All eyes are on President Donald Trump's administration plans for healthcare and medical research as they plan to slash budgets for the year 2018.

According to a 2018 budget published online – and rapidly withdrawn on 22 May – Medicaid, which provides healthcare cover for millions of Americans on low incomes or disability, was set to have a USD610 billion cut to the programme in over a decade, despite a campaign pledge not to touch Medicaid.

This is in addition to the USD839 billion cut written into the American Health Care Act – should the bill become law. It was passed by the House earlier this month. But the lingering questions about the Senate's plans for healthcare reform have made this unlikely.

Other health programmes that might be affected

The list included food stamps from the Supplemental Nutrition Assistance Program, which might have USD193 billion shaved off over the next decade.

Drug-free communities program, established to help build coalitions while decreasing substance use, and high-intensity drug-trafficking area programmes – which help state and local law enforcement agencies fight drug trafficking – will be eliminated if the cuts were implemented.

USD1 billion from the US Centres for Disease Control and Prevention, the country's health protection agency will also be slashed. This will indirectly affect domestic HIV/AIDS programmes – by reducing the testing and prevention services, and support services for persons living with HIV and prevention services, chronic disease preventions and health promotion programmes, as well as domestic CDC preventive health programmes.

International CDC preventive health programmes will also not be spared – the same with mental health services, community services block grants and federal participation in immunisation programmes.

Trump administration unable to touch previous initiatives

Medical research could also take a hit as the budget calls for slashing USD5.8 billion – nearly 20% – in funding for the National Institutes of Health (NIH).

Specific NIH funding cuts listed in Trump's budget include: a 19% cut for the National Cancer Institute, 18% for the National Institute of Allergy and Infectious Diseases, and 19% for the National Institute of Mental Health. The Substance Abuse and Mental Health Services Administration would see its budget fall by 9%.

But experts say that it is unlikely, as the Trump administration is unable to touch bills such as the 21st Century Cures Act that guarantees the NIH USD4.8 billion for the next decade - the majority of it, for three of Obama's signature initiatives.

Congress has also shown no signs of backing down from those appropriations, which may provide some sort of comfort to science advocates and researchers.

"I don't think it could be passed, honestly, through the House," said Representative Tom Cole, a Republican who leads the House health appropriations subcommittee. "And I'm certain it can't be passed through the Senate."

Administration turn to other alternatives to cut NIH budget

However, some Congressmen such as Andy Harris who represents Maryland, said he would support the NIH budget cuts provided that indirect costs be capped.

University administrators were concerned as they relied on these grants, which amounted to more than USD6 billion last year to carry out their research smoothly; the funding pays to keep freezers running, lights on and laboratories stocked with supplies.

In March, Health and Human Services Secretary Tom Price first hinted that indirect cuts could be cut, as he claimed 30% of grant funds cover indirect expenses, meaning that taxpayer dollars are supporting "something other than the research being done."

The Trump administration might state that many private institutions getting taxpayer funds to cover their amenities bills are quite wealthy. However, public universities do not have anywhere near the resources of an Ivy League school.

Bipartisan support for the NIH will make Trump's cuts unlikely

The budget document does not provide details on the capped rate – but two NIH sources say that indirect costs may be capped at 10%, compared to the usual 50 – 60%, according to a 2014 Nature investigation.

Should the proposal be passed, it "would seriously handicap the American research enterprise, in addition to immediately producing layoffs of thousands of fairly well-paid positions," said Dr Ross McKinney, chief scientific officer of the Association of American Medical Colleges.

Ironically, despite the ongoing controversy around indirect costs, the NIH has long elicited strong bipartisan support.

"I'm willing to look at anything that saves money, but you'd still be losing a lot of the support system for biomedical research," said Cole. "So until we have the chance to examine that and what the consequences are for research universities and institutions, it's premature to embrace." MIMS

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