HHS Testimony on The President’s Fiscal Year 2026 Budget

The mission of the Department of Health and Human Services (HHS or Department) is to enhance the health and well-being of the American people.

President Trump and all of us at HHS take that charge seriously. So, when a program is not as effective as it can be, or costs more than it ought to, or fails to deliver on its promise—change and reform are necessary.

The President’s Fiscal Year (FY) 2026 Budget applies this mindset to the work of the Department, making thoughtful and strategic decisions to transform HHS and better serve the health and well-being of the American people. The budget invests in methods to address chronic disease, protect American families from environmental toxins, promote nutrition as well as food and drug safety, strengthen services for American Indians and Alaska Natives, encourage innovation in America’s healthcare future, and focus resources toward proven and effective initiatives. This budget also recognizes the fiscal challenges our country faces today, and the need to update and redirect our investments to meet the needs of a rapidly changing world.

The FY 2026 Budget request includes reforms to put healthcare spending on a sustainable fiscal path. We must remake the government to maximize efficiency and productivity in order to fulfill the President’s promise to Make America Healthy Again (MAHA). HHS has made progress towards these goals, enhancing the health of Americans while instituting significant workforce reductions and identifying over $13 billion anticipated in contract savings. And there is more to come. Over the next few months, we will work together with Congress to restructure the Department and improve how we deliver services to the American people.

HHS takes seriously our role as responsible stewards of taxpayer dollars, and we look forward to working with you to implement the President’s agenda while continuing to cut government bloat. Protecting the health of Americans has to be done hand in hand with protecting our nation’s fiscal health—they rely on each other. The FY 2026 Budget will reduce duplication of programs and services, increase accountability, and work with state and local governments to improve flexibility.

The FY 2026 Budget protects key programs that Americans rely on that keep us competitive with our enemies, and fulfill promises made to Tribal Nations. It allows us to do our part to restore fiscal responsibility to the federal government while optimizing HHS’ ability to improve and save American lives. The reductions made are necessary to right-size the Department’s budget, which has ballooned by about 40 percent since the COVID-19 pandemic.

The FY 2026 Budget focuses on restructuring efforts to transform HHS to Make America Healthy Again. I look forward to working with you on our vision to Make America Healthy Again. The President’s Budget for HHS also reflects proposals to meet the President’s comprehensive Government-wide Transformation Plan through a sweeping restructuring that aims to identify opportunities to improve the work HHS does for the American people, in terms of its quality and cost- effectiveness.

The HHS restructuring will serve multiple goals while fortifying critical services. First, beginning in FY 2026 it could save taxpayers an estimated $1.8 billion per year through a reduction in workforce. Our reductions have focused on matching HHS staffing levels to the size of HHS prior to the COVID-19 pandemic, which saw an approximate 15 percent increase in the number of employees.

Second, it will streamline the functions of the Department. Currently, the 28 divisions of HHS contain redundant units. The restructuring plan will consolidate them into 15 divisions, including a new Administration for a Healthy America, or AHA. It will centralize core functions such as Human Resources, Information Technology, Procurement, External Affairs, and Policy. The restructuring plan intends to reduce our regional offices from 10 to five by closing offices in high-cost cities. This restructuring will reduce the number of full-time employees to approximately 62,000. Critical staff duties -- such as U.S. Food and Drug Administration (FDA) food safety inspections – will be preserved in this return to pre-COVID-19 headcount.

Third, the overhaul will implement our HHS goal of ending America’s epidemic of chronic illness by focusing on safe, wholesome food, clean water, and the mitigation of environmental toxins. These priorities will be reflected in the reorganization of HHS.

Finally, the restructuring will improve Americans’ experience with HHS by making the Department more responsive and efficient, while ensuring that Medicare, Medicaid, and other essential health services remain intact.

In summary, these changes will allow us to act more nimbly and focus on the core mission of improving the nation’s health. HHS can use federal dollars to more directly impact the lives of those served by HHS programs when we stop duplicating resources and expanding bureaucracy. We will be prepared to share additional information with Congress in the coming weeks. We look forward to working together in this budget process.

Making Americans Healthy

One of the Department’s top priorities is fighting the scourge of chronic disease facing our country. Americans’ overall health today is in a grievous condition. Over 70% of adults and one-third of children are overweight or obese. Diabetes appears to be ten times more prevalent than in 1960. Cancer among people 50 and under is rising by one or two percent a year. Autoimmune diseases, neurodevelopmental disorders, asthma, Alzheimer’s, ADHD, depression, addiction, and a host of other physical and mental health conditions are on the rise.

The United States has worse health than any other developed nation, yet we spend far more on healthcare than peer countries—at least double; in some cases, triple. Last year we spent $4.9 trillion, not counting indirect costs like missed work. That’s almost 17.6 percent of our nation’s gross domestic product. But more than that, it’s a human tragedy—today, over half of Americans are chronically ill.

The President’s Budget requests $94 billion in discretionary funding to combat these challenges. This budget includes strategic investments in the new Administration for a Healthy America (AHA). It is my vision for this new division to better coordinate programs targeted to improve chronic care, disease prevention, and mental health.

The FY 2026 Budget provides resources to HHS that would allow the Secretary to solve national problems related to diet, lack of physical activity, over-reliance on medication and treatments, the effects of new technological habits, environmental impacts, and food and drug quality and safety.

CMS

Medicare, Medicaid, and the Children’s Health Insurance Program remain a cornerstone of my agenda to improve outcomes for our seniors and children. This budget continues CMS program funding to maintain beneficiary service levels, streamline program administration, and move toward improved health outcomes while eliminating non-statutory and wasteful spending. The Trump Administration remains committed to protecting these programs by ensuring that federal taxpayer dollars are protected against waste, fraud, and abuse.

Mental Health and Substance Use

It is estimated that one in five adults in the United States lives with mental illness—that’s nearly 20 percent of the adult population. Approximately 16 million Americans with mental illness had serious thoughts of suicide. As the number of deaths by suicide continues to increase, it is more important than ever that HHS expand access to the care people need when they need it. An estimated 49.5 percent of adolescents have had a mental health disorder at some point in their lives. HHS is dedicated to providing mental health resources to children and youth in their communities.

The FY 2026 Budget invests in behavioral health by streamlining programs to avoid duplication and supporting block grant funding for these critical services. The Administration is committed, as President Trump did during his first term, to combatting the scourge of deadly drugs, especially synthetic opioids like fentanyl, that have ravaged American communities. The President has made reducing the initiation of drug use, particularly among young people, and increasing the number of individuals receiving evidence-based treatment, leading to long-term recovery from substance use disorders, a top priority. The Budget also proposes to refocus activities that were formerly part of the Substance Abuse and Mental Health Services Administration, by eliminating funding for programs that duplicate block grant funding, or are not large enough to have a national impact.

Primary Care

Under the President’s Executive Order to establish the Make America Healthy Again Commission, I am committed to investigating any potential root causes of the chronic disease epidemic. As part of AHA, programs related to primary care will be streamlined, and focused on needs of all Americans no matter where they may live and at what income level. The Budget and the transformation at HHS support these efforts and ensures that primary care includes prevention and addresses the root causes of chronic disease.

Head Start

For Americans to be healthy, we must start when they are children. The President’s Budget recommends Head Start continue to receive funding equal to the FY 2025 Enacted level. In exchange, Head Start needs to be consistent with Administration priorities. This includes increasing parental choice; improving health, education, and employment outcomes; increasing program delivery efficiency; and promoting parental engagement. Head Start directly supports local-level institutions, including faith-based centers, empowering them to oversee care. Head Start also enables parents to find dignity in work when their children are enrolled in a safe and secure Head Start program.

Making Food Safer

I am committed to making what Americans eat safer. I am working to make sure our tax dollars support healthy foods—and we are scrutinizing the chemical additives in our food supply.

Wholesome food is a key component of the MAHA agenda and FDA regulation that enables the United States to identify harmful ingredients and make the food supply safer, will be a key component to the Department’s ability to realize a healthy future.

Protecting Our National Security and Sustaining Scientific Competitiveness

This budget also supports the nation’s public health infrastructure and capacity to respond to existing and emerging public health threats, with a focus on infectious diseases, preparedness, and outbreak response.

HHS will continue to prioritize America’s national security and competitiveness. Biomedical research continues to be one of our country’s biggest exports. The NIH is the largest single public funder of biomedical and behavioral research in the world. This Budget includes $27.5 billion for the NIH, a rescaling that will focus on essential research at a more practical cost and investment in security infrastructure. We will focus only on Gold Standard science across HHS, increasing transparency for research done through the NIH.

The NIH has broken the trust of the American people with wasteful spending, misleading information, risky research, and the promotion of dangerous ideologies that undermine public health. The Administration is committed to restoring accountability, public trust, and transparency at the NIH.

Supporting and encouraging scientific research is a longstanding federal priority. It contributes to both economic growth and longer lifespans. Executing this responsibility demands that the federal government regularly considers how to organize this support in the most efficient manner possible. HHS is safeguarding taxpayer resources so that institutions are adequately supported at a sustainable level, and we are only funding essential costs in line with private-sector standards. The Budget proposes to consolidate major HHS research institutions in NIH to maximize the effectiveness of their research.

The proposed budget shifts NIH’s focus away from foreign interests and reforms its efforts on the core research activities that align with the President’s commitment to Make America Healthy Again. The NIH will no longer issue grants to promote poisonous radical gender ideology to the detriment of America’s youth, or fund dangerous gain-of-function research.

Restoring Trust

At HHS, we’re committed to empowering states, localities, and Tribal communities by supporting science-based policies, rebuilding trust in public health, and protecting future generations from harmful health exposures. We are committed to restoring a tradition of gold- standard, evidence-based science—not one driven by politicized DEI, radical gender ideology, nor sexual identity. We are removing the financial conflicts of interest in our agencies—to create an honest, unbiased, science-driven HHS, accountable to the President, to Congress, and to the American people.

Americans do not want their tax dollars going to initiatives that espouse radical ideologies. We are proposing to eliminate programs like the Community Services Block Grants that have been hijacked from true poverty reduction to fund DEI initiatives. This will save taxpayers $770 million. Americans need to trust that we are good stewards of the dollars they give us, and this budget shows our commitment to pursuing pathways to win back taxpayers’ trust.

We have also ended HHS as the principal vector for child trafficking. The Budget re-focuses the Unaccompanied Alien Children (UAC) program on its core mission of sheltering unaccompanied alien children while also protecting them from child trafficking and labor exploitation. During the Biden Administration, HHS became a collaborator in child trafficking for sex and slavery. The Biden Administration operated the UAC program like an assembly line, prioritizing the quick release of children to insufficiently vetted sponsors over the children’s safety. We ended that. We are very aggressively going out and trying to find these children that were lost by the Biden Administration.

The Budget refocuses the Centers for Disease Control and Prevention mission on core activities such as emerging and infectious disease surveillance, outbreak investigations, and maintaining the Nation’s public health infrastructure, while streamlining programs and eliminating waste. The Budget proposes merging multiple programs into one grant program that will address Sexually Transmitted Diseases, Viral Hepatitis, and Tuberculosis to give states more flexibility to address local needs.

Strengthening the Indian Health Service

Through the Indian Health Service (IHS), HHS is responsible for providing quality healthcare services to more than 2.2 million eligible American Indians and Alaska Natives.

HHS has a unique trust responsibility to provide healthcare for Tribes, including on remote reservations and other vulnerable communities in Indian Country. Without this support, many of these communities truly have no other options for care. The Budget prioritizes and preserves funding for this agency.

Looking forward, and consistent with our statutory authorities, we recognize that our provision of quality healthcare in Indian Country and beyond must change to achieve and ensure the high quality of these services. As more Tribes have assumed the responsibilities of providing healthcare for their members with support from the IHS, investments in the Budget reflect our support for the growth of Tribal self-governance in the provision of healthcare.

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The President’s 2026 Budget for HHS recognizes the importance of focusing government spending on programs that work and reforming our nation’s healthcare programs for a fast- changing world. This Budget recognizes that securing America’s future demands sound fiscal management and responsible decisions about our priorities. If we are serious about fulfilling HHS’s mission of enhancing and protecting the well-being of all Americans, we must adopt the bold innovation and direction espoused by the President’s Budget to Make America Healthy Again.