Beyond the Budget Cuts: The Real Cost of Undoing Federal Agencies
Examining the Impact on Health, Research, and American Lives
Do you know anyone who works at the FDA?
What do you suppose they do?
What about the National Institutes of Health? ARPA-H? The Advanced Research Projects Administration for Healthcare. I happened to meet the agency’s director at a summit at the White House. Have you been invited to serve on a scientific peer review committee with the Department of Defense under the Congressionally Directed Medical Research Program? I’ve served with civilian and military physicians and researchers for over six years, reviewing grants with a special focus on military readiness and health for armed service members and their families impacted by cancer.
Have you traveled to Washington, D.C., to work with lawmakers on bills regarding medical research funding, improved healthcare access for childhood cancer patients, and palliative care recruitment, education, and training to increase the healthcare workforce and better serve people living with serious illnesses?
Did you know that many patients in serious illness communities, like ALS and brain cancer, die while waiting for disability benefits and Medicare coverage to begin because there is a lengthy waiting period even after a person is deemed eligible? I know that because I’ve advocated for my community to support the Stop the Wait Act to eliminate these waiting periods.
Have you regularly attended quarterly meetings, convening a multidisciplinary group of government, industry, and private stakeholders to work on critical barriers in research and form working groups to address those barriers so that both public sector and private sector organizations can work more collaboratively to advance patient care?
Are you friends with actual doctors from the National Cancer Institute? Do you know patients enrolled in clinical trials at the NIH who saw their extended care team members laid off in real-time while they were inpatients at the NIH? Do you worry that the next promising clinical trial will abruptly halt or won’t start at all because of NIH cuts?
In response to the suggestion that the private sector can fill this gap, it's crucial to remember that NIH-funded trials often focus on areas neglected by industry and provide crucial access for patients who might not otherwise have options. The hard truth is that something like brain cancer isn’t very profitable. Sure, it’s high-risk/high-reward territory, but as an advocate on the frontlines of research advocacy, I can attest to the difficulty of large pharma investment in a disease with single-digit percentile five-year survival rates.
Have you received emails from terminated government scientists you’ve worked with who are searching for employment within their networks after being laid off because of “efficiency”? Did you ever think that all these tens of thousands of public sector employees have houses with mortgages, families, and bills to pay? Should they suffer because the wealthiest man in the world, who has nothing to lose from axing these agencies, acts on a whim?
What about the impact on local communities when laid-off workers no longer have discretionary funds to circulate in the local economy? What would home foreclosures do to your property value? Should career federal employees be punished because they just happened to work for an agency that the wealthy would rather see privatized?
Given the significant human and economic costs of these layoffs, we should raise the question, do these layoffs truly lead to efficiency? These are career staffers with decades of experience navigating the large bureaucracy of government agencies. I hear you: “That’s the problem! The bureaucracy!” But health and human services aren’t about turning a profit. The agencies under the HHS umbrella are designed to improve human lives. With hundreds of millions of Americans from diverse backgrounds, biology, and physiology, developing, approving, and distributing medical interventions requires thoughtful approaches and subject matter expertise. Layers of approval, quality assurance, and regulation are required to ensure Americans’ safety. What does "efficiency" truly mean in the context of our health?
Is efficiency only about cutting costs, or does it also involve effectively achieving the agency's mission of protecting public health and advancing research?
Do you understand the responsibilities of federal agencies like the Centers for Medicare and Medicaid Services (CMS), which administer a number of programs for pregnant women, people with disabilities, and the aging population, including people on Medicare and Medicaid? Do you know the function of the Assistant Secretary for Technology Policy (ASTP) that oversees data interoperability among health systems so that if you live and receive healthcare in California but have an emergency on vacation in Florida, a local specialist could access your records so you aren’t prescribed a drug with toxic interactions? What about the Substance Abuse and Mental Health Services Agency (SAMHSA) that provides funding for things like suicide crisis lines and community mental health clinics?
My own professional experience working with these agencies has given me firsthand insight into their critical functions. I’ve worked with these agencies professionally as part of my work for a professional services firm. Have you spent time with the employees who administer state-level social services? Do you think they are some sleeper cell of Marxists hiding in plain sight to lead a radical left lunatic revolution, or do you realize that people who work in government are just your everyday neighbors who serve our communities by performing their often mundane duties?
Did you know my sister benefits from these services?
The Trump Administration’s priorities, the Continuing Resolution (CR), and DOGE-like efforts at the state level eliminate or decrease funding for everything I described.
I understand the arguments for fiscal responsibility and the need to manage government spending, but are these the areas where we should make those cuts, especially when considering the potential human cost? The truth is that the long-term benefits of these programs, including advancing medical treatments, improved quality of life, and increased productivity, stand to gain more than we spend. Health and human services are an investment, not just an expense.
This is not to say that the private sector has no role to play in the HHS sector, but the private sector cannot replace the functions of these federal agencies, especially in terms of regulation, oversight, and ensuring equitable access. The way forward is collaborative, with public, private, and philanthropic funders coming together to advance the treatment of especially complex and recalcitrant diseases. To imagine that we’ll privatize HHS services and Social Security while maintaining democratic access is simply a pipe dream. What incentive would drug makers have to ensure equitable access to transformative therapies without the big stick of government? Check the balance statements of private health systems and insurers, and you’ll quickly learn that the private sector will not act democratically when left to the free market.
It’s my sense that the targets to the NIH, FDA, and CDC are born from Trump’s desire for vengeance against the agencies that he perceives wronged him during the pandemic or who promote the positive benefits of addressing diversity, equity, and inclusion in medical research so that our treatments do not benefit only white Americans of European descent.
The truth of science is that it only works in diverse environments, and public health is only truly public if it considers the full public.
I'm proud of my work improving care for people living with serious illnesses. I’ve had to watch my advocacy efforts unravel during the first two months of the Trump administration. Programs that I’ve helped build for nearly a decade are drastically reduced to funding levels from decades ago.
While it is my own assessment, the undercurrent I see in the Trump administration is an assumption that the administration has a right to determine the future of agencies without consulting the Congress that created them, the agency leaders and career staffers who run them, the Inspector Generals who oversee them, or the people impacted by the programs. MAHA (Make America Healthy Again) is a good example of this behavior. The FDA vaccine chief, Dr. Peter Marks, resigned over HHS Secretary RFK Jr.’s anti-vaccine stance.
Again and again, the Trump administration seems to dismiss the lives of everyday Americans, in favor of ideological concerns or preferring personal interests. Defunding these agencies not only for purported fraud, waste, and abuse but for their ideological stances proves again that Trump governs through division and preference for the wealthy rather than serving the lives of Americans who are punching a clock, raising kids, and caring for aging parents. Cuts to HHS abencies negatively impact middle and working class Americans in the “sandwich generation.”
Recall, the role of government is to serve its citizens, not profit the ruling class.
It's important to acknowledge that arguments exist for reducing government spending. Hell, literally for a living, my company helps agencies implement technology solutions to deliver actual efficiencies in government processes. But rather than problem solve and deliver solutions, this administration has literally taken a chainsaw to cuts as necessary for efficiency. When we examine the potential impact on critical areas like medical research and healthcare access, particularly for vulnerable populations, we must ask if these cuts are truly worth the cost.
Where is the respect for my dignity, life, and legacy?
Interested in seeing the NIH's impact in your state? Visit this interactive map from United for Medical Research.
In my home state of Indiana, the NIH has supported $408M in research grants, supported more than 5,300 jobs, and contributed to $1.1B of economic activity.