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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.
Hello and welcome to Health Affairs This Week. I'm your host, Bylander. We are recording on 04/16/2026. Today on the program, we have Jessica Bylander to discuss the proposed HHS budget. Jessica, welcome back to the program.
Jessica Bylander:Thanks for having me.
Jeff Byers:Yeah. So earlier this month, the White House proposed its budget for fiscal year twenty twenty seven. This proposal had some big cuts for HHS. Is that correct?
Jessica Bylander:Yeah. So kinda continuing in the, I guess, tradition of of the past budget, the budget request contains big cuts for HHS, including NIH. So this particular budget requests a 111,000,000,000 for HHS, and that's the discretionary budget, not like the mandatory pro programs like Medicare and Medicaid. And that would be, about 12.5% less than the amount that they actually received in 2026.
Jeff Byers:So for those that might not be familiar, what's what's generally the process with the White House budget? So I I kind of assume that this isn't exactly what's gonna happen. This may, like, kinda signal some things, but, like, what is this whole project like?
Jessica Bylander:Right. It is a super complicated process. And like you said, this is like a signal, almost like kind of like a wish list. So the new fiscal year starts on October 1, and it goes through next September 30. So in a nutshell, the process starts with the different agencies and the White House kind of working together or talking to each other at least to discuss their wants, and then also the president's sort of directions for for the for what federal funding will look like.
Jessica Bylander:So the president submits a budget request through the White House Office of Management and Budget to congress pretty early in the year that that the funding will begin. It's supposed to be in February, but obviously, this one's a little bit later, and it's often a little bit later. And from this document, then the real work of sort of determining appropriations and actual funding levels begin. So house and budget committees, including subcommittees, will will then kind of take it to their court and decide, you know, how much each department or agency will get, and they'll hold hearings and kind of ask people to justify their request. And so, you know, sometimes, generally, they would create a budget resolution, though that doesn't always happen.
Jessica Bylander:But at minimum, we have appropriations bills that determine how much, funding can be allocated. And, of course, as we're also familiar, if the budget hasn't passed by October, we either end up with a continuing resolution to keep the government open, while the budget's finalized, or we have government shutdowns.
Jeff Byers:Yeah. And that's gotten a little bit sticky, like a trickier situation as of late.
Jessica Bylander:Yes. Yes. I think we're we've seen a lot of very long shutdowns and just sort of, a lot of folks kind of using this process to hold out on things that they really, deemed important and want to include or not include in in various bills.
Jeff Byers:Yeah. Mediums will be had. So when when looking at the budget through a health care lens, what stands out to you?
Jessica Bylander:Yeah. So kind of focusing on the HHS portion of the budget, I mentioned that. So there's 12.5% less requested, and that's like about 16,000,000,000 less than was enacted last year. And of that, so there's some major cuts to some of our, you know, popular agencies. So a $5,000,000,000 proposed cut to NIH.
Jessica Bylander:So they would receive about 41,000,000,000 in funding. And as we know, the National Institutes of Health fund a majority of sort of biomedical research, kind of early stage research that's maybe then later used by companies to develop new products or drugs. And within that, they also are looking to eliminate some agencies within NIH. So that would include the National Institute on Minority Health and Health Disparities and also the National Center for Complementary and Integrative Health, which funds sort of research on alternative medicine. And kind of in most of the examples, especially the, Institute on Minority Health, some of the reasons behind cutting certain programs seem to point to sort of woke ideologies or basically any program or project that relates to diversity, equity, inclusion, including any research or program related to race or gender identity are kind of singled out as like a misuse of funds and a reason to to cut certain agencies and funding.
Jeff Byers:Yeah. So I noticed in the budget, there is a and we'll post a link in the show notes so people can check it out. They highlight creating efficiencies through which would equate to a reduction of $5,000,000,000, and then looking at it, the budget establishes the administration for a healthy America, which is the aforementioned not the American Hospital Association. What can you tell me about this?
Jessica Bylander:So this is, this is an initiative that the president has kind of been trying to establish. It was also in last year's budget request. So the administration for a healthy America, I think you can think of it as sort of like carrying out the objectives of the Make America Healthy Again MAHA movement. So that would they talk about it as prioritizing programs that improve nutrition, food, and drug quality and safety, and prevent chronic disease. So in creating this, they're they're really focused on some of those MAHA objectives of sort of of the HHS secretary Robert F.
Jessica Bylander:Kennedy. And like you said, they also say it will eliminate $5,000,000,000 in spending by creating efficiency. And and they say they'll do that by consolidating or eliminating programs in other agencies, including the CDC.
Jeff Byers:Just gut checking, you know, no no judgment, but I kinda think they should choose a different acronym. At least in the health care space, is widely
Jessica Bylander:known Well established.
Jeff Byers:Well established. Yeah. That's a better that's a better term. So we talked a little bit about that. Is there anything else on takeaways that you have for us?
Jessica Bylander:Yeah. I mean, also, I mean, there's a big cut also in the HHS budget to the Low Income Home Energy Assistant Program or LIHEAP. So that's a $4,000,000,000 cut. And that's also been proposed before, basically, again, kind of alleging misuse of the funds or the fact that they're just not needed because states have other ways of kind of helping people with low income meet their energy needs. So there's, I mean, there's a lot in there in terms of cutting existing programs and kind of eliminating what they refer to as abuse or or waste or sort of inefficiencies within the agency.
Jessica Bylander:So it's just sort of remains to be seen what the implications of all these things are and whether they'll actually be passed since, several of these were brought up in in prior budgets and just didn't make it through ultimately.
Jeff Byers:And in the same document, the only investment it talked about in its budget was MAHA or make America healthy again. So what do these investments say?
Jessica Bylander:I think the main mechanism is through the creation of the administration for a Healthy America which, again, is supposed to sort of be focusing on nutrition, food, drugs, and chronic disease prevention, all of the priorities of MAHA. And, you know, we've we've seen some of their areas of of main focus are sort of like processed foods and additives and foods and and sort of the contents of of what's within the foods that we eat and also just kind of reforming our diets.
Jeff Byers:Yeah. So at the risk of alienating listeners because when we've done food episodes in the past, it doesn't get as much engagement. So, you know, listener, bear with us here. What generally has been done at HHS regarding these MAHA initiatives so far?
Jessica Bylander:Yeah. So so thinking about foods, I mean, before even coming into office, it was very clear that RFK Junior was was gonna take a hard look and and kind of go after these food additives and ultra processed foods with the within our diet. So one thing they've been doing is working with industry to basically phase out a number of food dyes. They're focused on petroleum based food dyes, and they've been working on that since last year and actually have, you know, got a lot of commitments from different companies to phase out food dyes or color additives, and and some have already sort of completed that. And then as you may have seen, the administration updated its dietary guidelines last year.
Jessica Bylander:So kind of prioritizing whole foods and reducing highly processed foods. You've probably seen like the up upside down pyramid that circulated. And I mean, so, like, serving size wise, not super different from from past guidance, but kind of like emphasizing, you know, proteins and full fat dairy and and things like that and deemphasizing whole grains and and processed foods.
Jeff Byers:I saw for the first time, I don't know how widespread these are at the grocery store the other day, Doritos Simply, and it says simply NKD. So I I read that as simply naked without the vowels, and and maybe that's what that's meant. I assume that's what that's meant.
Jessica Bylander:Yeah. I mean, I think some foods will will pretty much be colorless going forward. And I mean, I personally don't think I'll miss, like, a brightly colored food. It's not necessary to my food enjoyment experience, but but, yeah, you you will start probably noticing that the foods that, you know, you eat or feed your kids are starting to look a little different because of that.
Jeff Byers:Yeah. Yeah. The bag is, like, completely white with the exception of the chip. I'm looking at it right now.
Jessica Bylander:I mean, I like
Jeff Byers:to read that. But yeah. Yeah. I like, I saw that in the wild, and I was like, oh, it's happening.
Jessica Bylander:It's coming.
Jeff Byers:Anyway, just a little frontline reporting Yeah. For everyone. So, Jessica, as we wrap up, any other notes on this proposed budget?
Jessica Bylander:Just that, you know, it's it's an interesting read. It certainly shows the thinking of of the White House and sort of which particular programs or initiatives kind of have gotten under their skin and they're they're really trying to weed out. As I mentioned, a lot of the examples pointing to to anything related to DEI, which as we know is something the the government has gone after. And, so yeah. And, of course, this this budget is is seeking to increase, defense spending while decreasing the nondefense spending, including for health.
Jeff Byers:Yeah. So listeners can check out that document if they wanna know more about the proposed HHS 2027 budget. And with that, Jessica Bylander, thanks again for joining us today on Health Affairs This Week. Thanks so much. Bye.
Jeff Byers:If you enjoyed this episode, please send it to the geese propagandist in your life. Thanks.