Analyzing the Proposed HHS Budget Cuts: Impacts on Vulnerable Populations

The recently leaked Office of Management and Budget (OMB) document dated April 10, 2025, outlines dramatic changes to the Department of Health and Human Services (HHS). This “passback” document, which represents an early stage in the budget process, proposes significant funding reductions and structural reorganization that would fundamentally alter federal health services. While these changes would affect all Americans, vulnerable populations would likely bear a disproportionate burden of these cuts.

Scope and Scale of Proposed Changes

The Trump administration is proposing to slash HHS’s discretionary budget by approximately $40 billion, reducing it from about $121 billion to around $80 billion – a reduction of roughly one-third12. This comes alongside a substantial reorganization that has already seen approximately 20,000 HHS employees depart through layoffs, buyouts, or early retirement2.

The document reveals a transformation of the HHS structure, including the creation of a new “Administration for a Healthy America” (AHA), elimination of multiple agencies, and dramatic funding reductions across nearly all operational divisions34. Key proposed changes include:

  • Centers for Disease Control and Prevention (CDC) budget reduced by 44% (from $9.2 billion to $5.2 billion)15
  • National Institutes of Health (NIH) funding cut by approximately 40%24
  • Food and Drug Administration (FDA) budget decreased by 19%5
  • Elimination of numerous established federal health programs6
  • Termination of the Affordable Care Act’s enhanced premium tax credits4

Impact on Children and Families

The proposed budget would eliminate Head Start, a program serving approximately one million children from low-income families across America76. This termination would have cascading effects:

“Eliminating Head Start would leave countless families without an option for care for their children, putting their job security and our national economy at risk,” according to an analysis by First Focus7.

The document also reveals cuts to other child-focused programs:

  • Elimination of Teen Pregnancy Prevention programs3
  • Defunding of childhood lead poisoning prevention efforts5
  • Cuts to maternal mental health services8
  • Reduction or elimination of child abuse prevention programs9

These changes would disproportionately affect working families who rely on these services for both child development and enabling parental employment. Children of color, who represent a significant portion of Head Start participants, would be particularly affected by these cuts9.

Healthcare Access for Low-Income Americans

The budget proposes significant changes to programs serving economically disadvantaged Americans:

Medicaid and Safety Net Programs

The leaked document indicates significant coming changes to Medicaid, though specific dollar amounts aren’t detailed910. Rural communities would be particularly affected, where “24% of people are covered by the program, including 47% of all births and a majority of nursing home patients”10.

Hospital closures would likely follow these cuts, especially in rural areas where facilities already operate on thin margins. As one expert noted, “This loss of funding will lead to deaths in our communities from preventable medical incidents, such as precipitous births, cardiac events, untreated diabetes complications, and preventable suicides”11.

Affordable Care Act Changes

The budget “assumes a decline in Federal Exchange enrollment due to the expiration of the enhanced premium tax credits”4, which would make insurance less affordable for many Americans. According to a Commonwealth Fund report cited in the documents, letting these subsidies expire would cost states “$34 billion in gross domestic product and $2 billion in tax revenue”4.

Impacts on Indigenous Communities

The Indian Health Service (IHS) faces particularly severe cuts, with approximately $900 million slated for reduction-about 30% of its budget1112. This includes:

  • Elimination of IHS advance appropriations, which protect tribal health funding during government shutdowns12
  • Defunding of tribal behavioral health grants12
  • Cancellation of new construction projects for already underfunded facilities13

Tribal leaders have warned that these cuts would be devastating: “If each facility across the IHS lost just 1 physician-level provider, 43 percent of those facilities would have to close their doors completely”11. The IHS already operates with a 30 percent vacancy rate and is chronically underfunded11.

Mental Health and Substance Use Treatment Reductions

The proposal drastically scales back mental health and addiction services at a time when the nation faces ongoing crises in both areas:

  • Cuts to the Substance Abuse and Mental Health Services Administration (SAMHSA)14
  • Elimination of numerous substance abuse prevention and treatment programs13
  • Reduction in crisis response resources, though maintaining some funding for the 988 Suicide Prevention and Crisis Lifeline13

The CEO Alliance, a coalition of 16 major mental health organizations, warned that “significant cuts to SAMHSA staff and resources would impact Americans in every corner of the country”14 and “curtail the progress we have made on reducing overdose deaths”14.

HIV/AIDS Response Dismantled

The budget would fundamentally alter the nation’s HIV response by:

  • Eliminating the Ending the HIV/AIDS Epidemic (EHE) Initiative, which had provided new funding and reduced HIV infections in targeted jurisdictions15
  • Discontinuing the cross-cutting Minority AIDS Initiative15
  • Cutting $239 million from the Ryan White HIV/AIDS program, which provides care and treatment to low-income people with HIV15
  • Eliminating CDC’s domestic HIV prevention and surveillance activities15

As the Kaiser Family Foundation notes, “while the proposal would maintain most but not all of the nation’s HIV care and treatment safety net, it would scale back (or potentially eliminate) federal HIV prevention efforts”15. This would likely lead to increased HIV transmission rates and worse health outcomes for those living with HIV.

Elderly and Disabled Americans

The proposed budget eliminates several critical programs serving older Americans and people with disabilities:

  • Long-Term Care Ombudsman program, which advocates for residents’ rights in nursing homes and resolved over 200,000 complaints in 202316
  • Elder falls prevention programs13
  • Elder justice and adult protective services13
  • Several disability services programs consolidated or eliminated13

The Consumer Voice expressed that “the dissolution of the LTCOP would place all residents in settings served by Ombudsman program representatives at risk”16.

Public Health Infrastructure Weakened

The CDC’s budget would be dramatically reduced, with elimination of programs addressing:

  • Chronic disease prevention (heart disease, obesity, smoking cessation, diabetes)1
  • Climate and health initiatives13
  • Childhood lead poisoning prevention13
  • Many infectious disease surveillance programs13

This reduction in public health capacity comes despite recent pandemic experiences, with the FDA also ceasing “routine inspections at food facilities”2. The proposed changes appear to focus on acute infectious disease response while reducing prevention and chronic disease management efforts.

Conclusion

The proposed HHS budget represents a fundamental shift in federal health priorities, dramatically reducing the government’s role in healthcare, public health, and social services. The $40 billion reduction would significantly impact America’s most vulnerable populations-children in poverty, rural communities, the elderly, people with disabilities, those with mental health and substance use disorders, and racial/ethnic minorities who already experience health disparities.

While the document is labeled “pre-decisional” and subject to change before becoming a formal budget proposal to Congress317, the restructuring and staff reductions already underway suggest that some of these changes may proceed regardless of congressional action. As McDermott+ noted in their analysis, “the FY 2026 president’s budget could wind up becoming less of a request and more of an actual operating budget”17.

The extent to which these changes eventually impact vulnerable populations will ultimately depend on the final budget approved by Congress, but the scope of proposed reductions suggests significant challenges ahead for many Americans who rely on federal health programs.

  1. Preliminary Budget Would Slash HHS Funding, Encourage Restructuring ↩︎ ↩︎ ↩︎

  2. HHS funding slashed by 30 percent in budget proposal - Politico ↩︎ ↩︎ ↩︎ ↩︎

  3. Leaked Budget Document Previews Potential Cuts to HHS Grants ↩︎ ↩︎ ↩︎

  4. Leaked HHS budget projects $40B in cuts, ACA subsidies expire ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

  5. For Our Health warns the proposed HHS budget cuts put Americans at risk ↩︎ ↩︎ ↩︎

  6. White House plan would eliminate Head Start ↩︎ ↩︎

  7. Trump Administration’s Plan to Eliminate Head Start Threatens Child Care ↩︎ ↩︎

  8. Maternal Health Can’t Wait: Proposed HHS Cuts Threaten Progress ↩︎

  9. The Trump Administration’s War on Children - ProPublica ↩︎ ↩︎ ↩︎

  10. Medicaid Cuts Rippling Through Rural America Could Bring Hospital Closures ↩︎ ↩︎

  11. Trump FY 2026 Budget Aims to Slash $900 Million from Indian Health Service ↩︎ ↩︎ ↩︎ ↩︎

  12. NCUIH Urges HHS to Reconsider Proposed Budget Cuts to Indian Health Service ↩︎ ↩︎ ↩︎

  13. Hhs_Re_Org_Chart_4_10_25_V2.pdf ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

  14. Cuts to SAMHSA Would ‘Impact Americans in Every Corner of the Country’ ↩︎ ↩︎ ↩︎

  15. Scaling Back the Nation’s HIV Response? What the Trump Administration’s HHS Budget May Do ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

  16. Department of Health and Human Services Budget Passback Proposes $40 Billion in Cuts ↩︎ ↩︎

  17. The Leaked OMB Passback Document: What It Is and Isn’t ↩︎ ↩︎