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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join host Jeff Byers, editors from Health Affairs Publishing, and guests as they discuss health policy’s most pressing news and trends.
Hello and welcome to Health Affairs This Week. I'm your host, Beyers. We are recording on 07/21/2026. I know. I know.
Jeff Byers:I know. I know. I know we were taking a summer break, but we interrupt that break to bring you an emergency pod to discuss canceled and or discontinued health grants. We thought it leveled up to the emergency pod code red, if you will, and here to discuss that we have Doctor. Aaron Carroll, President and CEO of Academy Health.
Jeff Byers:Aaron, welcome back to the program.
Aaron Carroll:Thanks for having me.
Jeff Byers:Yeah, so you joined Health Affairs This Week about a year ago talking about some page restorations and lost federal information. But first, you know, how are you? How's the year been?
Aaron Carroll:Oh, it's been fantastic. No no news at all. Right? Yeah. No.
Aaron Carroll:Yeah. I mean, I've been, know, all all kidding aside, it's it's it's been a, you know, rough year, I think, for the field, for health services research in general. I mean, I think even for science, I would say. Someday I'd love to join the program to talk about something, you know, uplifting and promising. But at the moment, once again, it feels like we're fighting to keep independent quality science going.
Jeff Byers:Well, until that day, I hope to have you on for that. But before that, we will talk about, what you are here to discuss, which is, discontinued grant funding. So for those that might not be steeped in this health policy world, you know, this could be someone's first episode. What's happening?
Aaron Carroll:Last week, and I mean, it even hasn't been a full week, I think it was last Wednesday, we started getting some frantic emails from researchers across the country that they had just received notification from ARC that grants that they were already in the midst of were being discontinued. So not to get too basic, but just so that everyone understands, when you apply for a grant from federal government and it's multiyear, you know, every year, you have to go back and submit a progress report and talk about how things are going. And usually things are going fine, and it's it's sort of just dotting i's and crossing t's, and then you get the funding released for the next year in what we call a noncompetitive renewal because you're not really competing with others for that. You're just making sure you're you're doing the right thing. Now, sometimes there's a problem with your grant.
Aaron Carroll:Maybe you're falling a bit behind on recruitment or you've come up against some issues. You have to work it out with your program officer. You figure it out and you move forward. Once in a while, very rarely, you're maybe a real problem with the grant or for some reason, might have really changed on the ground or in the country, and and your grant will be canceled. But it's rare.
Aaron Carroll:And when it happens, it's very specific to your grant and you know exactly why that's happened. But what happened last week was that AHRQ began notifying researchers across the country that continuation funding for previously supported projects will not move forward. And this work was already underway. We've been tracking at this point more than 82 grants or at least 82 grants, and the number keeps growing. And what's concerning to us is that very different projects appear to have received the very same rationale, including projects that directly align with the priorities cited in the notices.
Aaron Carroll:So the notices say we're discontinuing your grant because it doesn't align with federal priorities. Here are the federal priorities, and lots of those grants directly line up with the federal priorities.
Jeff Byers:And these Can you give an example just Yeah.
Aaron Carroll:So for instance, one of the rationales and priorities that gets listed is that antibiotic resistance is a real concern right now. And one of the projects is a randomized trial of antibiotic stewardship across 40 hospitals. How do you cancel a project on antibiotic resistance under a rationale that lists antibiotic resistance as a priority and saying it doesn't align. That that just makes no sense. Moreover, the scope of these grants are all over the place.
Aaron Carroll:There's research grants like r o ones, r eighteens, r 20 ones. There's career development awards, which are k awards. There's training programs like t 30 twos. There's infrastructure grants like p thirties. This is a broad action, not an isolated decision.
Aaron Carroll:And many of the grants focus on things that seem to be a priority both for the federal government and for those who are interested in MAHA, and it really makes no sense why they've all been canceled midstream after being left on the hook for quite some time.
Jeff Byers:Yeah. I think I saw a figure that said 67 grants last week potentially were discontinued. And there is maybe some confusion on my part and on other readers' part. These were discontinued grants. Is that right for the most part?
Aaron Carroll:Yeah. These are a 100% grants that had already been issued, that had already been started, where money had already been spent, and now they're being stopped midstream. So by our estimates, based upon those we've been directly contacted about, We know of 82 grants, and we know there are more out there, but we know for sure of 82 grants. Total funding for all those is more than $211,000,000. More than $97,000,000 has already been spent, and another $113,114,000,000 was supposed to be spent going forward that has been canceled.
Aaron Carroll:So it's not just that you have a $114,000,000 of funding that's now just been stripped from research projects all over the country. But we have almost a $100,000,000 of money that's already been spent starting these projects, recruiting patients, recruiting hospitals and clinics, getting data, setting things up, hiring people. And now they're saying, we need so badly to stop this. We don't mind that that $100,000,000 has basically been wasted and now it's just gonna get thrown away. And we're also gonna cancel another $114,000,000 of of stuff going forward.
Aaron Carroll:These are not abstract projects. They focus on safety, on affordability, and they focus on access. And when these investments stop, health systems, clinicians, patients feel it, everyone, not just researchers.
Jeff Byers:Yeah. I did want to get into some of the downstream impacts or effects from this in like next steps of what actually might happen. Because I assume some people might try to fight this at the same time. But, you know, you mentioned antibiotic resistance. What other areas health wise are these cancel
Aaron Carroll:I I mean, I know I've seen, grants on how Medicare and Medicaid policies affect vulnerable populations. Some have looked at medical debt after illness. Some have looked at behavioral health integration and primary care. But, again, some of these are career development awards. They're k awards, meaning that we've we've put forward money to say we wanna train the next generation of health services researchers.
Aaron Carroll:Some of them are t 32 or training programs. So you've hired fellows and gotten them involved and started them on their path. And now midstream, you're saying, nope, don't care. A huge number of them are infrastructure. They're they're part of the e star program, learning health systems work, training people to do really good high quality work.
Aaron Carroll:At its heart, everything that Americans hate about our health care system is what ARC focuses on. Americans are angry that health care costs too much. It's too expensive. That's ARC. They're angry that it takes too long to see a doctor.
Aaron Carroll:Wait times are too long. That's ARC. They're angry that they're not getting the quality that they feel like they should given how much money we invest in health care. That that's ARC. When you even talk about math things, when you're like, why are so many people having chronic disease?
Aaron Carroll:Why are, you know, we not getting the bang for the buck? Why can't we focus on better nutrition? That's all ARC. And it's baffling that while prioritizing these things, they're canceling grants that focus on them.
Jeff Byers:Yeah. So I noticed today, my apologies. I'm not a subscriber to the Academy Health Substack currently. I I'm sure I'll rectify that No. I'm happy with this recording.
Jeff Byers:But so I noticed in your Substack, Academy Health has been tracking this for for quite some time, and in this idea of, like, the slow cancellation of ARC. Can you go, you know, into your perspective about that? You know, for someone, again, that might not know too much about that.
Aaron Carroll:Yeah. I mean, the this is the latest step in what's been at least a year of disruption. I mean, going all the way back to, you know, fiscal year twenty twenty five when there was an enormous amount of money that was appropriated and not spent, and SGIM brought a lawsuit, is still underway, about what we believe are illegal impoundments of fiscal year twenty twenty five money. Now we're in fiscal year twenty twenty six. We've still seen ARC staffing dramatically reduced.
Aaron Carroll:Our estimates are about 20% of its prior staff are are still being employed. Its grant making has been slowed and effectively stopped. Researchers have been waiting months for clarity on what's going on, and no one knows. And if I were congress, I would be livid because this is not, again, an old budget. This is the fiscal year twenty six budget.
Aaron Carroll:It was passed by this congress, by this house of representatives, by this senate. It was signed into law by this president, and they're not following the law. There are minimum staffing requirements in this law for HHS to make sure that the business can be done. They have not been followed. There's money that has been appropriated that is supposed to be spent.
Aaron Carroll:It is not being done so. Fiscal year twenty six does not have much time left to it. And rather than step up their grant making to follow the law and get the money out that this congress has put out, they're canceling grants which have already been funded and have been started. It makes no sense whatsoever. Again, I don't know why congress is okay with this.
Aaron Carroll:I don't know why anyone is okay with this. It's it's not following the law, and it's not putting money into research that everyone knows will focus on the things that Americans need fixed in their health care system.
Jeff Byers:Yeah. So let's go to those impacts, those downstream impacts. So, like, when we knew we were gonna talk to each other, like, one of the questions I had are, like, what are those downstream impacts to, like, organizations like NORC or universities or journals that publish research?
Aaron Carroll:It's chilling all the way down. I mean, you know, we we have talked to researchers who were funded with career development awards who think this will effectively end their career. We know there are training programs that have been funded to, you know, train the next generation, and they're probably going to need to be canceled. What's even more concerning is that I imagine some of these institutions have been waiting since, I think even the end of twenty twenty five to know what's going on with their grants. They've probably had to float people to keep them funded because everyone would expect that grants would continue to be funded.
Aaron Carroll:And now they're finding out that they're canceled months and months and months later, which means maybe they're on the hook for money that's been put out. They've started huge trials which just have to be canceled, which means effectively telling everyone that's participated in them like too bad. It's it has a chilling effect on research. It's going to have an incredibly negative effect on the economic viability of many of the institutions that do this work. It's going to result in a, you know, slowdown or lack of information on how to improve the health care system.
Aaron Carroll:And, these seem to be the things that Americans are most upset about with respect to health care and the things that this government continues to say are most important to their agenda. None of this makes sense.
Jeff Byers:Yeah. And so we don't have a large amount of time left, but I do wanna make sure I get to ask you a couple more questions. So a headline from yesterday on science.org is US judge rejects Trump's justification for terminating thousands of grants. I don't think this relates to the health care grants. I could be wrong.
Jeff Byers:If someone could, you know, fire off common Spotify, let me know if I'm wrong or right, would be helpful. Get that engagement up either way. But I say that to say, you know, we've seen this pattern of the administration making a decision and then being paired back. So or like being or a jud a regulatory body, like, has them walk that back, you know. So that's just one example.
Jeff Byers:For this, do you foresee potentially these cancellations going that way or, like, what are the next steps?
Aaron Carroll:I mean, I'm I'm not a legal expert, but my
Jeff Byers:Fair enough.
Aaron Carroll:But I will say that it seems very similar because these are also grants that are being canceled sort of en masse for a very simple and yet doesn't seem rational justification. Because if you're gonna claim, it's all about changing priorities and then list your priorities and these grants follow some of those priorities, that doesn't make sense. So, you know, agencies have the authority to make funding decisions, but those decisions have to follow the processes and standards that govern federal grants. Were these individual determinations on the merits or a broad policy applied across very different projects without the required analysis? And moreover, every administration has priorities.
Aaron Carroll:This is not new. The issue is how they're implemented. When you end funded work already underway across dozens, if not more, of projects, there needs to be transparency about how those decisions are made. There's still laws and regulations on how this should be done. And I have heard a lot about radical transparency in the last year, but this seems to be the opposite.
Aaron Carroll:We don't know why each individual grant was canceled. We don't know why these decisions were so delayed. We don't know why they're not spending the money. We don't know what their plans are for doing it, and we don't know why they are not following the law. And, yes, there are court cases to try to stop that.
Aaron Carroll:And when they all get overturned or pushed back or these these things are rolled back, it's because the judicial system is saying they were illegal. It would be nice to just stop doing this. It would also be nice if congress would weigh in and start to push back on asking good questions about why the law is not being followed with respect to appropriated money for research by this federal government.
Jeff Byers:Well, I know Academy Health, has a lot to say about research advocacy. So, like, is there anything that your organization is doing to address the recent happenings?
Aaron Carroll:Yeah. I mean, absolutely. First of all, we've been we've been tracking it, in order to make sure that we know exactly what's going on. We've been, you know, sort of talking with members and briefing them constantly on what's going on. We've been pushing this information to the media so that they can highlight the terrible impact of all of these changes as well as the fact that nobody really knows what's going on, and we've certainly been spending a lot of time talking to congress.
Aaron Carroll:We talked to lots of representatives' offices and senators' offices and continually brief them on what's going on and why. And, you know, I think it's really important to talk about the fact that, like, you know, congress is a separate branch of government. Because a number of times when I've been talking about ARC in the last few months, people have said to me, well, you know, this is they you know, they're just trying to get rid of ARC. And my pushback is always, who is they? Because this Congress passed a budget which absolutely funds ARC.
Aaron Carroll:This president signed a budget which absolutely funds ARC and has minimum staffing requirements. You know, this congress, bipartisan, keeps ARC going. And so to say they want to get rid of ARC, I really need to know who they is because they seem to be acting against the will of congress, the will of the president, the will of the American people. And we're not gonna stop pushing for that because what's going on right now is not okay.
Jeff Byers:Well, doctor Aaron Carroll, as we wrap up this conversation, any final words on this? I know that wasn't a rosy conversation, but
Aaron Carroll:It's important that we keep pushing for for what's right. It's important that we keep, you know, advocating for the research that's going to improve the access, the quality, and the cost of The US health care system. And it's important that we keep holding everyone responsible for what the law says. And in this case, this is an appropriated agency of the federal government that has funding, that has worth, that's doing important work, and it needs to be allowed to continue. And we're you know, I'm I'm happy that we get a chance to highlight it, and we're gonna keep pushing for that to keep going.
Jeff Byers:Anything else, from the academy help front while I hear that you wanna highlight?
Aaron Carroll:You know? No. I just you know, I we we just encourage people to get involved. We encourage people to remain, vigilant and to, you know, to know about all the things that are going on. But, you know, like you, we encourage everyone to sign up for the substack.
Aaron Carroll:It's free, you know, just to to know what's going on so you can be aware and you can do what you can do to help support all of this research.
Jeff Byers:And if there's, anything I haven't learned in my time in the media, it's that people love free stuff.
Aaron Carroll:Yeah. And that this is absolutely free and it's great content as well.
Jeff Byers:With that, Doctor. Thank you again for joining Health Affairs This Week. If you, the listener, enjoy this episode, please send it to a friend. And we will see you in August for real this time.
Aaron Carroll:Perfect.