With plans that include significant cuts to Medicaid, health research, and anti-poverty programs, the 2018 federal budget proposal from the Trump administration is being met with concern by APTA and most other health care and consumer organizations. However, like nearly every other budget submitted by a US President, the chances of the $4.1 trillion proposal surviving Congress intact is unlikely.

The proposal, released May 23, combines cuts in health care, education, and anti-poverty spending with significant increases in spending on defense and border security. The President’s plan would boost 2018 discretionary spending for defense to $607 billion, with nondiscretionary defense spending set at $560 billion—an overall increase of 10% for military spending. The $2.6 billion for border security would include $1.6 billion for the construction of a border wall with Mexico.

The budget also proposes 2% cuts across-the-board for all nondefense spending for the next 10 years, as well as significant cuts to nearly every other facet of government, including the departments of labor, interior, education, and state, which would all be cut by double-digit percentages ranging from 10.9% (interior) to 31.2% (Environmental Protection Agency). Besides defense and homeland security, the only other department slated for an increase is the Department of Veterans Affairs, with a proposed 5.8% increase.

Cuts and other changes that may be of specific interest to physical therapists, physical therapist assistants, and students include:

• $1.4 trillion in cuts to Medicaid—$800 billion achieved if the American Health Care Act is passed, and an additional $600 billion in reductions realized through a switch to a per capita or block grant system at the state level
• 0.6% cut to Medicare, a cut that the Congressional Budget Office/Office of Management and Budget says would amount to an $8.7 trillion reduction over 10 years if no policies are changed
• $5.8 billion in cuts to the National Institutes of Health, including cuts to agencies involved in research on cancer, aging, infectious disease, and child health and development (the arm of NIH that also includes the National Center for Medical Rehabilitation Research)
• Elimination of the Agency for Healthcare Research and Quality
• More than $10 billion in cuts to education programs, with $9 billion tied directly to cuts in the Department of Education
• Phase-out of the public service loan forgiveness program for any student loans originating after June 30, 2018, as well as elimination of subsidized student loans
• A 5% cut to the Office of National Drug Control Policy, which coordinates federal efforts to combat the opioid epidemic (rumors were that cuts could be as high as 95%)

"The budget proposal we're seeing represents a dramatic shift in spending, but it is consistent with what we anticipated, given the stated priorities of the administration," said Justin Elliott, APTA vice president of government affairs. "It is important to remember that Presidential budgets are almost always viewed more as a wish list from the administration. They are very rarely enacted as presented."

But APTA isn't making any assumptions about the fate of Trump's budget.

"Many of the proposed cuts would have a direct detrimental impact on our patients, and are in opposition to the core values of APTA and the physical therapy profession," said APTA President Sharon Dunn, PT, PhD. "We will join with many other health care and patient advocacy organizations to work with Congress toward a budget that supports wide access to affordable health care, strengthens research capabilities, and helps to improve the overall health of society."