Trump’s NIH Funding Cuts and the Influence of Project 2025
Introduction: Unexpected Cuts to Cancer Research Funding
In the early days of President Donald Trump’s administration, a surprising move was made that caught many off guard: the announcement of significant funding cuts to the National Institutes of Health (NIH), the nation’s leading federal cancer research agency. This decision was unexpected, especially given the critical role NIH plays in advancing biomedical science and research. What many voters didn’t know was that this move was part of a broader conservative plan laid out in a document called Project 2025, compiled by the Heritage Foundation, a well-known conservative research group in Washington, D.C. Despite Trump’s claims during his campaign that he knew nothing about Project 2025, his administration has closely followed the playbook, leaving many questioning his earlier disclaimers.
The Heritage Foundation’s Project 2025 and NIH Funding
Project 2025, a 922-page conservative blueprint for governance, outlines specific goals for reshaping the nation’s health care system. One of its key recommendations is to break the NIH’s "monopoly" on directing research and to cap payments to universities and their affiliated hospitals. The document argues that such measures would help reduce federal taxpayer subsidization of what it refers to as "leftist agendas." These changes are part of a larger effort to limit the influence of what conservatives see as progressive ideologies within academic and research institutions.
Universities and medical research institutions have been vocal in their opposition to these cuts, arguing that they will have a devastating impact on ongoing and future biomedical research. The cuts not only affect the research itself but also the overhead costs that universities rely on to support their research infrastructure. Legal challenges from medical institutions and 22 states led to a federal judge temporarily halting the cuts to medical research on February 10, highlighting the significant opposition to this policy.
Rapid Adoption of Project 2025’s Objectives and the National Health System
The swift implementation of many of Project 2025’s objectives suggests that Trump’s team, many of whom were contributors to the document during his first term, have been quietly laying the groundwork to disrupt the national health system for years. This contradicts Trump’s repeated claims of ignorance about the document, including his statement at a rally in Albuquerque, New Mexico, where he said, "I have no idea what Project 2025 is. I’ve never read it, and I never will."
Opposition groups and state Democratic leaders have been quick to respond, leveraging the predictability of Trump’s actions based on the Project 2025 playbook. They are preparing for further actions, including potential litigation, as the administration moves to implement additional recommendations from the document. These recommendations include changes to Medicaid, Medicare, and other federal health agencies, which could have far-reaching consequences for millions of Americans.
Impact on Medicaid and Medicare
One of the most concerning aspects of Project 2025’s recommendations is its potential impact on Medicaid and Medicare, two of the nation’s largest and most important health programs. The plan calls for state flexibility to impose premiums, work requirements, and lifetime caps or time limits on Medicaid coverage for certain enrollees. These changes could lead to a significant increase in the number of uninsured individuals, particularly after the Biden administration’s expansion of Medicaid coverage.
Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit, explains that while these proposals may not directly alter eligibility for Medicaid or the benefits provided, the ultimate effect would be fewer people with health coverage. "When you erect barriers to people enrolling in Medicaid, like premiums or documenting work status, you end up rationing coverage by complexity and ability to pay," Levitt said.
Rollback of Transgender Health Protections and Global Health Initiatives
In addition to changes in domestic health care, the Trump administration has also taken steps to roll back protections for transgender individuals and limit global health initiatives. For instance, an executive order signed by Trump banned federal funds for transition-related care for people under 19 and directed the federal government to recognize only two sexes, male and female, using the term "sex" instead of "gender." The Project 2025 document also calls for deleting the term "gender identity" from federal rules, regulations, and grants, arguing that it advances a "radical redefinition of sex."
These changes have had immediate and far-reaching consequences. The Centers for Disease Control and Prevention (CDC) removed online information about transgender health and LGBTQ+ health data, although a federal judge later ordered much of this information to be restored. However, the administration added notices to some webpages labeling them "extremely inaccurate" and claiming they don’t "reflect biological reality."Additionally, the CDC delayed the release of information on bird flu in its Morbidity and Mortality Weekly Report, and federal workers were told to retract papers containing words such as "nonbinary" or "transgender."
Opposition and Legal Challenges
The implementation of Project 2025’s health policy goals has faced significant opposition from advocacy groups, researchers, and legal experts. Many argue that these policies pose a threat to medically necessary care and discriminate against certain groups, particularly transgender children and their families. Lawyers, advocates, and researchers have expressed concerns about the anti-science and anti-data nature of these policies, with some describing the playbook as presenting an "antiscience, antimedicine agenda."
In response to these concerns, numerous court challenges have been filed, and organizations are preparing for further legal battles. Noah Bookbinder, president of Citizens for Responsibility and Ethics in Washington, noted that the predictability of Project 2025’s recommendations has allowed opposition groups to plan their legal strategies in advance. "There has been a lot of planning on the litigation side to challenge the executive orders and other early actions from a lot of different organizations," Bookbinder said.
Conclusion: The Future of U.S. Health Care and Policy
The rapid implementation of Project 2025’s recommendations has raised concerns about the future of U.S. health care and policy. While the Heritage Foundation has sought to distance itself from Trump’s executive orders, the close alignment between the document and the administration’s actions is undeniable. Versions of Project 2025 have been produced roughly every four years since the 1980s, influencing other GOP presidents, including Ronald Reagan. However, the Trump administration has gone even further than the document’s recommendations in some cases, such as scaling back the U.S. Agency for International Development (USAID) and reinstating the "global gag rule," which has had a chilling effect on international family planning efforts.
As the administration continues to push forward with its agenda, it faces growing public opposition. Nearly 60% of voters expressed negative feelings about Project 2025 in a September poll by NBC News, indicating that the administration’s policies may not have the public support needed to sustain long-term changes to the health care system. Despite this, the implementation of Project 2025’s goals is setting the groundwork for even more significant changes to U.S. health care and policy in the future. As Ally Boguhn, a spokesperson for Reproductive Freedom for All, put it, "Project 2025 was never a thought exercise; it was always a blueprint."
