1146: Budget Battles and Capitol Hill Updates

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Monday, June 15, 2026. I'm John Sheehan, with news from the Association of State and Territorial Health Officials.

Today: budget battles and Capitol Hill updates. We hear the latest on the future of public health programs being discussed in Washington. ASTHO Senior Analyst for Government Affairs, Catherine Jones, breaks down Secretary Robert F. Kennedy Jr.'s FY27 budget hearings, where lawmakers examined proposed reductions to HHS funding and questioned how cuts to public health programs align with the administration's Make America Healthy Again agenda. Then ASTHO Vice President of Government Affairs, Jeffrey Ekoma, reviews a Legislative Alert and explains developments in congressional appropriations pending public health leadership nominations, proposed changes to federal grant regulations, and the possibility of another reconciliation package before the end of the year. First, here's Catherine Jones.

So, Catherine, last April, Secretary Kennedy held his FY 27 budget hearings. What's the significance of these hearings?

CATHERINE JONES: 

Yeah, just to recap, this past April, HHS Secretary Robert F. Kennedy Jr. participated in a marathon series of seven House and Senate hearings. These hearings highlighted the administration's public health priorities for FY27, and Congress had the opportunity to ask the secretary questions about his accomplishments and vision for our nation's health system. The overall significance of these budget hearings was that it was less about a single budget proposal and more about signaling a broader shift in the federal government's approach to public health. With over 20 hours of testimony, Secretary Kennedy outlined a vision focused on restructuring HHS, reducing spending, and reorienting towards prevention at the same time, lawmakers made clear that Congress intends to assert its authority over funding decisions, especially where proposed cuts could impact core public health programs.

SHEEHAN: 

Okay, well, let's start there. What were some of the major funding changes that were proposed?

JONES: 

Well, the president's FY27 budget proposes cuts of about $111 billion in discretionary funding for HHS. This represents a $15.8 billion or 12.5% reduction from FY26 levels. These reductions raise bipartisan concern, particularly because many of the programs targeted for cuts are central to improving public health, long-term health outcomes, and to reducing health care costs, but it's not just the money that is needed, as some congressional representatives pointed out. These programs need people. They need federal employees to run departments that programs depend on, and many federal agencies have seen drastic cuts in workforce that are impacting their ability to provide technical assistance and federal expertise. Public health departments around the nation rely on these services.

SHEEHAN: 

Okay, and how does the proposal and these cuts, how does it all fit within the framework of the Make America Healthy Again concept?

JONES: 

Yeah, Secretary Kennedy's MAHA framework emphasizes prevention, individual responsibility for one's health, such as good nutrition and exercising, improving the U.S. food supply, and reducing chronic disease burdens, and improving mental health conditions. While the framework calls for improving outcomes and efficiency, lawmakers questioned whether cutting existing public health programs and the potential impacts of the One Big Beautiful Bill would undermine the very goals that MAHA aims to achieve.

SHEEHAN: 

Sure, so, what were these concerns raised by lawmakers?

JONES: 

They were focused heavily on the real-world impacts of funding cuts and program disruptions. Key concerns included reductions to maternal and child health programs, elimination of injury and violence prevention initiatives, cuts to environmental health, and the instability caused by delayed or terminated grants in the public health space. Lowering drug prices and making health insurance affordable were other topics raised by lawmakers repeatedly.

SHEEHAN: 

Yeah, can you elaborate some of those concerns? Because you cited things that are, studies shown what happens when certain funding gets reduced.

JONES: 

Yeah, many of the budget cuts are aimed at data collection as well as programmatic work. Public health relies on data to form evidence-based interventions and policies, and to track progress, or the lack of progress. For instance, we are in the midst of a maternal health care crisis in the United States. We need as much data from the Pregnancy Risk Assessment Monitoring System, also known as PRAMS, as we can gather to figure out what's going wrong and how to fix it. Lawmakers' concerns, as I mentioned, also focused on federal workforce reductions and whether agencies would have the capacity to implement programs effectively, even if funding is restored or maintained, or ideally, increased. Rural and territorial health were also mentioned, repeatedly, as having critical needs for sustained and adequate public health funding. And this was in addition to the $50 billion Rural Health Transformation Funds that were part of the One Big Beautiful Bill. Lastly, I'll say the spotlight was trained on food safety, microplastics, glyphosate, which is a fertilizer that is believed to cause cancer. These were mentioned by various lawmakers and Kennedy provided his latest efforts to work on these issues.

SHEEHAN: 

Okay, and you know this was a budget proposal, so it has not been passed, but what does this mean for public health, potentially? You know that this is the direction that they're trying to head.

JONES: 

Yeah, how this will end; where we don't know. But the hearings highlighted concerns about the future direction of public health. Decisions made in this budget cycle will shape how federal agencies, states, and territories build workforce capacity, maintain infrastructure, and respond to emerging threats. Sustaining predictable investment in public health, along with a strong workforce at federal, state, and local levels, remains essential, and most importantly, people need to trust in that system and the public health messaging it provides.

SHEEHAN: 

Absolutely, Catherine Jones. Thanks so much.

JONES: 

Thank you.

SHEEHAN: 

Catherine Jones is ASTHO senior analyst for government affairs. Now, let's get the latest from Washington with Jeffrey Ekoma, ASTHO vice president of government affairs.

So, Jeffrey, as usual, it's busy on the Hill. What's going on? What's top of mind?

JEFFREY EKOMA: 

There's been a significant amount of movement as it pertains to appropriations. There has been some movement in the House that I would love to share more about. We are also actively tracking activity around nominations from the administration that require approval from the Senate. Notably, before the Senate HELP Committee are the nominations for Dr. Erica Schwartz to be the next CDC director, Sean Kaufman to be the next for ASPR, and Dr. [Nicole] Safier to be the next surgeon general. We're also analyzing a proposal from the White House Office of Management and Budget that would, one, directly impact government-wide requirements for federal grants, two, would change the merit review process, three, codify the ability for agencies to terminate active grants mid-award with the need for agencies to provide a written rationale to impacted grantees, four, clarify allowable expenses and activities conducted with federal funding, and lastly, clarify the reimbursement request process for grantees. The proposed rule would impact everyone across the United States government, and once finalized, individual cabinet-level agencies would have their discretion on how they would interpret the rule. So, it's something that we're tracking really closely, still analyzing, and we do, ASTHO is trending towards submitting formal written comments to the proposed rule.

SHEEHAN: 

It kind of sounds like you just said that every agency would have discretion at how they interpret the rule.

EKOMA: 

That is correct. Yeah, the rules are incredibly expansive, as you can imagine. So much, and so many federal grants go from federal agencies to many different types of grantees, stakeholders, community, so it does have a far wide-reaching impact across the board.

SHEEHAN: 

Wow, okay. Let's, let's start with one of the first developments you mentioned, that's budget and appropriations movement in the house.

EKOMA: 

There's a lot, so, there's lots of movement there. The House Labor, Health and Human Services, and Education Appropriations Committee released its version of its Labor HHS Bill that funds much of public health and human services, and education. We actually released a Legislative Alert that delves deeper into the bill and also includes relevant report language for individual programs that I would love for everyone to take a look at, if you already haven't. The bill was successfully marked up and voted out of the subcommittee and the full appropriations committee, compared to the FY26 bill. This is the FY27 bill. The FY27 bill is slightly more reasonable in terms of allocation for programs, and also, language included within the bill. It does reject many of the administration's FY27 budget proposals to restructure public health programs. However, it does continue the trend of eliminating programs that are not of a priority to the administration. Overall, there's about a $4 billion cut to HHS when compared to FY26, and most federal public health agencies saw a decrease to their budgets. The appropriations process is still somewhat in its early stages, and things are far from final. The Senate has not begun its process of considering appropriation bills while that was supposed to begin last week. We do anticipate that it will begin shortly, after they're able to settle disagreements on top-line funding levels, as well as policy riders that some senators have deemed to be essential to attaching to appropriation bills. We also do anticipate consideration of the Labor HHS bill to happen sometime in July. It's supposed to happen towards the end of the month, but with this setback, that likely will happen post July 4.

SHEEHAN: 

Okay, okay, a lot of moving pieces outside of appropriations and budgets, and outside of some of the stuff that is currently in the proposal stage. Is there anything else happening on the Hill that public health leaders need to be aware of?

EKOMA: 

Oh, the many, many, many things that are happening. I do want to know on reconciliation. Reconciliation is something that the folks from our government affairs team have talked about at length in the past. Recently, the House passed another reconciliation bill that the Senate passed that is focused on immigration enforcement and DHS funding for ICE and CBP. So, that's been done. Now, there remains a significant appetite to consider another reconciliation bill before the end of the current session of Congress, which ends at the end of the calendar year. Now, that package would focus on addressing fraud, waste, and abuse, as well as affordability issues around a host of topics that also includes health care. There are active discussions within the House on what this could look like, and there are also lots of discussions on whether specific priorities could make it to the finish line. Now, those discussions, like I said, have for the most part been in the House. There's not been lots of discussions in the Senate. A framework for what this bill could look like is forthcoming, and as you can imagine, it's something that we will be tracking incredibly closely. I think, from our estimation, the One Big Beautiful Bill Act was a large piece of legislation in terms of the amount of new funding that it authorized, and the second reconciliation bill that I talked about is another bill. We anticipate that the amount of spending for this bill was some will be somewhat in the middle of those two if it were to make it to the finish line.

SHEEHAN: 

Right, of course. Oh boy. Okay. In the next few weeks, what else are you watching out for?

EKOMA: 

I mean, I can't overstate it, but the big thing is appropriations. I think there's a lot of interest in Congress to get appropriations to a point where they can't go any further, and then things will begin to potentially move after midterm elections in November. We're also actively monitoring sort of the post-midterm election priorities for different committees on Capitol Hill, and what that could mean for public health. And last but not least, we're actively tracking concerns that we've heard from state and total health departments on grants that have not flowed to states. And I kindly ask that if there are folks that are having any trouble with any outstanding or upcoming NOFOs or NOAs that have not been posted, that they reach out to anyone at ASTHO, so we can be supportive in sort of advocating that those are released at the right time.

SHEEHAN: 

Yeah, because as you mentioned, it's a new ball game after the midterms.

EKOMA: 

Absolutely, things will look very, very different than they do now.

SHEEHAN: 

Jeffrey Ekoma, thanks as always.

EKOMA: 

Thanks so much.

SHEEHAN: 

Jeffrey Ekoma is ASTHO's vice president of government affairs. Earlier, we heard from Catherine Jones, ASTHO's senior analyst for government affairs.

Join ASTHO and the Public Health Foundation on June 18 for an insightful webinar exploring the power of academic health department (AHD) partnerships. In this session, participants will gain a foundational understanding of AHD partnerships and hear how the Public Health Institute's Center for Health Leadership and Impact, supported by the California Endowment, developed the California Academic Health Department initiative. Join us to learn proven strategies for building academic practice partnerships that cultivate a workforce ready to serve their communities. Find more at the link in the show notes.

Congratulations to ASTHO's Ali Maffey, vice president of social and behavioral health, on receiving the Ellen R. Schmidt Award from Safe States Alliance. This prestigious honor recognizes her leadership and contributions to advancing injury and violence prevention. Ali and fellow honorees will be recognized at the Safe States 2026 Annual Injury and Violence Prevention Conference, June 24-25. A link is in the show notes.

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.