President Trump and the GOP want to dismantle the Affordable Care Act and restructure Medicaid, and “American First: A Budget Blueprint to Make America Great Again” provides further evidence that they do not want to invest in a healthy and thriving North Carolina. While many North Carolinians may not feel the impact of the provisions outlined in the budget immediately, there are significant threats to public health, our state’s ability to address their health, and capacity to strengthen our healthcare workforce.
In addition to an 18 percent cut to the U.S. Department of Health and Human Services (HHS), the Trump budget outlines a $5.8 billion cut to the National Institutes of Health (NIH), a 31 percent cut to the Environmental Protection Agency (EPA), and the only mention of the Centers for Disease Control and Prevention (CDC) is in reference to a $500 million block grant to states. These cuts are threats to North Carolina’s public health because the NIH funds research that could help identify innovative cancer treatment, the EPA helps to ensure that rural communities have access to safe drinking water (Note: 80 of North Carolina’s 100 counties are rural), and cuts to the CDC could impact vaccine development for the next epidemic.
Addressing the social determinants of health—or the conditions that people are born into, live in or work in that affect their health—is also on the Trump budget chopping block. The CDC notes that poverty is a social determinant that impacts community and individual health. The Trump budget is an attack on those living in poverty as it proposes to cut programs that are safety nets for low-income and poor people. For example, the budget cuts the Community Services Block Grant, which funds programs such as Head Start in poor neighborhoods. The budget also cuts the Low Income Home Energy Assistance Program. The Trump budget underestimates the impact of these programs: They are critical investments into improving long-term health outcomes for people living in poverty.
Finally, the Trump budget would have direct implications for North Carolina’s success in boosting its health care workforce. In the 1115 waiver application to reform Medicaid, there is an initiative to address workforce shortages in rural and under-served communities. Trump’s budget would cut $403 million in health profession and nursing training programs as they “lack evidence” to improve the healthcare workforce. That’s just not true. North Carolina’s waiver states that community-based residency and education programs are critical to strengthening the healthcare workforce. The waiver application even request federal dollars to implement the program. Unfortunately, funding to transform North Carolina’s ability to address the unmet needs in rural and underserved communities may be stunted if there are significant cuts to workforce education, training, and development.