Policy Updates: Hill Happenings and Administration Activities
Hill Happenings
Budget Reconciliation and FY2026 Appropriations
Senate Republicans are working to sidestep policy disagreements with their House counterparts and kick-start Fiscal Year 2026 (FY2026) spending negotiations. On April 5, the Senate approved a budget resolution that would initiate the budget reconciliation process, a legislative procedure that enables Congress to pass a spending package via a simple majority. However, House Republicans have not coalesced behind the Senate’s spending strategy, potentially delaying budget reconciliation until bicameral policy and spending disagreements are resolved. Democrats will have limited opportunities to block the reconciliation package if the Republican caucus is able to build consensus for a single, identical bill in both chambers.
Additionally, on April 3, House Appropriations Committee (HAC) Chair Tom Cole (R-OK-04) released FY2026 programmatic guidance for the lower chamber’s appropriations subcommittees. The HAC will accept member spending requests through May 23, teeing up spending negotiations over the summer months.
NASTAD will continue to monitor the congressional appropriations process and advocate for the highest possible funding for HIV, hepatitis, and drug user health programs.
Senate Confirms Dr. Mehmet Oz for CMS Administrator
On April 3, the Senate voted to confirm the nomination of Mehmet Oz to serve as the Administrator of the Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS). A physician by training, Oz became a well-known daytime TV personality and later grew popularity with conservatives thanks to his promotion of hydroxychloroquine to treat COVID-19 during the pandemic. Oz ran an unsuccessful bid in 2022 to represent the state of Pennsylvania in the US Senate. As CMS Administrator, Oz will navigate a shifting federal health landscape to implement the Trump Administration’s policy priorities, which include shoring up CMS workflows after mass layoffs at HHS and CMS, applying potential cuts to Medicaid programs approved through the Congressional spending process, and implementing work requirements for Medicaid coverage eligibility and block grant structures.
Congress Responds to HHS Reduction in Force and Restructuring Plans
On March 31, Senate Appropriations Committee Vice Chair Patty Murray (D-WA), Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS) Ranking Member Tammy Baldwin (D-WI), and House Appropriations Committee Ranking Member Rosa DeLauro (D-CT-03) sent a letter to the HHS Secretary, Robert F. Kennedy, Jr., requesting more information on the agency’s sprawling reorganization and reduction in force (RIF) plans that went into effect on April 1. The appropriators highlighted the unprecedented nature of the cuts, the harms to federal, state, and local public health programs, and the likelihood of worsened health outcomes and reduced healthcare access for all Americans.
Additionally, on April 1, Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Bill Cassidy (R-LA) and ranking member Bernie Sanders (I-VT) invited Secretary Kennedy to testify at a committee hearing. The HELP Committee will examine the reasoning behind the RIF and reorganization plans and assess early impacts to health programs. The committee leaders referenced Secretary Kennedy’s commitment made during the confirmation process to report before the HELP Committee on a quarterly basis to further justify the Secretary’s participation.
And, on April 2, House Energy & Commerce (E&C) Committee Ranking Member Frank Pallone (D-NJ-06) and Ranking Member of the Subcommittee on Health Diana DeGette (D-CO-01) sent a letter to E&C Chair Brett Guthrie (R-KY-02) requesting a hearing with the HHS Secretary. The Ranking Members characterized the HHS restructuring and RIF plan as unauthorized actions that indiscriminately cut the federal health workforce and highlighted the E&C Committee’s role in exercising oversight on the Administration’s actions.
Administration Activities
NASTAD Condemns Mass Workforce Cuts at Federal Health Agencies
On April 1, HHS began implementation of its reduction in force (RIF) plan, which will eliminate about 10,000 jobs. HIV prevention services are heavily impacted by the RIF, putting decades of progress towards ending the HIV/AIDS epidemic at risk. The Centers for Disease Control and Prevention (CDC) faced some of the largest losses, significantly impacting its programmatic capacity. Entire branches in the National Center for HIV, Hepatitis, STDs, and Tuberculosis Prevention (NCHHSTP) were eliminated, putting everyone in the United States at risk for disease outbreaks and worsened health outcomes. NASTAD strongly condemns these cuts and urges Congress to step in and protect our nation’s public health safety net. The end of the HIV/AIDS and hepatitis epidemics in the United States is within sight, but these cuts are a huge step backwards and will harm the health of the American people and the American economy. Click here to read NASTAD’s full statement on the recent HHS actions.
HHS Ordered to Cut Contract Expenditures
In addition to the RIF and programmatic restructuring, HHS is expected to implement additional cuts by reducing contractual spending across all of its agencies and operating divisions. The Trump Administration is requiring HHS to reduce up to 35% of its contract expenditures, which could affect a range of federal functions, including research partnerships with universities, state and local programmatic support and grantmaking, and operational expenditures, such as office maintenance and procurement of specialized equipment. CDC must determine which contracts it will scale back or terminate by April 18.
Trump Administration Withholds Title X Family Planning Program Funds
On March 31, sixteen providers participating in the Title X Family Planning Program received notice that HHS would withhold program payments as the Administration determines whether the grantees are complying with new federal requirements. The Title X program, the nation’s only federal program dedicated to providing affordable access to contraceptive services and sexual and reproductive preventive care including HIV and STI testing, has been a target of Congressional Republicans and the previous Trump Administration, which sought to force Title X providers out of the program. Almost $35 million in funds are being withheld, resulting in the loss of all Title X-funded programming in seven states.
Resources
“Embedding implementation science (IS) research into health departments can foster relevant and robust research that is responsive to health department needs. However, few health department evaluators have formal IS training. Building internal health department capacity to conduct rigorous evaluation has the potential to catalyze improvements in Ending the HIV Epidemic (EHE) service delivery… IS short-courses are a promising strategy to increase health department evaluators' understanding of IS and to gain confidence in how to apply IS methods to their own EHE evaluations.”
KFF: 5 Key Facts About Medicaid Coverage for People with HIV
“Medicaid is the primary source of insurance coverage for people with HIV, playing a key role in financing HIV care and prevention efforts…Policy proposals being considered by Congress to reduce federal spending for the Medicaid program could have negative implications for people with HIV and those at risk. It is unclear what specific policies might be implemented to achieve federal reductions and a range of options are being considered, but reductions in federal Medicaid funding would shift costs to states and could result in coverage losses, reduction in benefits, cost-shifting to HIV safety-net programs, and/or reductions in payment rates to providers, if states do not offset federal dollars.”
KFF: Medina v. Planned Parenthood: What Does the Case Mean for Medicaid Beneficiaries?
“The Supreme Court is considering whether Medicaid beneficiaries can sue in federal court to enforce the program’s “free-choice-of-provider provision” that allows beneficiaries to seek care from any provider qualified and willing to participate in the program. The outcome of this case would have an impact on Medicaid beneficiaries in South Carolina and could also affect people in other states that may want to exclude Planned Parenthood from their Medicaid programs. The Court is expected to rule in June.”
Hepatitis C Mentor and Support Group Webinar: Hep C Stigma – From the Clinic to the Streets
Date: Tuesday, April 22 from 5-6 pm ET
“HCMSG will host a webinar focusing on stigma and hepatitis C. Learn how providers work with their hepatitis C patients experiencing stigma across various populations.”
Job Postings
Executive Director of Programs – New York City, NY
The New York City Health Department is seeking an Executive Director of Programs to join its Bureau of Hepatitis, HIV, and STIs (BHHS). The Executive Director of Programs will provide day-to-day oversight and operational support to BHHS’s HIV Care and Treatment Program, HIV Epidemiology Program, HIV Prevention Program, STI Program, and Viral Hepatitis Program, which comprise the majority of the bureau’s staff. The Executive Director of Programs will report to BHHS’s Assistant Commissioner and work alongside the Assistant Commissioner and BHHS leadership to ensure these Programs are supported to function optimally and collaboratively, and that BHHS is well-positioned to implement its strategic priorities and achieve its mission to improve the lives of New Yorkers by ending transmission, illness, stigma, and inequities related to viral hepatitis, HIV, and STIs. For more information or to apply for the position, visit the job posting on NYC Jobs, here.
Communicable Disease Epidemiologist – Cheyenne, Wyoming
This position will serve as the Communicable Disease AIDS Drug Assistance Program (ADAP) Coordinator, Wyoming TB Controller, and Disease Intervention Specialist (DIS) for the Communicable Disease (CD) Treatment Program. Assist in outbreak response to ensure the safety of Wyoming residents; by interviewing cases for exposure information, updating news outlets on the progress of outbreak control, analyzing exposure data utilizing epidemiological and statistical methods.
News Bulletin
What Happens If a Highly Effective HIV-Prevention Drug Is No Longer Free?
“But PrEP might soon be beyond reach once again. The U.S. Supreme Court is gearing up to hear Kennedy v. Braidwood Management Inc., a case that could effectively sever access to cost-free preventive care services — including PrEP. The court’s decision could have major implications for Black Americans, who are more likely than other demographic groups to underutilize the drug. Though Black Americans account for roughly half of the country’s HIV diagnoses, studies have shown that only about 12% of PrEP users are Black. A decision in the Braidwood case is expected this summer. This uncertainty comes as extensive job cuts rattle federal health agencies, including sections responsible for HIV research. One infectious diseases expert remarked that this latest round of mass layoffs — some 10,000 workers were fired on Tuesday — ‘will go down as one of the darkest days in modern scientific history.’”
Trump administration axes more than $125M in LGBTQ health funding, upending research field
“The nation’s LGBTQ research field is collapsing. In recent weeks, academics who focus on improving the health of lesbian, gay, bisexual, transgender and queer Americans have been subjected to waves of grant cancellations from the National Institutes of Health. More than 270 grants totaling at least $125 million of unspent funds have been eliminated, though the true sum is likely much greater, researchers told NBC News.”
Democratic-led states sue to block Trump from $11 billion health funding cut
“A group of Democratic-led states on Tuesday sued Republican U.S. President Donald Trump's administration to challenge its cancellation of $11 billion in federal grants the states were allocated during the COVID-19 pandemic. Attorneys general and governors from 23 states and the District of Columbia in a lawsuit filed in federal court in Rhode Island argue the U.S. Department of Health and Human Services lacks the authority to unilaterally claw back funding the states had already built health programs around.”
Replication Study Refutes Naloxone “Moral Hazard” Paper
“Seven years ago, a deeply controversial paper claimed that states introducing laws to expand naloxone led to increases in opioid-related emergency room visits and arrests, in a reflection of “moral hazard.” The paper, which sparked headlines everywhere from the Atlantic to the Washington Post and CNN, was heavily criticized by harm reduction advocates and other public health experts at the time. A researcher in Australia has now sought to replicate the study—and found major flaws which made its conclusions unjustifiable.”