By Jamie Ducharme
March 11, 2019

President Donald Trump’s proposed 2020 budget includes nearly $300 million meant to “defeat the HIV/AIDS epidemic” in the U.S. — even as it calls for a 12% reduction in total funding to the Department of Health and Human Services (HHS).

During his February State of the Union address, Trump announced an ambitious plan to “eliminate the HIV epidemic in the United States within 10 years.” During a subsequent call with reporters, health officials said the initiative would focus on 48 at-risk counties across the country and would involve promoting early HIV treatment and diagnosis, expanding access to the preventative drug PrEP and strengthening outbreak responses.

At the time, financial backing for the plan was not specified. Now, Trump’s proposed budget requests a total of $291 million for the project, although that money is not guaranteed.

While presidential budget proposals reflect the White House’s spending priorities for the coming year, they must be approved by Congress before going into effect, which often does not happen. Democrats, who control the House of Representatives, have already spoken out against many of the proposals in the budget. Senate Minority Leader Chuck Schumer, for one, called the budget a “gut-punch to the American middle class and a handout to the wealthiest few,” pointing to cuts to Medicare, Medicaid and Social Security.

Anti-HIV and AIDS initiatives, however, have traditionally gained bipartisan support in Congress, and it’s possible that Trump’s plan will move forward even if other parts of his budget do not. The proposed budget calls for $140 million for the Centers for Disease Control and Prevention (CDC) to collaborate with local health departments on HIV response and prevention. The proposed budget also allocates $120 million for the Health Resources and Services Administration to provide medical care through systems like the Ryan White HIV/AIDS Program, which offers HIV treatment to those who otherwise could not pay for it. The budget also calls for reauthorizing the program, so that federal funds could be allocated to help at-risk populations struggling with HIV. In Trump’s 2019 budget, he proposed $58 million in cuts to the Ryan White Program’s budget.

At the same time, though, the 2020 budget would reduce funding to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), an international effort to fight HIV and AIDs, by about 22%, and pledges less than what the Global Fund to Fight AIDS, Tuberculosis and Malaria said was necessary to replenish its funds.

Overall, the proposed budget requests $87.1 billion in discretionary funding for HHS — a 12% decrease from its estimated 2019 funding level — in addition to $1.2 trillion in mandatory funding for the department. The budget also requests $33 billion for the NIH, a more than $5 billion drop from last year. It also reintroduces the idea of replacing the federal Affordable Care Act with state-based grant systems.

In a statement, HHS Secretary Alex Azar praised not only Trump’s HIV budget allotments, which he called “historic new funding dedicated to one of the most important public health initiatives undertaken this century,” but also those related to other health initiatives, including efforts to lower the costs of health insurance and prescription drugs, expand access to mental health treatment and suicide prevention resources and curtail the opioid epidemic.

Among other items, the budget also includes a proposed $500 million for pediatric cancer research. It also proposes a new user fee on e-cigarettes, which would effectively function as a tax paid by e-cigarette manufacturers, and raises by $100 million the Food and Drug Administration’s (FDA) current $712 million user fee cap. These actions, according to the budget, would support the agency’s regulatory oversight of the products and ensure it has the necessary “resources to address today’s alarming rise in youth e-cigarette use as well as new public health threats of tomorrow.”

Write to Jamie Ducharme at jamie.ducharme@time.com.

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