The Chopping Block: Administration’s FY26 Discretionary Budget Proposal Targets Public Health Lifelines

Policy: FY26 Discretionary Budget

(AI image created by author)

On May 2, 2025, President Trump presented Congress with his comprehensive discretionary budget proposal for Fiscal Year (FY) 2026, spanning October 1, 2025, to September 30, 2026.¹ This document lays bare the administration's proposed federal spending priorities and anticipated revenue streams for the coming fiscal year. Within this detailed FY26 blueprint, several proposed funding adjustments directly and indirectly threaten the infrastructure of our nation's public health system. Of particular concern is the proposed complete elimination of funding for the Hospital Preparedness Program (HPP), a critical initiative administered by the Administration for Strategic Preparedness and Response (ASPR).

This article will explore the profound and potentially devastating consequences of this proposed defunding, arguing that such an action would severely undermine hospitals' ability to effectively prepare for and respond to high-consequence public health threats, including special pathogens like Ebola. The consequences of dismantling this vital program extend far beyond mere budgetary adjustments, posing a significant threat to our health care system's readiness and jeopardizing the safety of both patients and staff.

ASPR HPP: How Federal Funding Fortifies Emergency Response

In an era marked by increasing and varied threats, from natural disasters to pandemics and the potential emergence of special pathogens like Ebola, ASPR’s HPP provides essential federal funding and infrastructure for the nation's health care readiness. Through cooperative agreements, HPP funds states, territories, and metropolitan areas’ emergency planning and response capabilities. A key component of the program is the infrastructure support of the Health Care Coalitions (HCCs), which foster crucial partnerships among various health care organizations and systems by creating shared goals in emergency preparedness, response, and recovery.

HPP funding supports a range of activities, including regional collaboration initiatives, training and exercises for high-consequence events, and essential capabilities to manage patient surges and complex medical needs (eg, specialized personal protective equipment (PPE) and decontamination equipment). Health care facilities’ budgets do not fund these specialized resources and generally require dedicated funding, often met by the HPP. As the only dedicated federal funding stream for health care system readiness, HPP directly improves patient outcomes during crises and supports front-line staff’s ability to care for patients in real time.

The Looming Threat to HPP: A Closer Look

The administration's rationale for this drastic measure, citing the program as "wasteful and unfocused,"¹ stands in stark contrast to the reality of HPP's crucial role in health care system readiness. With current FY25 funding for HPP standing at $240 million (ending September 30, 2025),² the proposed $240 million cut for FY26 effectively amounts to a complete defunding of the program at the federal level.

Should Congress approve this budget line item, the implications for hospital emergency preparedness across the US would be profound. To understand the potential impact of this decision, it is crucial to examine the key areas that would be directly affected. The notion that states and territories could effectively absorb and finance these critical preparedness needs independently fails to acknowledge the reality of financial constraints and the necessity for a coordinated federal approach to public health security.

Compromised Care: How HPP Cuts Threaten Patient and Staff Safety

The elimination of funding would significantly compromise both patient and staff safety during the care of a patient with a special pathogen like Ebola. The reduced funding and resource allocation would directly impact essential equipment and infrastructure availability. Hospitals may not have funding available to purchase the quantities of specialized equipment needed in the event of an emergency.

In addition, it places health care systems in a position to prioritize funding already limited funding for capital investments to maintain critical infrastructure like negative pressure rooms. This impacts the ability of facilities to receive and care for not only special pathogens but also an influx of measles cases, endangering other patients and health care workers.

Furthermore, the proposed defunding would eliminate crucial resources for specialized training and access to essential best practice guidelines, significantly jeopardizing health care facilities' emergency preparedness and response capabilities.

Consequently, frontline staff may manage patients with highly dangerous pathogens without the necessary training for safe care. This lack of preparedness elevates the risk of errors in protocol adherence, improper use of personal protective equipment (PPE), unsafe patient handling, and critical delays in implementing vital isolation and treatment measures, directly endangering the health and safety of both infected patients and the health care team. Furthermore, this defunding would devastate the already weakening infrastructure essential for effective regional and national collaboration during public health emergencies.

Regulatory Fallout: HPP Defunding and Compliance Challenges

Beyond the immediate operational impacts, the elimination of HPP funding poses serious challenges to health care facilities' ability to meet critical regulatory requirements set forth by the Centers for Medicare & Medicaid Services (CMS), The Joint Commission (TJC), and various state and local public health agencies. At the same time, existing standards mandate preparedness for emerging high-priority organisms, such as Lassa fever; the absence of dedicated HPP resources would make compliance exceedingly difficult, particularly for smaller and rural hospitals already operating under significant financial constraints.

For instance, CMS requires health care facilities to maintain robust emergency preparedness programs with specific policies and procedures for responding to diverse emergencies, including high-priority infectious agents. The lack of HPP funding could severely strain hospitals' capacity to conduct the necessary regular drills and exercises tailored to special pathogens, potentially leading to findings of non-compliance during CMS surveys.

Similarly, TJC's accreditation standards demand comprehensive emergency management plans and demonstrable effectiveness in responding to potential crises. Without the dedicated support from HPP for specialized training, essential equipment procurement, and the development of specific protocols for managing highly infectious diseases, hospitals may struggle to meet these stringent accreditation standards, potentially jeopardizing their accreditation status and impacting Medicare and Medicaid reimbursement.

Ultimately, while eliminating HPP doesn't directly change existing regulations, it would significantly hinder hospitals' ability to adhere to these requirements, particularly those concerning preparedness for and response to highly infectious diseases. This increased difficulty in meeting regulatory expectations could lead to heightened scrutiny, leading to potential penalties from oversight bodies.

Fractured Collaboration with Emergency Services and Public Health

The HPP is critical in fostering essential collaboration and communication among hospitals, Emergency medical services (EMS), and public health agencies--partnerships vital for a coordinated response to special pathogen incidents. Eliminating this funding would severely weaken these connections, hindering our ability to act cohesively during a crisis. HPP supports the infrastructure and activities of HCCs, which bring together these diverse partners to collectively plan and prepare for emergencies. These coalitions facilitate the development of regional communication networks, patient transfer agreements, and resource-sharing protocols.

For instance, in FEMA Region 9 (Arizona, California, Hawaii, Nevada, and various Pacific Islands), Cedars-Sinai Medical Center in Los Angeles, California, serves as the designated special pathogen treatment center.³ The loss of HPP funding would undermine the functionality and sustainability of the HCC that enables such regional coordination, potentially leading to fragmentation and a lack of clear pathways for patient transfer during a crisis. Imagine a scenario where a patient with a high-priority organism like Marburg virus presents to your local emergency room, and the established transfer process to a designated treatment facility is not well known or nonexistent.

Additionally, HPP often supports initiatives that directly integrate hospital preparedness efforts with local, state, and federal public health agencies. This integration is crucial for effective early detection, surveillance, contact tracing, and coordinated public health interventions during a special pathogen event. These funds are needed for programs to facilitate multidisciplinary planning meetings, shared training exercises, and clear communication channels between hospitals and public health. The loss of funding increases the risk of a more disjointed overall response, ultimately jeopardizing our ability to effectively contain and manage a public health threat in our facility.

Take Action: Protecting Hospital Preparedness

Here's how you can act now to safeguard critical hospital preparedness funding:

1. Understand the Proposed Cuts: Review the "Fiscal Year 2026 Discretionary Budget Request" (Fiscal-year-2026-discretionary-budget-request.pdf) to understand the proposed reductions or eliminations affecting various public health programs. Familiarizing yourself with these recommendations is a crucial first step.
2. Assess Local Impact and Engage Leadership: Connect with your facility's Emergency Preparedness Coordinator or program to understand how the defunding of HPP could specifically impact your hospital's emergency response capabilities and ability to conduct essential training and exercises. Discuss these potential consequences with your leadership to ensure they are fully aware of the risks involved.
3. Advocate for Continued Funding: In the next few weeks, reach out to your local House and Senate representatives to strongly advocate for maintaining ASPR HPP and all public health funding. In the coming weeks, Congress will begin assembling its proposed budget, incorporating recommendations from the President's "Fiscal Year 2026 Discretionary Budget Request." This proposed budget will be discussed in subcommittees before a vote to approve the funding draft. Your voice is critical in urging your representatives to prioritize and protect this vital program.

Closing thoughts

The potential approval of the proposed FY26 budget proposal, with its complete defunding of ASPR HPP, paints a bleak picture for the future of public health readiness in the US. Beyond the immediate financial strain on hospitals, the loss of HPP would dismantle the very infrastructure that supports coordinated emergency response, specialized training, and access to crucial resources. This shortsighted decision would not only hinder our nation's ability to effectively manage emerging infectious disease threats but would also directly undermine the efforts of infection preventionists and other frontline health care workers to ensure the safety of both patients and staff.

References

1. Executive Office of the President, Office of Management and Budget. Fiscal Year 2026 discretionary budget request. Published May 2, 2025. Accessed May 2, 2025. https://www.whitehouse.gov/wp-content/uploads/2025/05/Fiscal-year-2026-discretionary-budget-request.pdf

2. US Department of Health and Human Services. Fiscal Year 2025: The Administration for Strategic Preparedness and Response. Published 2024. Accessed May 2, 2025. https://aspr.hhs.gov/Documents/ASPR-cj.pdf

3. National Emerging Special Pathogens Training and Education Center. Partners & regional contacts. Published 2025. Accessed May 2, 2025. https://netec.org/about-netec/partners-regional-contacts/

Additional Resources

For further information and action, please consult the following resources:

1. HPP Funding Allocation by State (FY2024): Visit the Administration for Strategic Preparedness and Response website to review the "Final HPP Fiscal Year 2024/Budget Period 1 Funding" details. This resource provides a breakdown of funding allocation amounts by state, allowing you to assess the potential financial impact on your specific region(s). [https://aspr.hhs.gov/Health careReadiness/HPP/Pages/Final-HPP-FY2024-Budget-Period-1-Funding.aspx] (Retrieved May 2, 2025)
2. Contact Your Congressional Representatives: Utilize the official websites for the U.S. House of Representatives and the U.S. Senate to identify and obtain contact information for your local representatives in both chambers. Engaging with your elected officials is a crucial step in advocating for the preservation of vital public health programs.

• U.S. House of Representatives: [https://www.house.gov/representatives/find-your-representative]
• U.S. Senate: [https://www.senate.gov/senators/senators-contact.htm]

3. Understanding the Federal Budget Process: For a concise overview of how the federal budget is created, including annual funding areas and the various stages involved, please refer to the USA.gov resource on the federal budget process. [https://www.usa.gov/federal-budget-process]