Tradeoffs is reporting from Colorado this week, where the Aspen Ideas: Health conference just wrapped up. The annual three-day conference brings together policymakers, clinicians, business leaders, advocates, academics and journalists to talk about some of the biggest issues facing health care.
In a year of roiling health care news, these were some of the meeting’s big takeaways:
America’s role in global health is at a turning point
Physicians Atul Gawande, former assistant administrator for global health with the U.S. Agency for International Development, and Deborah Birx, who served as director of the Centers for Disease Control and Prevention’s global HIV/AIDS division between 2005 and 2014, criticized the White House’s abrupt halt to global health aid in a session Monday.
“The process was flawed,” said Birx, who also served in the first Trump administration. “I don’t think anybody can agree to the process as it was.” Still, she said, she believes work can continue to combat HIV and malaria and improve maternal health despite swift moves by the White House to dismantle USAID. “I think that we can make this work,” Birx said. “If we stay mission-focused. If we go back to our fundamentals.”
Gawande called the cutbacks a turning point at a moment when continued investment could significantly improve survival around the world. The White House cuts will leave a skeleton staff inside the U.S. Agency for International Development, he said, and eliminated more than 80% of the global agency’s programs. “We are potentially walking away from that mission and we can’t.”
Cuts have already set back direct investment in the small, local organizations doing global health work, he said. “We have to bear witness to the damage that’s actually done.” Funding losses have already cost lives, he said.
Gawande reminded the packed audience that Congress is still debating whether to make recent USAID cuts permanent and considering proposals to slash even more. “This isn’t done yet,” he said.
The White House is asking Congress to approve its deep cuts. The House version of the budget recissions proposal, meanwhile, would wipe out the nation’s funding for the largest distributor of vaccines to low-income countries.
The fight over what comes next, Gawande said, is a debate over America’s role as a leader “helping galvanize the world to attack the biggest killers of humanity itself.”
Lots of fear, few answers on the future of health care research
Several sessions touched on the uncertain future of health care research and data. Estimates of NIH grants terminated by the Trump administration range from $1.8 billion to nearly $10 billion. There are also significant concerns that large national datasets that track everything from the cost of care to behavioral health to maternal health could disappear.
“[Losing access to this data] puts the health of all of us at risk,” said Megan Ranney, the Dean of Yale’s School of Public Health.
Speakers from public health, academia, philanthropy and business all agreed that no one can fill the gap that federal disinvestment will leave. Sema Sgaier, co-founder and CEO of the AI company Surgo Health, said the private sector can collect some data, but only the federal government has the capacity to run large-scale surveys that are critical for research and public health. “These are expensive and they take a lot of time,” Sgaier said. “They need consistency.”
Karen McNeil-Miller, president and CEO of the Colorado Health Foundation said even the largest foundations are “a rounding error” compared to the resources available from the federal government. McNeil-Miller and Rich Besser, president and CEO of the Robert Wood Johnson Foundation, said some foundations are doubling down on supporting research on health disparities in the face of attacks from the Trump administration. But McNeil-Miller and Besser are disappointed that more are not.
“I’m seeing more duck and cover in philanthropy,” Besser said. “That’s the most common mode of action we’re seeing.”
Trump administration officials drew big crowds, offered few specifics
Two of the most popular sessions featured top leaders in the current Trump administration, though they offered little in the way of new information about the federal government’s health priorities.
Stephanie Carlton, Deputy Administrator for the Centers for Medicare and Medicaid Services, mostly sidestepped questions about the administration’s actions on vaccines and pointed out CMS’ limited role in vaccine policy. “[CMS] still pays for vaccines throughout our health care programs, and that’s really where our role is focused on vaccines at CMS,” she said.
Carlton repeatedly came back to the role she believes technology can play in improving the health care system and outcomes for patients. “That is a huge priority for us,” Carlton said. The agency is focused on making personal health data and Medicare data on health care use more accessible to patients, she said. “We don’t want to stop with price transparency for patients.”
Much of Carlton’s session focused on congressional Republicans’ proposal to add work requirements to Medicaid nationwide. In 2018, 18,000 people lost Medicaid under Arkansas’ work requirements policy. But Carlton said she believes CMS will be able to use technology to make it easier for people to demonstrate compliance and avoid losing coverage. “We will work hard to make sure that is easy to report on,” she said.
She also said CMS questions the Congressional Budget Office’s estimates that 11 million people will lose Medicaid and ACA coverage under the House-passed “Big Beautiful Bill.” “We’re convinced that they will not be as significant as CBO is estimating.”
National Institutes of Health Director Jay Bhattacharya said, “the commitment for the NIH to researching the health priorities for minority populations is unabated,” despite the administration terminating hundreds of research grants viewed as focusing too much on diversity, equity and inclusion. Bhattacharya said the NIH will continue to support research that is “concrete, actionable and actually has a chance of improving the health of minority populations,” though he did not articulate how grants that had been terminated failed to meet that standard.
Bhattacharya outlined other NIH priorities, including funding more studies that attempt to reproduce findings of earlier research. He also said he wants health researchers to take more risks, adding, “We’ve become much more conservative, much more afraid of failure in science than we had been in the past.”
One way of addressing this fear of failure, he said, is to provide more support to early-career researchers, who he said are more likely to research new, innovative ideas. Bhattacharya’s comments come as many academics say funding cuts and uncertainty around federal support is undermining the next generation of researchers, and the Trump administration is proposing to significantly cut funding for training grants given to new scientists.
When an early-career scientist in the audience asked Bhattacharya how he plans to support new researchers, the NIH director said he hadn’t “specifically looked into the mechanisms” and was “really open to ideas.”
Note: An earlier version of this post misspelled the last name of National Institutes of Health Director Jay Bhattacharya. He is Jay Bhattacharya, not Bhattacharrya.
You must be logged in to post a comment.