Proposed cuts in President Donald Trump's 2018 budget for HHS would reduce funding for rural hospitals and hurt the supply pipeline for black and Hispanic healthcare professionals.
The budget proposal targets several rural hospital grants in its projected cuts. The Rural Hospital Flexibility Grant, at $42 million, is proposed for elimination. The Obama administration previously had recommended cutting the program, saying it was duplicative.
The new budget also zeroes out grants to state offices of rural health, a $9 million program.
The Rural Hospital Outreach Grant program, which helps small rural hospitals get resources to create collaboratives with long-term care facilities or with ambulance services, is slated for a reduction of $13 million, to $51 million annually.
"I would expect our members to be extremely vocal on this," said Alan Morgan, CEO of the National Rural Health Association. "These are small-dollar grant programs that are extremely targeted toward rural providers."
He added that it's surprising such programs are being targeted given that so many rural hospitals are struggling to survive. "It makes no political sense or policy sense."
But he expressed confidence that lawmakers representing rural areas would protect these programs.
"The members of Congress that are going to be driving this train have a firm grasp on rural health challenges," he said. "At the end of the day I'm extremely optimistic they'll safeguard rural communities. But that doesn't let the administration off the hook for what they've done."
The proposed budget would also eliminate funding for diversity initiatives in workforce development, which cost $83 million in fiscal 2016 and had an $85 million request in 2017. The largest portion of that funding is the Scholarship for Disadvantaged Students program, which spent $46 million to help 2,940 students in 2016.
The budget also would eliminate HHS support for training oral health professionals, geriatric specialists and public health professionals. It would end all funding for nursing workforce development with the exception of the Nurse Corps scholarship and loan repayment program. Together, these workforce supports would decline by $403 million.
Morgan said the workforce training cuts would have a direct impact on his 22,000 members.
Dr. Elana Rios, president of the Hispanic Medical Association, said when more people have access to providers who offer culturally and linguistically appropriate care, health outcomes are better.
"Patients who don't feel respected, who don't feel the doctor understands them, they're not going to come back," she said.
In a healthcare system where only 5% of doctors are black and only 5% are Hispanic, private scholarship fundraising like her own organization's work is not enough, she said.
"You have to have the staff and coordination, and that's what the (Health Resources and Services Administration) does."
She said minority health professionals are more likely to practice in low-income neighborhoods and more likely to see Medicaid patients.
The federally funded scholarships are open to low-income whites as well as to minorities.
Adaeze Enekwechi, a former Office of Management and Budget health policy director who now works for McDermott + Consulting, agreed that the workforce training cuts would damage rural healthcare. McDermott has worked with the Medicare-dependent Rural Hospital Coalition.
"Oral care—to zero that out is really unbelievable," she said. She also called cutting $146 million from nursing workforce development troubling.
Matthew Shick, director of government relations at the Association of American Medical Colleges, said it would be a mistake to eliminate funding for training geriatric specialists given the aging U.S. population.
With Trump proposing to kill nearly every workforce training program, Shick is worried that will be the baseline for negotiations between the White House and congressional Republicans in the coming budget debate.
Shick said with the massive cuts to Medicaid and the National Institutes of Health in the HHS budget, these "little programs that could" may well be overshadowed and lose out.
"There's definitely going to be a fight for attention over which programs to save," he said. The AAMC, which includes teaching hospitals in its membership, will encourage its members to contact their congressional delegations.