
Written by Hussein Sesay
Every four years, as we welcome a new president, we often ask: what will change? A shift in leadership usually brings dramatic changes, and a second term frequently builds on the previous one. But what happens when a president returns after a break? The last example was Grover Cleveland, our 22nd and 24th president, back in the late 1800s.
As we step into another Trump presidency, health centers and hospitals are questioning how it will affect their funding. Will we see improvements, or should we brace for possible cuts? While we can't predict the future, looking at past initiatives can provide insight.
In this article, we'll delve into key policy trends from President Trump's first term (January 2017-January 2021), examining how his decisions shaped healthcare grant funding and what they might signal for the future.
Repeal and Replace “Obamacare”
In 2016, Donald Trump campaigned on a promise to "repeal and replace" the Affordable Care Act (ACA), achieving some successes during his presidency.
Enacted in 2010, the ACA aimed to make health insurance more accessible and affordable by promoting preventive care, eliminating lifetime limits on essential benefits, and prohibiting preexisting condition denials. It encouraged universal participation through premium tax credits and cost-sharing reductions.
The ACA significantly impacted health centers, increasing their funding and allowing them to expand services and reach larger patient populations. The Medicaid expansion under the ACA led to an increase in patient volume at Federally Qualified Health Centers (FQHCs), enabling them to offer a broader array of services, including mental health and dental care. Health centers also played a critical role in facilitating insurance enrollment. According to the Kaiser Family Foundation, the percentage of uninsured individuals decreased by 6.8 percentage points from 2013 to 2016.
Despite these improvements, the ACA had its drawbacks. Some individuals faced premium increases and limited plan choices, posing challenges, particularly in rural areas served by many FQHCs. The complex enrollment process deterred participation, and issues emerged regarding narrow provider networks. Moreover, criticisms arose over specific ACA regulations, including the employer mandate and tax penalty. The shift to value-based pricing aimed at reducing hospital admissions also placed financial strain on health centers and hospitals, requiring them to care for patients with greater needs while facing reduced revenue.
In May 2017, the House of Representatives passed the American Health Care Act (AHCA) to replace the ACA. The AHCA aimed to lower healthcare costs and grant more flexibility to states, employers, and individuals. Key features included the repeal of ACA taxes, restructuring Medicaid funding into block grants, and promoting Health Savings Accounts (HSAs). However, the proposal faced opposition in the Senate and ultimately was not enacted.
Nevertheless, some AHCA reforms did persist, such as the elimination of the ACA's tax penalty, relieving individuals from disclosing their healthcare insurance status. The Trump administration ended subsidies to health insurance companies that help pay deductibles, co-payments and out-of-pocket charges for lower-income Americans. Additionally, Congress established exemptions to contraceptive coverage for employers and healthcare organizations opting out.
2. Medicaid Reform
There was an overall increase in federal healthcare spend during the Trump Administration, with a combined $1.2 trillion allocated to Medicare ($829 billion) and Medicaid ($671 billion) in 2020 alone. However, between 2016 and 2020 Medicaid funding and policy experienced significant changes, reflecting the Trump administration's focus on state-level control and fiscal conservatism.
A notable initiative was the introduction of Medicaid work requirements, implemented through 13 state waivers that made eligibility contingent on meeting specific work or community engagement criteria. Supporters argued that this approach could foster self-sufficiency, while critics raised concerns about the potential for significant coverage losses. For instance, in Arkansas, over 18,000 individuals lost Medicaid coverage within six months of the policy's implementation in 2018, often due to administrative barriers instead of a lack of willingness to comply.
Between 2017 and 2019, prior to the pandemic, Medicaid and CHIP enrollment declined by approximately 2.3 million individuals. This decline was primarily attributed to a strong economy, which increased access to employer-sponsored insurance, alongside stricter eligibility verifications. Additionally, the administration proposed restructuring Medicaid financing through block grants or per capita caps. These measures aimed to give states increased flexibility in managing funds while capping federal expenditures.
However, the Congressional Budget Office estimated that such changes, proposed under the 2017 American Health Care Act, could have resulted in a reduction of federal Medicaid funding by $1 trillion over ten years, leading states to make challenging decisions, including potential reductions in benefits or eligibility.
These proposals faced substantial public scrutiny, as a 2018 Kaiser Family Foundation poll indicated that 70% of Americans opposed work requirements if they led to coverage losses. Despite this opposition, by the end of Trump's presidency, 19 states had sought approval for work requirements, although many implementations encountered legal challenges and were subsequently reversed under the Biden administration.
Impact on Grant Funding:
Between 2016 and 2020, the percentage of uninsured individuals increased by approximately 10 percent, while enrollment in the Affordable Care Act (ACA) decreased by 2.8 million people. The formula-based grant allocations tied directly to insurance enrollments also declined in certain states. As a result, some state agencies saw reductions in grant funding for healthcare initiatives, leading to fewer pass-through grants for Federally Qualified Health Centers (FQHCs) that serve a higher number of uninsured patients. In response, healthcare organizations began to pursue alternatives to state and federal government grant funding.
However, there were some positive developments. Under the Trump Administration, funding to deploy telehealth expanded, particularly for rural and underserved communities. Medicare payments to rural hospitals also increased in an effort to address a decade of rising closures and to improve access to care in these areas.
ACA enrollment and Medicaid expansion has made a comeback under the Biden Administration. Many congressional representatives have indicated that the ACA is now considered "the law of the land." It remains to be seen whether "repeal and replace" efforts and Medicaid reform will be revisited in a second Trump Administration and what impact that may have on future funding.
3. Funding for Public Health and Pandemic Preparedness
Public health funding during the Trump administration faced a mix of challenges and opportunities. The administration frequently proposed budget cuts to agencies such as the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), citing broader efforts to reduce federal spending. In 2018, the administration proposed an 18 percent reduction in the NIH annual budget, cutting it from $31.8 billion to $26 billion.
This included significant cuts to several institutes: $1 billion for the National Cancer Institute, $575 million for the National Heart, Lung, and Blood Institute, and $838 million for the National Institute of Allergy and Infectious Diseases. The CDC was also at risk of losing 17 percent of its budget, which would have amounted to $1.2 billion. Such cuts could have resulted in a reduction of $333 million in funding for programs to combat infectious diseases, $136 million for the CDC Office of Public Health Preparedness and Response, and $76.3 million for the CDC Center for Global Health.
However, the COVID-19 pandemic in 2020 prompted significant emergency appropriations. The Coronavirus Aid, Relief, and Economic Security (CARES) Act, a $2.2 trillion economic stimulus package passed in March 2020, provided extensive funding to address the immediate impacts of the pandemic.
Key allocations included $100 billion to hospitals and healthcare providers; $27 billion to the Public Health and Social Services Emergency Fund for vaccine and therapeutic development, stockpiling medical supplies, and other pandemic-related activities; $4.3 billion allocated to the Centers for Disease Control and Prevention (CDC) for public health response efforts, including testing and contact tracing; and $945 million to the National Institutes of Health (NIH) for research into vaccines, treatments, and testing.
Impact on Grant Funding: The CARES Act bolstered healthcare grants and supported critical initiatives like vaccine development and public health infrastructure. More than $150 billion was allocated to state and local governments for healthcare-related needs, including testing, contact tracing, and hospital support.
These emergency funds highlighted the role of grants in addressing public health crises. Additionally, many states used this funding to support programs that tackled social determinants of health, such as food insecurity, shelter, and health literacy, which can significantly affect health outcomes.
In 2020, Grant Writers for Health applied for nearly 60 grants, a significant increase from our previous average of about 20 applications per year. We’ve observed that many of our clients have enhanced the intensity and duration of their patient support services with the help of CARES funding, leading to increased annual budgets.
We assisted clients in securing computers, creating testing sites, establishing virtual programs, purchasing vehicles, and serving two to three times more beneficiaries. Additionally, we helped them increase reimbursement for food, shelter, and clothing for their patients. However, in the years since, many organizations have struggled to find funding that keeps pace with the expanded programs initiated through CARES.
It is unlikely that the U.S. will experience such a large infusion of healthcare funding under normal circumstances. However, it raises the question of which areas might be worth future funding when the next Trump administration takes office.
4. Funding for Mental Health
During President Trump's tenure, substantial efforts were made to address the opioid epidemic, which had been declared a public health crisis. In fiscal years 2018 and 2019, the Trump administration secured $6 billion in funding to combat opioid abuse, misuse, and overdose.
Furthermore, a significant legislative achievement was the signing of the SUPPORT for Patients and Communities Act in 2018, a bipartisan law aimed at expanding prevention, treatment, and recovery initiatives nationwide. Key accomplishments under this initiative included a reduction in opioid prescriptions and enhanced access to medication-assisted treatment (MAT). The administration reported a nearly 40% increase in the number of Americans receiving MAT since 2016.
Efforts to make naloxone more accessible were intensified, contributing to a decrease in opioid-related fatalities. Additionally, the administration launched a nationwide public awareness campaign targeting youth opioid abuse, reaching 58% of young adults in America to prevent addiction before it starts. For the first time in nearly 30 years, drug overdose deaths declined in 2018, a milestone attributed to coordinated efforts across federal, state, and local levels, emphasizing prevention and intervention.
Impact on Grant Funding:
In 2019, the administration announced $1.8 billion in new grants to assist states in combating the opioid crisis. This included over $900 million allocated directly to states and territories to address opioid misuse within their communities, and $900 million in research funding for overdose treatment and improving overdose data, awarded through the Centers for Disease Control and Prevention (CDC).
Conclusion
During Trump’s previous presidency, healthcare policy and funding trends were highly centered around reducing federal involvement, promoting market-based solutions, and liberalizing the health sector. While some initiatives aimed to reduce the burden on consumers and provide more freedom of choice, others faced criticism for undermining coverage and equity.
The legacy of these policies continues to shape the American healthcare landscape, influencing debates on the role of government, the balance between market forces and regulation, and the prioritization of public health investments.
Stay tuned for our 2025 Healthcare funding predictions in our next article!
At Grant Writers for Health, we strive to stay ahead of the curve when it comes to federal healthcare funding trends. By closely monitoring developments in the field, we provide our clients with expert guidance to enhance the competitiveness of their grant applications.
Our insights empower you to adapt proactively, whether it's pivoting your approach or seizing new opportunities as they arise.
If you’re seeking a dedicated partner who shares your passion for health and is committed to your success, we invite you to consider working with us. Take a moment to complete our Grant Needs Survey and discover how our team can support you in navigating the grant landscape and securing the funding you need to make a meaningful impact.
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Editor: Dondra Ward Uzoka
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