President Trump recently released his fiscal year (FY) 2021 budget request totaling $4.8 trillion. Overall, the proposal includes deep cuts to research, public health programs, federal student financial aid and loan forgiveness, and graduate medical education (GME), all of which are vital to educating the next generation of osteopathic physicians and improving patient health across the nation.
Highlights from the proposal pertinent to osteopathic medical education include the following:
Department of Education
Requests $66.6 billion, a $5.6 billion or 7.8 percent reduction in funding from FY 2020 enacted levels.
- Proposes institutions participate in student loan risk sharing but does not describe what that plan looks like in depth. Any program must be authorized by Congress.
- Consolidates multiple income-driven repayment (IDR) plans into a single plan.
- Caps borrower’s monthly payment at 12.5 percent of discretionary income.
- For undergraduate borrowers, any balance remaining after 15 years of repayment would be forgiven.
- For borrowers with graduate debt, any balance remaining after 30 years of repayment would be forgiven.
- Proposes to auto-enroll severely delinquent borrowers in IDR.
- Removes standard repayment cap.
- Calculates payments for married borrowers filing separately using their combined household Adjusted Gross Income (AGI).
- Eliminates the Public Service Loan Forgiveness program.
- Eliminates subsidized loans for undergraduate students.
- Proposes to set annual and aggregate limits of $50,000 and $100,000 respectively for graduate students, exclusive of any undergraduate borrowing.
- Graduate student borrowing would be consolidated under one graduate loan program with the same corresponding loan terms and conditions as the current Grad PLUS program.
- Recommends the evaluation of the Office of Federal Student Aid (FSA) as an independent, separate organization.
Department of Health and Human Services
Requests $96.4 billion in discretionary funding, a 9 percent decrease from FY 2020.
- Provides $38 billion for the NIH, a nearly $3 billion (7.2 percent) cut from the FY20 enacted level.
- Combating the Opioid Crisis -- Proposes $5 billion to combat the opioid epidemic, while trimming the overall Substance Abuse and Mental Health Administration’s budget by $142 million.
- Continuation of $1.6 billion, an $85 million increase, in State Opioid Response Grants and $1.85 billion for the Substance Abuse Prevention and Treatment Block Grant.
- Consolidates GME spending in Medicare, Medicaid, and the Children’s Hospital GME Payment Program into a new mandatory GME capped grant program.
- Extends Teaching Health Centers Graduate Medical Education (THCGME) Program, Community Health Centers, and the National Health Service Corps.
- THCGME Program: Includes $126.5 million in mandatory resources for residency training in primary care medicine and dentistry in community-based, ambulatory settings. This is level funding with FY 2020.
- National Health Service Corps: Provides $430 million, including $120 million in flat discretionary funding. Additionally, the budget continues the $310 million mandatory appropriation fund for FY21, which would require congressional reauthorization.
- Health Centers and Free Clinics: Provides a total of $5.7 billion, including $4 billion in mandatory funding.
- Title VII and Title VIII Programs – Eliminates thirteen health professions training and workforce programs, including the Loan Repayment/Faculty Fellowships; Health Professions Training for Diversity (including the Scholarships for Disadvantaged Students and Health Careers Opportunity Program); Primary Care Training and Enhancement; Oral Health Training Programs; Graduate Medical Education for Health Care Professionals; Area Health Education Centers; Geriatric Programs; Public Health/Preventative Medicine; Advanced Nursing Education; Nursing Workforce Diversity; Nurse Education, Practice and Retention; and Nurse Faculty Loan Program.
- Preserves funding for the Centers of Excellence, Behavioral Health Workforce Development Programs, and NURSE Corps Scholarship and Loan Repayment Program with a slight decrease.
- Proposes to eliminate the Agency for Healthcare Research and Quality (AHRQ) as a standalone agency and transfer its authority to a new institute within NIH as the National Institute of Research on Safety and Quality (NIRSQ). This was proposed previously in the past three budget year proposals. The FY21 request for AHRQ/NIRSQ is $257 million, a decrease of $81.3 million or 24 percent below AHRQ’s current funding level.
Department of Veterans Affairs
Requests $105 billion in discretionary funding in 2021, a 14 percent increase from FY 2020, and $94.2 billion in advance appropriations for VA medical care programs in 2022. Additionally, the budget requests:
- Provides $90 billion, a 12.7 percent increase, to fully support veteran medical care.
- $309.4 million to fully support implementation of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018.
- $787 million for VA research in FY21, a $23 million or 1.6 percent decrease from FY20 enacted levels.