Emma Bascom , 2025-05-21 15:42:00
Key takeaways:
- PCPs depend on resources from AHRQ and SAMHSA to provide preventive and mental health care.
- Experts gave Healio specific examples of how cuts to these agencies may directly impact patients.
Major cuts to some federal health agencies could have a detrimental impact on the everyday work primary care providers do, according to experts.
On May 2, the Trump administration released its 2026 budget proposal, sometimes referred to as the “skinny budget.”
The proposed budget includes funding for HHS resources that would help “tackle issues related to nutrition, physical activity, healthy lifestyles, overreliance on medication and treatments, the effects of new technological habits, environmental impacts, and food and drug quality and safety,” according to a White House press release.
However, discretionary funding levels in fiscal year 2026 include massive cuts to federal health agencies — roughly $33.3 billion for HHS as a whole (a 26.2% reduction from fiscal year 2025).
The specific cuts to some of the major, more easily recognizable agencies include:
- $17.965 billion cut to the NIH;
- $3.588 billion cut to the CDC;
- $1.732 billion cut to the Health Resources and Services Administration (HRSA); and
- $674 million cut to CMS.
Jason M. Goldman, MD, FACP, president of the ACP, told Healio that “without question” everyday PCPs are impacted by the work of federal health agencies. For example, NIH, CDC and HRSA work to improve access to preventive care like cancer screenings, keep the public informed about infectious diseases and are otherwise “important resources for physicians.”
Drastic cuts to the critical programs in the agencies could “have a generational effect on the longevity and health of the population,” he said.
PCPs may particularly be impacted by cuts to the Agency for Healthcare Research and Quality (AHRQ) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
Alan Dow, MD, MSHA, FACP, a Ruth and Seymour Perlin Professor of Medicine and Health Administration at Virginia Commonwealth University, told Healio that “the relationship between these agencies and the front-line delivery of health care is complex.”
“Cuts to these agencies may worsen the inequities we see in access to care and lead to strain across the health care system,” Dow, who is also a Healio Primary Care Peer Perspective Board member, said. “We may see some unpredicted outcomes from cuts.”
“These cuts need to be careful because they certainly could lead to some unexpected, bad results,” he continued.
AHRQ
AHRQ is facing a $129 million cut.
“AHRQ oversees the U.S. Preventive Services Task Force, which is the leading entity for creating screening recommendations. These recommendations not only guide care from PCPs and others, but also help determine what screening tests get paid for,” Dow said. “AHRQ also does research on front-line care, and this research changes practice.”
Ann Greiner, MCP, president and CEO of the Primary Care Collaborative, told Healio that the USPSTF is “a really important task force” for the everyday PCP.
As part of HHS’ restructuring, AHRQ will merge with the Assistant Secretary for Planning and Evaluation to create the new Office of Strategy.
The proposed budget states that much of AHRQ’s research “is wasteful or duplicative of research conducted elsewhere in the Department, such as NIH,” and will, therefore, be eliminated. It also said the budget will eliminate funding for grants and contracts “not aligned with the administration’s priorities.” The document cites two examples that are “wholly unrelated to MAHA” priorities: a study on reducing carbon emissions in health care and a project at Seattle Children’s Hospital that uses telehealth to increase access to gender-affirming care. (The proposal stated that, by funding the latter project, “AHRQ has also pushed radical gender ideology onto children.”)
According to the proposal, “the budget increases accountability by prioritizing AHRQ’s statistical work, eliminates the digital health portfolio, ends new grants, and offloads contracts and interagency agreements not associated with statistical activities.”
Greiner also said that AHRQ is the sole office in the federal government that is dedicated to primary care research. Therefore, the cuts could “potentially undermine our ability to understand what’s the most effective primary care.”
“In terms of the percentage of support for primary care research versus all the other things that the government supports, [primary care] is already dramatically underinvested in, and these cuts can make it even more difficult to do the research to find what are the most effective approaches to primary care — particularly when we’re talking about ways to prevent chronic conditions and ways to manage them or even reverse them,” Greiner said. “If you’re making cuts to that research, it’s going to be more challenging to find those more effective pathways.”
Goldman also stressed the importance of AHRQ. On average, he said he sees 20 to 30 patients daily, and they could come in with “anything from a common cold to a cancer diagnosis to a significant infection to basic preventive services, as well as mental health screening and depression treatment.”
With so much information to balance, Goldman said it can be difficult to keep up, and “if I don’t have up-to-date recommendations, if I don’t have the resources in place to be able to treat these patients, they’re going to suffer.”
“[AHRQ] allows for new ideas, innovations, evidence-based treatments and a framework to be able to provide good-quality care and new ways of delivering care. That information is critical for how we treat our patients,” he said. “I worry that if we don’t have access to this, that we won’t have the best, high-quality, up-to-date recommendations to treat our patients.”
AHRQ officials did not respond to Healio’s request for comment.
SAMHSA
SAMHSA is facing a $1.065 billion cut, with the budget maintaining $5.7 billion “for activities that were formerly part of SAMHSA.” As part of the HHS’ restructuring, SAMHSA is being integrated into the newly minted Administration for a Healthy America.
According to the budget proposal, SAMHSA grants in the previous administration “were used to fund dangerous activities billed as ‘harm reduction,’ which included funding ‘safe smoking kits and supplies’ and ‘syringes’ for drug users.”
“The budget proposes to refocus activities that were formerly part of SAMHSA and reduces waste by eliminating inefficient funding for the Mental Health Programs of Regional and National Significance, Substance Use Prevention Programs of Regional and National Significance, and the Substance Use Treatment Programs of Regional and National Significance,” the proposed budget states. “These programs either duplicate other federal spending or are too small to have a national impact.”
On May 14, provisional data from the CDC’s National Center for Health Statistics reported that, in 2024, there were 80,391 drug overdose deaths in the U.S. — down nearly 27% from 110,037 in 2023. The number of annual drug overdose deaths are now projected to hit the lowest level since 2019, according to the CDC.
A SAMHSA spokesperson told Healio in a statement that the agency “recognizes the integral role PCPs play in the behavioral health care system, and supports education and training efforts to better promote prevention, screening and early behavioral health interventions across the continuum of care.”
“Since a primary care setting may be the first encounter an individual in need of behavioral health care has, SAMHSA works to ensure providers have the knowledge and networks to connect patients with appropriate services,” the spokesperson said. “PCPs use a variety of SAMHSA resources to help inform their care of patients with behavioral health concerns.”
The spokesperson provided a list of SAMHSA programs but did not respond to questions from Healio about why funding was cut and how this will affect the agency’s activities.
Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence, told Healio the cuts will “be incredibly destructive.”
“It’s unfortunate that any administration would disrupt the hard-won progress that’s been made over the last years. Opioid-related overdoses have decreased,” he said. “We have said to various agencies in the administration and the members of Congress that they should anticipate that there will be increases in drug use and there will be increases in death.”
“It takes a very long time to reverse drug use and overdoses,” he said. “It took years for that to happen over the last couple of years, which means that it’s going to take years to try to reverse it once again.”
That likely means more strain on primary care, according to Goldman. He said SAMHSA “has been so helpful for our patients” because PCPs go through the agency to get certifications, resources and training to administer medications for opioid use disorder and other addictions.
“If we don’t have that, how are we going to be able to impact the drug crisis?” he said. “I don’t see how they’re going to make up for [the cut resources] and be able to actually treat our patients.”
Simply, if SAMHSA does not “have the support they need,” PCPs, patients and the health care system as a whole will all feel the effects, he said.
“So those providers who do the mental health, behavioral health and substance abuse as part of their primary care practice are not going to have the basic funding to be able to continue those programs, which is going to further impact not only access to patient care, but also treatment,” he said. “And where are those patients going to go? They end up in emergency rooms and hospitals, which is going to further strain the already stressed system, and it’s going to drive up costs and reduce access to care.”
Greiner also said that many mental health services are provided through primary care, “and there’s a lot of support in the community for integrating behavioral health into primary care.”
“SAMHSA operates grant programs that support that kind of integration, and we’re concerned that those kinds of cuts could make it more difficult to provide that more holistic kind of care,” she said. “If you’re no longer supporting those grant programs that help to provide behavioral health in primary care, then I think it’s more difficult for people to get primary care services, so that’s a real-world implication.”
Goldman also mentioned how “more and more” mental health care is falling to PCPs since, for many patients with mental health or substance abuse issues, their “first touch with the health care system” will be with their PCP.
“If the programs aren’t there, the grants aren’t there to be able to integrate with primary care, we’re not going to be able to sustain these models, to be able to take care of our patients,” he said. “It’s very difficult to get a patient into a psychiatrist or a mental health treatment or a substance abuse treatment [specialist] because they’re just not available. They just don’t have anyone there to take care of them. So, by and large, it falls upon PCPs to step up and take care of those patients in the mental health space and the substance abuse space.”
Benefits?
The experts agreed that fraud, waste and abuse should be cut from the budget.
“I think that most people agree that there could be some streamlining in the federal government,” Greiner said. “Budget cuts, I guess, offer that opportunity. But generally, you have to be very strategic about evaluating where there is waste or fat, if you will, and where you’re going to be cutting into the bone. I think that takes time to do that kind of evaluation, and these efforts seem to be moving very quickly.”
Dow said that the U.S. has “too large” of a budget deficit and spends “way too much” on health care — “way more than our peer countries for similar or worse health outcomes.”
“Potentially, these cuts may be part of the solution to our financial challenges, but these cuts make up less than 1% of the cuts or tax increases needed to get to a balanced budget,” he said. “We need to be careful about spending, and we need to realistic about what changes are really going to solve our financial problems.”
Goldman agreed that everyone wants an efficient, effective government, but said that “can’t be at the expense of” patient care.
“We want to make sure that things are done correctly, things are done efficiently, but it has to be done in such a way that makes sense. We need to approach government spending with a scalpel and not a chainsaw or a sledgehammer. You can’t say ‘we’re just cutting everything’ and hope for the best,” Goldman said. “You want to make sure that if there are areas that need to be done better, we need to look at it carefully and make sure it’s done. without completely destroying the core function of what these agencies are supposed to do. We need to still have the safety nets in place. We need to have the resources in place.”
Parrino said he “can’t imagine what” benefits to the SAMHSA cuts specifically would be. He said that “in terms of real impact on public health,” these cuts will “create more harm.”
“You have to be thoughtful about what you’re doing,” he said. “I mean, why do you want to run the risk of reversing the hard-won gain of reducing the use of fentanyl or other drugs, and then creating more death? I simply do not understand it,” he said. “Only the sort of extreme view would say, ‘well, these people don’t have value.’”
Take-home message
Dow said PCPs should be aware of how things may change.
“Being involved with local medical societies and professional organizations is one way to do this,” he said. “I also think PCPs may need to find new sources of information for topics like immunizations and screening guidelines.”
Greiner said PCPs “rightfully, could be concerned about some of these proposed cuts that could undermine their efforts to provide more comprehensive primary care,” but they have power in their voices and experiences.
“What PCPs can do is tell their story about the impact of behavioral health integration — because oftentimes, when you have a chronic condition, you can also have a mental health challenge,” she said. “Sometimes those go hand in glove. So, if those kinds of services are cut, they have the potential to undermine the administration’s agenda to make America healthy, and I’m sure they would not want that to happen.”
Goldman said in these “very challenging times for health care,” it is important to “err on the side of patient care and do what’s best for them, as far as making sure they have access to good physicians, to the up-to-date resources, to the highest standards that we can achieve.”
“But we also want to make sure that on the governmental side, they continue to fund these necessary and life-saving programs, because if we destroy the public health infrastructure, then the ripple effect on the rest of the country and the health of the population will be devastating. It’s not just going to affect a small subset,” Goldman said. “When you do away with the public health infrastructure, you’re going to end up affecting the entire system, driving up costs, being less efficient, ending the health of the patients and jeopardizing the care that we are providing.”
“We need to have a more effective, efficient, but common-sense approach to maintain a good public health infrastructure without destroying these life-sustaining and critically important programs,” he continued.
For more information:
Alan Dow, MD, MSHA, FACP, can be reached at alan.dow@vcuhealth.org.
Jason M. Goldman, MD, FACP, can be reached at primarycare@healio.com.
Ann Greiner, MCP, can be reached at agreiner@thepcc.org.
Mark Parrino, MPA, can be reached at mark.parrino@aatod.org.
