FY 2018 Budget Proposal

President Trump's budget request, which is not binding, nearly early eliminates funding for nursing workforce development programs. Additionally, it proposes significant reductions to the Medicaid program but does not propose any direct reductions to Medicare funding.

AONE and the Nursing Community issued statements expressing disappointment over the President’s budget proposal.

Highlights of the budget request are below.
 
NURSING WORKFORCE
Contains a 64 percent decrease in funding for nursing workforce development programs, a reduction of $146 million, while maintaining current funding for the NURSE Corps Scholarship and the Loan Repayment Program. See the Nursing Community's chart for details on the funding cuts.
 
MEDICAID
Proposes savings of $627 billion over 10 years, of which $610 billion is attributable to the request’s Medicaid reform proposal. The budget also assumes $250 billion in savings from the repeal of the Affordable Care Act (ACA).

  • Would achieve savings by giving states a choice in how they restructure the program’s financing through either a per capita cap or block grant option. States would be allowed to advance further programmatic changes that include work requirements.
  • Includes Medicaid savings of $399 million over 10 years for medical liability reform and $16.7 billion in savings resulting from the two-year extension of Children’s Health Insurance Program (CHIP) funding by keeping Medicaid-eligible children enrolled in CHIP.

MEDICARE
Would not make any direct reductions to Medicare funding. It requests the following policy changes with indirect spending impacts:

  • Proposes $1.3 billion (over 10 years) to reform the Medicare appeals process to address the backlog of pending appeals.
  • Seeks $70 million in new Health Care Fraud and Abuse Control Program funding for FY 2018.
  • Would repeal the Independent Payment Advisory Board, created in the ACA, for a savings of $7.6 billion (over 10 years).
  • Includes $31.4 billion in savings resulting from a medical liability reform legislative proposal. This includes capping non-economic damages, creating safe harbors when clinical standards are followed and federal guidance on state health tribunals, among other provisions.

CHIP
Extends CHIP funding through FY 2019 while calling for $5.8 billion in additional savings from program funding over the two-year window. The budget request recommends the following budget-saving proposals:

  • Eliminates the current law enhanced federal match of 23 percentage points;
  • Ends the eligibility maintenance of effort requirement; and
  • Caps the CHIP income limit at 250 percent of the federal poverty level.

NATIONAL INSTITUTES OF HEALTH
Decreases funding for NIH. Among the larger funding reductions:

  • National Institute of Nursing Research would decline by more than $36 million.
  • National Cancer Institute would decline by $1 billion in FY 2018.
  • National Institute of Allergy and Infectious Diseases would decline by $838 million.
  • National Institute of Mental Health and National Institute on Drug Abuse would decline by more than $500 million combined.