Will this be the House of the setting sun for the Agency for Healthcare Research and Quality? The Trump Administration has been trying to eliminate AHRQ, the one federal agency responsible for research into healthcare safety and quality. And now it looks like the House Appropriations Committee is going along with that plan.
The House committee’s new proposed bill and budget doesn’t include AHRQ, calling the agency “duplicative” in a recently-released fact sheet without specifying exactly how and why. This is part of the committee’s proposed 6% slash to the U.S. Department of Health and Human Services budget for this upcoming fiscal year. Also included in the HHS cut is a 19% slice to the Centers for Disease Control and Prevention budget. The big Q—meaning question—about AHRQ then is how not having the agency around anymore may affect the safety and quality of the healthcare that you and your loved ones receive? That could be literally a life-and-death question.
The Trump Administration Has Been Trying To Eliminate AHRQ
So how did things get to this point? Well, you know the saying if at first you don’t succeed try try again? Well, the Trump administration episode one had already tried to eliminate AHRQ during Donald Trump’s first term as President back in 2017 as I covered in Forbes at the time. But Congress didn’t really listen to Trump back then. So AHRQ survived. Ah, but it looks like things are oh-so-different in oh-so-many ways for this second coming of the Trump administration.
Once Trump became President on January 20, it didn’t take long for his administration working with Elon Musk heading the so-called Department of Government Efficiency known as DOGE to completely get rid of the U.S. Agency for International Development known as USAID. This happened fairly rapidly without Congress stepping in and saying we can’t go for that, no, no can do. So, on July 1, USAID, which had been around since 1961, was officially shut down. The State Department then sucked up like a Roomba the remaining slivers of USAID’s operations and programs.
The Trump administration hasn’t yet toppled the smaller AHRQ in quite the same manner. Instead, over the past several months, it’s been more a death by a thousand cuts with progressive layoffs and dismissals of personnel and cuts to funding and operations. I’ve been told by contacts at AHRQ that at this point empty chairs far outnumber people at meetings there. And it looks like the Trump administration wants AHRQ to go the way of the Dodo bird, too, not including AHRQ in its proposed budget for the next fiscal year.
AHRQ Was Officially Established in 1999 By Bipartisan Efforts
It’s important to remember the “p” word when it comes to the Trump administration’s proposed budget. It’s proposed meaning that Congress doesn’t have to go along with it. That’s because of all the checks and balances, separation of powers Constitution thing. Yet, it looks like House Appropriations committee is following the Trump administration’s lead in many ways. doing so at least when it comes to AHRQ. The fact sheet does clearly state, “This bill supports President Trump’s efforts to safeguard taxpayer dollars, eliminate out-of-touch progressive policies, and end the weaponization of government by eliminating or reducing more than 100 programs.
And the House bill would indeed take the significant step of eliminating AHRQ, an agency that’s officially been around since 1999 but can trace its roots all the way back to 1968. That was the year that the National Center for Health Services Research and Development got started. During the 1970s and 1980s, this Center went through a Diddy-like phase, where the Center’s name, configurations and oversight were changed multiple times. That was until the Omnibus Budget Reconciliation Act of 1989 designated what was a Center to become its own operating agency with the name the Agency for Health Care Policy and Research. It went by the acronym AHCPR, which looks a bit like saying, “Ah, CPR.”
That was until the Healthcare Research and Quality Act of 1999 officially formed the AHRQ as we know it today—at least as we knew it before the Trump Administration and DOGE began dismantling the agency. Forming AHRQ was a bipartisan effort. Senator Bill Frist (R-Tennessee) sponsored the bill with support from Senator Ted Kennedy (D-Massachusetts), Representative Michael Bilirakis (R-Florida) and Representative Henry Waxman (D-California). President Bill Clinton then signed everything into law. That established AHRQ as the lead Federal agency on healthcare quality and safety research.
How Eliminating AHRQ May Affect The Quality And Safety Of Your Healthcare
Through its subsequent two-and-a-half decades AHRQ has published a range of influential healthcare reports. For example, in 2001, there was the “Making Healthcare Safer: A Critical Analysis of Patient Safety Practices” that listed 73 evidence-based patient safety practices that were not routinely done in hospitals and nursing homes across the country. Then in 2003, AHRQ released The National Healthcare Quality Report and The National Healthcare Disparities Report, which were at the time the first attempts to provide a comprehensive view of the quality of healthcare and differences in people’s access to healthcare services across America.
Additionally, AHRQ has established different programs and toolkits to help patient safety. This has included ones to help doctors, nurses, hospital managers, patients and others reduce medical errors and healthcare associated infections as measure quality of care. It’s also established programs and tools to help with discharging patients from hospitals, arranging post-discharge care, preventing hospital readmissions and identifying preventive services.
AHRQ has also been an important—or actually the important—funder of researchers in universities, academic medical centers and other organizations working on issues related to healthcare quality and safety. For example, in 2009 alone, AHRQ awarded $17 million to fund projects aimed at fighting healthcare-associated infections. Without AHRQ around, it’s not clear who will support such research going forward. This could mean less science about how to make healthcare safer and better for everyone. That will end up hurting everyone including you, unless you happen to be something indestructible and never requiring healthcare like Superman, Supergirl or a fruitcake.
Without AHRQ, It’s Not Clear What Other Part Of HHS Will Oversee Healthcare Quality And Safety
Again even though the House committee fact sheet called AHRQ “duplicative,” it did not provide any facts supporting this statement. It did not list any other parts of the federal government that is currently doing AHRQ-like work. Other places in the federal government that may bear the words “healthcare” and “quality” like say the CDC’s Division of Healthcare Quality Promotion haven’t really done the same things that AHRQ has been doing. Plus, the CDC and other parts of HHS may get further cut as well.
I will continue to reach out the contacts in HHS for further clarity about these proposed cuts and their potential effects. An ongoing question is how much of these cuts of scientific programs and funding are being guided by, you know, science, scientists and people who actually understand the areas well enough to know the ramifications of such decisions. For example, scientific studies have shown how different AHRQ efforts and AHRQ-funded projects have been associated with or led to reductions in medical errors and healthcare associated infections over time. These in turn have saved lives and costs.
The House Bill Proposes Various Cuts To CDC
As alluded to earlier, AHRQ wouldn’t be the only HHS victim of the House bill’s cuts. The HHS budget would drop by $7 billion from its fiscal year 2025 allocation down to $108 billion for the next fiscal year. Included among these cuts would be a 19% slash to the CDC budget. Yes, you heard that correctly. The CDC would have to say bye-bye to nearly a fifth of its funding.
Why does the committee want to make CDC take this fifth? Well, the stated rationale on the House fact sheet is “focusing the Centers for Disease Control and Prevention (CDC) on communicable diseases rather than social engineering” by “streamlining 35 duplicative and controversial programs while increasing funding to combat emerging and zoonotic infectious diseases.” Again, the fact sheet doesn’t really detail how the programs are ”duplicative and controversial.”
Moreover, focusing the CDC on communicable diseases could overlook the heavy and complex interplay between communicable and non-communicable diseases and other aspects of society. For example, a range of different infectious pathogens and diseases can lead to different chronic medical conditions such as COVID-19 leading to long COVID, human papillomavirus to cervical cancer, Helicobacter pylori to stomach ulcers and cancer, Epstein-Barr Virus to lymphoma. hepatitis B or C viruses to liver disease and cancer and HIV to heart disease. Similarly, many chronic medical conditions can make you more susceptible to infectious diseases and more severe outcomes. Furthermore, numerous studies have shown how different aspects of society such as social interactions, the environment, access to healthcare and the presence and absence of various economic resources can affect the spread of infectious diseases.
What’s Next For The House Bill And AHRQ
The next step for the House bill is to get marked up by the House Appropriations Committee, which is scheduled to happen late Tuesday. Whatever eventually makes it out of the committee will then be reviewed, modified and voted on by the House of Representatives. Of course, the House is just one of two legislative bodies comprising Congress. I’ve already written in Forbes about the proposed Senate budget. At some point, whatever comes out of the House will have to be reconciled with whatever comes out of the Senate.
So, there are still chances that the AHRQ could get rescued at some point by the House of Representatives. But the proposed budget by the Appropriations Committee doesn’t look very House warming to the AHRQ right now.
