What’s at Stake

The first 100 days of the Trump administration have come and gone. For supporters, it was a period of triumph and promises kept. For opponents, it was a chaotic disaster. Public opinion polls show that Americans remain divided, with a slight and growing majority expressing disapproval.

One thing most people might agree on: it was a sweeping and unprecedented use of executive authority. To date, President Trump has signed 147 executive orders in this term - more than President Biden signed during his entire four-year term.

But the dynamic is about to shift. To move forward with much of his remaining agenda, the President will need legislative approval. He's released a broad outline of his budget proposal, which Congress will now consider. Appropriations legislation requires 60 votes in the Senate, meaning bipartisan support will be necessary.

What's at stake in this budget? Just about everything.

The President's budget proposal would drastically reshape domestic priorities, further downsize the federal government, and slash - or eliminate entirely - funding for core programs. The overall proposed reduction is $163 billion annually, or 22.6% below current spending levels.

Here are some key areas I'm watching:

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Cuts to Programs

Medicaid:
This is the big one. Medicaid is jointly funded by federal and state governments and administered by the states within federal guidelines. In New York State, Medicaid accounts for about 28% of the total state budget and is the largest payer of health and long-term care services.

Potential federal cuts of $880 billion over 10 years are on the table and included in a recent House budget resolution. For New York, this could mean a staggering $10 billion loss annually. The specific impact depends on how the cuts are implemented, but the outcome could be devastating. Medicaid cuts are politically toxic, even among some Republicans, but hitting the proposed budget targets may not be possible without them. The pressure is on from all sides.

SNAP:
The Supplemental Nutrition Assistance Program (SNAP) is the nation's most powerful tool to fight hunger and food insecurity. It serves 42 million Americans monthly, including 2.8 million New Yorkers. The proposed cuts - $230 billion over the next decade - are severe.

For New York, this could result in a combined $18 billion loss. Reductions could come through several mechanisms: shifting costs to states, revising the Thrifty Food Plan, imposing stricter work requirements, or eliminating broad-based categorical eligibility. The full impact on New York depends on which combination of options are selected.

WIC:
The Women, Infants, and Children (WIC) program is an essential nutrition support for pregnant women and low-income families with children under age 5. It provides free, healthy foods, personalized nutrition education, breastfeeding support, and more. On average, WIC helps 6.2 million Americans each month, including 450,000 New Yorkers - about two-thirds of those eligible.

While the President's budget does not directly target WIC for cuts, changes to Medicaid and SNAP could indirectly affect WIC participation, as eligibility is often tied to those programs.

Cuts to Health Agencies

The administration has already taken a heavy hand to shrink the federal government, and this budget proposal would go even further. It calls for $33.3 billion in cuts to the Department of Health and Human Services (HHS) - about a third of its current budget. While it would create a new "Administration for a Healthy America" (AHA) with a $500 million allocation, it proposes major reductions elsewhere:

• National Institutes of Health (NIH): A proposed $18 billion cut would cripple biomedical research on cancer, heart disease, stroke, HIV/AIDS, and more.
• Centers for Disease Control and Prevention (CDC): The CDC's budget would be nearly halved, from $7.5 billion to $4 billion. The proposal cuts funding on infectious disease, opioids, viral hepatitis, sexually transmitted infections, and tuberculosis in half. It also eliminates centers on disease prevention and health promotion, environmental health, injury prevention and control, global health, public health preparedness and response, as well as preventive health and human services block grants.
• Health Resources and Services Administration (HRSA): A $1.7 billion cut would impact the Ryan White HIV/AIDS Program, family planning, maternal and child health, and health workforce development.
• Substance Abuse and Mental Health Services Administration (SAMHSA): The budget proposes folding SAMHSA into the new AHA and slashing its funding by $1 billion.

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Department of Veterans Affairs (VA):

The VA is an exception. Its budget would increase by $5.4 billion - largely to modernize electronic health records and reduce veteran homelessness. It's a bit of a headscratcher, as the VA also plans to lay off 80,000 workers. You can read more about what's happening at the VA here.

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Budgets are, of course, about numbers. And in the federal government, those numbers are enormous. But it's about so much more than numbers. It's about our health and wellbeing, hunger and poverty, national security, economic prospects, our priorities and values as a nation, and our collective future. Everything that matters is at stake.

By David Sandman, President and CEO, New York Health Foundation
Published on Medium on May 13, 2025