Policy Updates: Hill Happenings and Administration Activities
Hill Happenings
House Passes One Big, Beautiful Bill Act
On May 22, the House of Representatives passed the One Big Beautiful Bill Act (H.R. 1), a domestic budget and policy bill that advance many of President Trump’s priorities, including changes to tax law, boosted immigration enforcement and defense spending, and an increase to the debt ceiling. Republicans leveraged the budget reconciliation process to pass H.R. 1, a legislative procedure that fast-tracks budget bills by lowering the vote threshold to a simple majority vote, waiving the Senate’s ability to filibuster, and restricting some opportunities for the Senate to amend House-passed bill text. Notably, to achieve the deep spending cuts called for by the White House, H.R. 1 includes sprawling changes across federal agencies and programs. The health proposals in the bill contain controversial changes to the Medicaid program, including an $800 billion cut to core Medicaid and ACA funding, new eligibility requirements for some programs that would restrict access to coverage for millions, and targets access to care for vulnerable populations.
FY2026 Appropriations
Appropriators have been working behind the scenes to establish spending agreements for the Fiscal Year 2026 (FY2026) bill while the One Big Beautiful Act captures priority attention. On May 23, the House and Senate appropriations committee stopped accepting member spending requests and began developing bill text. On May 21, the House Appropriations Committee scheduled a subcommittee markup for the Labor, Health and Human Services, Education, and Related Agencies Bill on July 21 and a full Appropriations Committee markup on July 24. Additionally, Senate Democrats continue to question the Administration’s withholding of Congressionally-approved funds for some programs, and urge the Government Accountability Office to identify mechanisms to address potential violations of the Impoundment Control Act.
HHS Secretary Defends HHS Budget During House, Senate Committee Hearings
On May 14, Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. (RFK) appeared before the House Appropriations Labor, Health and Human Services, Education, and Related Agencies (LHHS) Subcommittee and the Senate Health, Education, Labor, & Pensions (HELP) Committee to defend the policy and spending proposals included in the President’s Budget Request to Congress for FY2026. The White House released a “skinny budget” on May 2 that proposed over $30 billion in cuts across HHS agencies and operating divisions for FY2026, which could further jeopardize programs that have limited capacity following the Administration’s reduction in force plans that it launched on April 1. During both hearings, some Republicans joined Democrats and pressed the Secretary to reconsider proposals that eliminate or scale back critical health programs, including infectious disease prevention programs at the Centers for Disease Control and Prevention (CDC). RFK maintained that the Administration’s changes would streamline programs and promote efficiency, and that certain programs were bloating federal health spending despite not achieving consistent gains year-after-year to prevent disease and reduce morbidity and mortality.
NASTAD Urges Congress to Reject Medicaid Funding Cuts and New Restrictions on Beneficiary Eligibility
On May 16, NASTAD and The Partnership to End the HIV, STI, and Hepatitis Epidemics urged Congress to reject proposals targeting Medicaid funding and enrollment in the budget reconciliation bill. The coalition highlighted the important role of the Medicaid program for people living with HIV (PLWH), which is the single largest source of coverage for PLWH and makes up 45% of all federal funding for HIV treatment. Additionally, the Partnership emphasized the work-supporting role of Medicaid, which empowers beneficiaries to gain and maintain employment by supporting their overall health and ability to work.
NASTAD Calls on Health Appropriators to Provide Funding for Health Data Modernization in FY2026
On May 23, NASTAD and 71 organizations called on House and Senate LHHS leaders to provide funding for Centers for Disease Control and Prevention (CDC) public health data modernization efforts in FY2026. The coalition highlighted the important role of building and maintaining world-class health data systems and public health workforce in order to safeguard the nation’s health against acute, chronic, and emerging threats. Additionally, the advocates urged Congress to protect data modernization programs from further fiscal and programmatic interruptions after the Administration’s HHS-wide reorganization and reduction in force plan impacted existing efforts.
NASTAD Urges Congress to Reject Cuts to Planned Parenthood
On May 13, NASTAD and a coalition of 83 organizations called on Congress to oppose any efforts to “defund” Planned Parenthood through the budget reconciliation process. The coalition highlighted the safety-net role that Planned Parenthood health centers play for millions of patients who rely on them for care, including Medicaid beneficiaries and rural and medically underserved communities. In many communities, Planned Parenthood health centers are the only affordable provider with expertise in sexual and reproductive health.
Administration Activities
White House Releases Agency-Level Budget Details for FY2026
On March 30, the Trump Administration released the Department of Health and Human Services (HHS) Budget in Brief, which provides agency-level and programmatic details on the Administration’s budget proposals for FY2026. The Budget in Brief proposes large cuts to health funding, including HIV prevention, and the creation of a new agency the Administration for Healthy America (AHA). Not all details on the budget proposal have been released, but the known proposals can be found below.
- HHS Office of Infectious Disease and HIV/AIDS Policy - $8 m
- The budget proposes $8 million for these activities at AHA.
- Minority HIV/AIDS Fund
- The budget proposal eliminates the Secretary’s HIV/AIDS Fund.
- Centers for Disease Control and Prevention (CDC)
- Division of HIV Prevention
- The budget proposes eliminating HIV prevention activities at CDC. This is a decrease of $793.7 million. This would impact funding for health departments, community-based organizations, and surveillance programs.
- The budget proposes moving Ending the HIV Epidemic Initiative HIV prevention activities to the Administration for Healthy America.
- Viral Hepatitis, Sexually Transmitted Infections, and Tuberculosis Prevention
- The budget proposes $300 million for a consolidated grant program to address Viral Hepatitis, Sexually Transmitted Infections, and Tuberculosis Prevention. The purpose is to “reduce administrative inefficiency and allow for more coordinated approaches. Also, the budget will be used to enhance surveillance and improve disease outbreak detection.”
- Opioid and Infectious Diseases
- Funding for the Opioid and Infectious Diseases program has been eliminated in the budget proposal.
- Center for Injury Prevention
- The Center for Injury Prevention was moved to AHA and a cut in funding was proposed. The new AHA program will continue to support opioid overdose prevention and surveillance activities, but it is unclear what activities will be continued and at what level.
- Health Resources and Services Administration (HRSA)
- Ryan White HIV/AIDS Program
- The budget proposes moving the Ryan White HIV/AIDS Program to be housed within the newly created AHA.
- The budget proposes eliminating Part F AETCs, Part F Dental, and Part F SPNS. The budget does not show a breakdown for the other parts, but based on the total funding proposed, we can assume all other parts, including Ending the HIV Epidemic funding, are flat funded in the proposal.
- Bureau of Primary Care
- The President’s Budget Request includes funding for Ending the HIV Epidemic at the Primary Care section of AHA. It is unclear at what levels.
- Title X Family Planning Program
- The Title X Family Planning Program is eliminated in the proposal.
- 340B Drug Pricing Program
- The budget proposes moving the 340B Drug Pricing Program oversight from HRSA to the Centers for Medicare and Medicaid Services.
- National Institutes of Health (NIH)
- The Budget proposes cutting NIH by $17 billion dollars.
It is important to note that this is a budget request and does not have the power of the law. Only Congress has the power to appropriate funds. NASTAD will be advocating for the highest possible funding levels for programs.
Matthew Buzzelli Named Acting CDC Director
On May 14, HHS Secretary RFK confirmed that Matthew Buzzelli is serving as the CDC Acting Director during the Senate HELP hearing on the Administration’s FY2026 budget request to Congress. Buzzelli is a lawyer by training and has limited public health experience. Prior to being named Acting Director, Buzzelli was the CDC Chief of Staff, where he served as a key contact to the White House for CDC matters. He replaces Susan Monarez, the current nominee to lead the CDC, who became ineligible to serve as Acting Administrator due to restrictions against cabinet nominees serving as interim agency leaders. Monarez replaces former legislator Dave Weldon, whose nomination was pulled due to concerns that his controversial health beliefs would derail his nomination and detract from the (MAHA) agenda being spearheaded by RFK.
CMS Launches New Value-Based Care Model for Certain Preventive Services
On May 14, the Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) launched its new strategy to “Make America Healthy Again.” CMMI incorporated evidence from over a decade of testing alternative payment models in order to reduce the cost of care and improve the quality of health networks. The new strategy is anchored by three pillars: Promote evidence-based prevention, empower people to achieve their health goals, and drive choice and competition for people. Notably, the new strategy prioritizes prevention of chronic illness, a key priority for the right-wing health movement, including adding value-based payment models for preventive care and incentivizing health promotion efforts.
USPSTF Updates Recommendation to Screen for Syphilis during Pregnancy
On May 13, the US Preventive Services Task Force (USPSTF) released a final recommendation statement for syphilis screening among pregnant people that calls for universal screening of all asymptomatic pregnant women. USPSTF assigned an A grade to the recommendation, which would maintain the cost-free status of syphilis screenings for consumers covered by both public and private insurance. The new recommendation reaffirms the 2018 recommendation and incorporates new evidence into its assessment.
DEA Publishes National Drug Threat Assessment
On May 15, the Drug Enforcement Administration (DEA) released the 2025 National Drug Threat Assessment (NDTA). Each year, DEA conducts a comprehensive review of the threats posed by the consumption and trafficking of illicit drugs in the US and summarizes the findings in the NDTA, which is used to inform federal drug policies and strategies to address threats to the public health. The 2025 NDTA acknowledged the recent decline in overdose death rates but highlighted the need for continued efforts to sustain decreases in opioid overdose morbidity and mortality. Additionally, the NDTA found that veterinary sedatives like xylazine continue to be the primary contaminant in an increasingly unpure illicit fentanyl supply. Notably, the report highlights the emerging threat of medetomidine, a veterinary sedative more potent than xylazine that is becoming more prevalent in the fentanyl supply.
DHS Updates its List of Jurisdictions Designated as Sanctuary Jurisdictions
On May 29, the Department of Homeland Security issued a list of jurisdictions it designated as a sanctuary city, county, or state in response to a directive included in the Executive Order (EO), Protecting American Communities From Criminal Aliens. The EO directs DHS to locate sanctuary jurisdictions, notify them that they are violating federal immigration laws, and identify federal grants and contracts that could suspended or terminated if they continue to violate the law. DHS characterizes sanctuary jurisdictions as “lawless,” and claim they protect dangerous criminal illegal aliens from facing consequences and put law enforcement in grave danger. On Sunday, June 2, DHS removed the list from its website due to broad criticism and pushback from local officials of both political parties.
CDC Data Show Progress in Reducing Overdose Mortality Rates
On May 14, the CDC National Center for Injury Prevention and Control released preliminary data that show a nearly 27% decrease in overdose deaths from 2023 to 2024. CDC highlighted the impact of comprehensive public health strategies and interventions to reduce opioid overdose morbidity and mortality, including expanded access to and distribution of naloxone, improved access to treatment for substance use disorders (SUD), and sustained investments in prevention initiatives. Notwithstanding the progress, CDC raised the need to maintain and deepen investments in overdose prevention strategies and programs that employ comprehensive and whole of society approaches.
Resources
“Broad access and availability of vaccines is critical for immunization programs to avert disease. Since 1994, the U.S. Vaccines for Children (VFC) program has covered the cost of vaccines for children whose families might not otherwise be able to afford them…During the VFC program era, routine childhood immunizations in the United States have been an important cost-saving public health strategy. Childhood immunizations continue to provide substantial health and economic benefits and promote health equity.”
AIDS and Behavior: Epidemiologic and Economic Impacts of Halting National HIV Prevention Efforts
“This modeling approach estimates that between 2025 and 2030, halting national HIV prevention efforts will increase 6-year total HIV incidence by over 213,300, 6-year total deaths by over 10,600, prevalence by over 202,700 (in 2030 alone), and prevalence of persons in care by over 90,900 (in 2030 alone). The heightened costs of medical care (above the costs of non-HIV related care as well as accounting for any “savings” by slashing HIV prevention efforts) between 2025 and 2030 would tally over $85.2 million (again, this estimate is in excess of any programmatic “savings” so ending HIV prevention would not save money even in the next half-decade). The discounted lifetime costs of medical care that must be accounted for with each additional HIV infection (estimated here at $274,079 which is a relatively low estimate in the HIV cost of illness literature) total over $52.4 billion given increasing incidence. The value of statistical lives lost due to increased deaths would total over $131.8 billion (this calculation uses a $13 million value of a statistical life for each additional death caused by cutting HIV prevention, and this $13 million value is what was recently employed by the White House to calculate the eco-nomic impact of fentanyl-related deaths.”
JAMA: Local Anesthetics Adulterating the Illicit Fentanyl Supply
“Adulteration of IMF with veterinary sedatives, such as xylazine and now medetomidine, has become commonplace across the US, leading to prolonged sedation that cannot be reversed with naloxone.1 Clinicians, harm reduction experts, and others continue adapting to such changes in the drug supply (eg, testing drug products with test strips and the increased use of oxygen when treating overdoses). In recent months, we have identified a worrisome trend related to the increased identification of local anesthetics (or “-caines”) in IMF and biospecimens obtained from patients.”
GU O’Neill Institute: Quick Takes
- The Ryan White HIV/AIDS Program: The Program’s Parts Work Together to Make It Effective
- “A strong and vibrant RWHAP is also needed to extend the strong outcomes achieved by the program. As Congress contemplates fundamental changes in how federal health care programs are funded and administered, protecting and reinforcing this critical program can keep the darkest periods of the HIV epidemic from returning.”
- Our Interconnected HIV Care Financing System is Under Threat
- “Over time, our nation has built an increasingly effective and robust system of financing and delivering HIV primary and specialty care for people with and at risk for HIV in the U.S. Potential changes to Medicaid and private insurance, combined with reduced support for HIV programs, would lead the nation backward.”
“in a new analysis, KFF estimates the potential impact of the proposed $625 billion in federal Medicaid cuts over 10 years on state budgets and Medicaid enrollment…Based on the Congressional Budget Office estimate that the reconciliation bill could decrease Medicaid enrollment by 10.3 million people nationally by 2034, KFF’s analysis shows Washington, Virginia, and Montana could see the largest drops. In each of these states, Medicaid enrollment could fall by 15% to 32%.”
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
Judge shuts down drugmakers’ 340B rebate plans, for now
“Drugmakers have to continue paying hospitals upfront discounts for drugs in the 340B program — at least in the near term — after a federal court ruled late last week against major manufacturers that wanted to issue rebates for 340B drugs instead. However, the D.C. district court didn’t entirely rule out drugmakers’ paying after-the-fact rebates in the future, instead determining that the companies would need to get prior approval from the Health Resources and Services Administration, the HHS subagency that oversees 340B. It also directed HRSA to reconsider a rebate plan from Sanofi that regulators had denied.”
Judge temporarily blocks Trump administration from laying off federal employees
“A federal judge on Friday temporarily blocked President Donald Trump’s executive order that enabled the administration to fire tens of thousands of federal workers and to eliminate certain agencies entirely. The ruling puts on hold the White House’s plans to implement government-wide layoffs, including expected staff cuts at the departments of State, Treasury, Transportation, Veterans Affairs and the Social Security Administration. Senior U.S. District Judge Susan Illston said in her order federal laws give the president broad power to reorganize the government, including to order mass layoffs. But she added the White House must also follow a set of rigorous legal and procedural requirements.”
A pill could end the HIV epidemic. Why do so few Mississippians take it?
“Jermany Gray worked up the nerve to ask his doctor about preventive medication for human immunodeficiency virus, or HIV, at his last check-up before leaving Jackson to go to college. He knew that for someone like him – a young, Black, gay man living in Mississippi – the odds of acquiring HIV were alarmingly high… He asked his doctor to prescribe him pre-exposure prophylaxis, or PrEP, a highly effective medication that people who are not living with HIV can take to protect themselves from the virus. But she refused to write the prescription and instead recommended that he abstain from having sex. Gray’s experience isn’t an anomaly. Thousands of Mississippians with risk factors for HIV don’t take PrEP due to insufficient provider education, lack of awareness, stigma, affordability and limited access to health care.“