The Trump administration’s oversight of public health dollars is under heavy fire. The impact of controversial political decisions on key federal health agencies and programs has been widely documented. Key actions taken by officials, particularly by Russell Vought, the Director of the Office of Management and Budget, have raised alarms about accountability and the delivery of essential health services.
Yet from the start, the administration took the decision to starve federal offices of funding. They stooped to intimidating those who dared to keep the government accountable. They countered by silencing whistleblowers and terminating billions of dollars in research and international health grants. The implications of this decision reached beyond 2024’s funding, extending into early 2025. We can’t overstate the impact of these decisions on public health agencies, who have faced major funding gaps and disruptions in how they operate.
In August, the Centers for Disease Control and Prevention (CDC) announced a deeply alarming trend. Their hub for HIV and TB prevention spent $167 million below their historical average. This alarming decrease in funding has hindered vital services, forcing many clinics to lay off case managers, reduce clinician hours, and close sites altogether. The impact goes beyond the direct loss of healthcare access—they’ve caused dangerous delays for patients requiring critical emergency medical care.
Vought has unprecedented power over government spending. This authority undermines congressional mandates and makes it harder to direct funds to vital public health programs. The Office of Management and Budget activated funds in installments—a tactic outlined in Project 2025—causing significant delays in the funding process. This left state governments and nonprofit organizations at the mercy of unknown future funding. They were given just a few weeks to prepare complex, highly-detailed applications for multimillion-dollar grants.
As one CDC official explained, to the extreme confusion of health organizations just trying to figure out the funding landscape, strapped for cash by grant recipient letters lining everyone’s inbox asking, ‘Where do we go from here?
In truth, the administration’s draconian moves had real-world consequences on the communities that depended on federal reimbursement for the essential health services. A successful federal project to protect Alabama residents from raw sewage and hookworm met major resistance. Soon it too fell victim to budget cuts and wasn’t ever implemented. The only nationwide surveys that could be tracking rising maternal and infant mortality rates were instead frozen for about five months because of funding holdups.
When a measles outbreak descended on Texas in late March, state officials swiftly sought federal emergency funding to respond. Sadly, those vital resources didn’t come through until May. This delay is just one acute example of Vought’s budgetary machinations cutting public health in every state in the union.
These delays have a profound, sometimes fatal, effect on people living with HIV. Millions have been unable to access necessary health services after clinics cut their availability due to real or feared shortages. Consequently, many patients are currently booked out three to four months for dental care. This is a welcome shift from the mere few weeks they’ve seen prior to these funding cuts.
Scott Wilks, a health expert from Louisiana, highlighted the long-term effects of these budget cuts. “There may be fewer people who have this very specific expertise next year in Louisiana and Mississippi.”
The uncertainty surrounding federal funding has affected HIV service providers, with 81 organizations warning that “with every day of delayed FY2025 funding release, the delivery of essential HIV services is compromised.” This thinking reflects the growing alarm among the public. They are deeply concerned that continuous financial instability would bring devastating consequences to our nation’s public health workforce.
Critics have warned that Vought’s tactics are a dangerous new precedent in how and where public dollars are awarded and spent. Shortly after his passing, public affairs powerhouse Joe Carlile lamented Carl’s death in a powerful tribute. He continued, “A one-branch veto of spending…neuters the power of the purse in the Constitution that Madison considered the fundamental check on the executive branch.” He upped the ante on those stakes when he explained, “I know this is boring as hell, but it’s insane-crazy high stakes.”
As federal health organizations navigate these extraordinary challenges, many find themselves asking how committed this administration truly is to a robust and thriving public health infrastructure. An unspecified source lamented, “It’s such a terrible shame to play with people’s health this way,” expressing concern about how budgetary decisions can directly affect lives.
