI software takes cardiac risk assessments to another level

AI-powered tools can significantly enhance cardiac risk assessments through improved plaque evaluations in patients. These advancements can influence patient care by providing more accurate risk assessments, potentially leading to better cardiovascular health management and representing promising personalized medicine developments.

#Patient, #Provider

Biennial Lung Cancer Screening Could Be Appropriate for Some Patients

Modeling studies suggest biennial CT lung cancer screening may benefit moderate-risk patients, particularly those under 60, while requiring fewer screenings than annual options. This approach could maintain most annual screening benefits while reducing healthcare costs and patient burden.

#Patient

The Rise in Adolescent Bariatric Surgery Doesn’t Mean GLP-1s Have Failed

Increasing adolescent bariatric surgery rates do not indicate GLP-1 medication failure in obesity treatment. The existing divide in obesity treatment between children and adults hampers effective care, calling for more integrated approaches to treating obesity as a chronic disease across all age groups.

#Patient

A Conversation with Jeremiah Johnson, Executive Director of PrEP4All

Executive Director Jeremiah Johnson discusses the critical role of preexposure prophylaxis (PrEP) in HIV prevention. He expresses caution regarding recent Lenacapavir advancements, suggesting comprehensive approaches to HIV prevention and treatment rather than relying solely on new drug developments.

#Patient

Additional Articles Consulted

Impact of Staffing Reductions, Budget Cuts, and Other Changes Still Reverberate Across the Health Sector

• Opinion: Pioneer HIV researcher Robert Gallo: Cuts to medical research funding leave us vulnerable to viral threats
• STAT+: Basic science publications have been falling for a decade. NIH budget cut would likely accelerate the decline
• Amid ongoing federal layoffs, new fellowships offer opportunities for affected employees
• This EPA research office safeguarded Americans’ health. Trump just eliminated it –
• Former federal science leaders warn Trump proposals could cripple U.S. research
• There’s a Major Publishing Slowdown at CDC’s Flagship Journal
• 14 Republican senators urge White House to release delayed NIH funds
• Court filing details what layoffs White House was seeking at over a dozen agencies
• RFK Jr. Reportedly Planning to Fire All USPSTF Members
• Trump Administration’s N.I.H. and F.D.A. Cuts Could Curtail New Drug Development, Budget Office Says
• How Changes to Funding for the NIH and Changes in the FDA’s Review Times Would Affect the Development of New Drugs
• New analysis predicts sprawling effects of proposed NIH budget cuts
• STAT+: AlphaFold developer Google DeepMind to fund CASP as NIH funding falls short
• Amid ongoing federal layoffs, new fellowships offer opportunities for affected employees
• Basic science publications have been falling for a decade. NIH budget cut would likely accelerate the decline

Medicare Advantage News

• House bill aims to bring parity to Medicare reimbursement
• UnitedHealth Says It Is Under a Federal Investigation and Cooperating
• Opinion: Plans to test prior authorization in traditional Medicare are deeply troubling
• Humana cuts some prior authorization, launches gold card program
• UnitedHealth, Blue Shield of CA push Medicare Advantage HMOs
• UnitedHealthcare, Humana rule Medicare Advantage markets: study
• Prior Authorization Is Likely Only Going to Get Worse

More from the Payment Rules Published Last Week

PFS

• Physician fee schedule proposal hits specialist billing codes
• Medicare doctor pay plan would hit specialists, curb AMA clout

OPPS

• Medicare’s $7.8B outpatient payments clawback plan, explained
• CMS is taking a stab at site-neutral payment. Here’s what to know
• Medicare targets site neutrality, price transparency in hospital outpatient rule

HHS Announces Major Organ Transplant System Reform

• Why Is HHS Targeting the Organ Transplant System?
• HHS to reform organ transplant system
• HHS Targets Transplant System Amid Reports of Donors Showing ‘Signs of Life’
• STAT+: After explosive federal report, Congress fears plummeting trust in organ donation

More on the Big Beautiful Bill

• What to know about the tax law’s $50B fund for rural providers
• Tillis: Rural Hospital Fix Could Be Opening For Potential Bipartisan Health Deal
• Proposed Medicaid Changes Could Lead to Thousands of Preventable Deaths and Billions in Economic Losses
• Republican tax law leaves experts searching for words
• A Closer Look at the $50 Billion Rural Health Fund in the New Reconciliation Law
• GOP megabill’s final score: $3.4T in red ink and 10 million kicked off health insurance, CBO says
• STAT+: 10 million expected to lose health insurance under Trump’s tax cut law, CBO says
• ‘One Big Beautiful Bill’ to add $3.4T in debt: CBO