27 current institutes and centers would be folded into 8, with 4 eliminated
By Megan Molteni, Jonathan Wosen, and Anil Oza — April 16, 2025
Original article on STAT News
A draft Trump administration budget for the Department of Health and Human Services leaked to reporters on Wednesday proposes a massive $20 billion cut for the National Institutes of Health in 2026 — roughly a 40% reduction — and a sweeping consolidation.
Previous plans floated by Republican members of Congress have proposed restructuring the NIH’s 27 institutes and centers into 15 revised ones. The Office of Management and Budget proposal, which is dated April 10 and labeled “Pre- decisional,” goes much further — consolidating down to just eight.
If a budget cut of this magnitude were approved by Congress, it would be devastating for biomedical science, research stakeholders said. “Short-term, this is going to be a really big deal,” said Jason Owen-Smith, executive director of the Institute for Research on Innovation and Science, a consortium of dozens of universities. “Long-term, it represents, conservatively, a fundamental change in the national aspirations of the U.S. in the field of biomedicine. I don’t think there’s another way to think about a change of this magnitude.”
HHS did not immediately respond to a request for comment on the draft budget, which was first reported by the Washington Post.
The document is described as a “passback,” Washington parlance for an official OMB reply to an agency’s budget proposal. While NIH has long enjoyed strong bipartisan support in Congress, it’s unclear how the current GOP-controlled House and Senate will respond.
“I think the number and range of interests in what NIH research produces, and the range of lives and businesses, people that biomedical research touches, are going to make it a tough vote,” Owen-Smith said.
Under the draft plan, some of its institutes and centers would be combined into new ones. The National Institute of Arthritis and Musculoskeletal and Skin Diseases; National Heart, Lung, and Blood Institute; and National Institute of Diabetes and Digestive and Kidney Diseases would become the National Institute on Body Systems. A new National Institute of Behavioral Health would absorb the existing National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism.
Others, like the National Institute of Environmental Health Sciences, which conducts research into how exposures in our environments — like toxins in industrial waste and other pollutants — contribute to disease would move into the newly created Administration for a Healthy America.
The National Center for Advancing Translational Sciences, a small institute tasked with streamlining the transformation of lab discoveries into usable medical treatments, and the Advanced Research Projects Agency for Health, created in 2022 to bankroll high-risk, high-reward life sciences projects, would both move into another newly created agency, dubbed the Assistant Secretary for Innovation, or ASI. ASI would also be the new home for the Biomedical Advanced Research and Development Authority, which finances the development of new biomedical technologies and countermeasures to be used in times of health emergencies.
The proposal eliminates the National Institute for Nursing Research, the National Center for Complementary and Integrative Health, the Fogarty International Center, and the National Institute on Minority Health and Health Disparities.
“I’m fundamentally not sure what the point is, what they’re trying to accomplish,” said Jeremy Berg, a professor at the University of Pittsburgh who previously led the National Institute of General Medical Sciences at NIH. “All that you’re going to have is a bunch of divisions within these larger organizations that will probably look an awful lot like the existing institutes.”
He said there are consolidations that could make sense at the NIH, like combining the alcohol and drug abuse institutes or the neurological disorders and the mental health institutes. But, making changes on the scale outlined in the document “is going to completely consume NIH for a year or two,” Berg said.
Only the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the National Institute on Aging would remain individual entities as currently structured.
Stefano Bertuzzi, CEO of the American Society for Microbiology, was relieved to see that NIAID would be unscathed. But he said the proposed cuts would nonetheless be “a bloodbath” and that he hopes that the version of the draft plan sent to Congress looks radically different than the document leaked Wednesday. He added that a 40% budget cut would likely mean that NIH wouldn’t award new grants for a long time if the agency plans to honor obligations to fund existing grants.
The document states that it assumes that the NIH’s recently proposed 15% cap on research indirect costs will continue and be implemented in 2026 — though the administration’s attempt to impose the change in February has been stalled by court rulings. Indirect costs include administrative and facilities costs and other shared expenses that can’t be easily allocated to individual research grants.
Andrew Rosenberg, a science policy expert and fellow at the Carsey School for Public Policy at the University of New Hampshire, was sharply critical of the proposed NIH cuts and reorganization.
“This is clearly an effort to destroy the capability to use science-based policies to improve the health and safety of Americans,” he told STAT. “It is clear there is no plan. No strategy on how to make anything better. No sense really of how to use science to inform effective policies from biomedical research to childhood education.”
Additional HHS restructuring
Besides the envisioned overhaul of NIH, the budget proposal had clues about the future of other HHS agencies.
- Services for people with disabilities were particularly affected when HHS announced its reorganization, including the gutting of the Administration for Community Living. The remaining bits of the agency — which served as a federal hub for disability education, policy and grantmaking — will be divided up elsewhere. Not every program will survive the move, however. The preliminary budget eliminates several programs that supported seniors, including chronic disease management, fall prevention and assistance for people struggling to navigate Medicare.
- The health tech community had long speculated that the HHS office that handles health IT — formerly known as the Office of the National Coordinator for Health IT, last year renamed the Assistant Secretary for Technology Policy — would be rolled into CMS under the Trump administration. However, the proposed plan creates a new Office of the Chief Technology Officer, which would house both ASTP and the “Office of Chief Information.” The new CTO office would be funded with $103 million, $94 million of which would go to the CIO’s office to support “department-wide cybersecurity efforts,” and $9 million to ASTP to “fund existing staff to continue carrying out mission critical functions.” ASTP, which currently spearheads HHS’ AI efforts, as well as oversees the certification of health IT tools like electronic health records, had a 2023 budget just north of $66 million. This complicates the Trump administration’s goal of aggressively implementing AI in all government agencies, as outlined in recent memos.
The proposed plan also axes HHS’ digital health care research program, which is currently housed under the Agency for Healthcare Research and Quality.
Brittany Trang and O. Rose Broderick contributed reporting.