Reimagining the Future of Health Research After Sweeping Cuts

Dan Gorenstein (DG): The Trump administration has tried repeatedly to upend health care research in the U.S.

They’ve cut staff, terminated grants, tried to slash funding and add more political review at the National Institutes of Health.

But it’s the decimation of a smaller, more obscure research agency, known as AHRQ, that has many academics deeply concerned.

Aaron Carroll (AC): Everything that Americans hate about the health care system is what AHRQ research is trying to address.

DG: Today, we zoom in on the Agency for Healthcare Research and Quality, the cost of its collapse and a vision for how it could be rebuilt stronger than before.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.

*****

DG: When Sebastian Tong first started practicing family medicine over a decade ago, he noticed something that didn’t sit right with him. 

He saw patients admitted to the hospital looking for help with substance use disorder. 

Sebastian Tong (ST): And in many cases, those patients were coming in alone. 

DG: No family by their side. No friends to help.

Sebastian knew there were evidence-based addiction treatments that work – but patients often struggled to get them.

ST: I saw patients who would drive two hours to see me. And I’m sure there were then people who couldn’t drive those two hours who didn’t have access to those medications.

DG: In 2025, more than 80% of Americans with substance use disorder DID NOT receive treatment. That’s almost 40 MILLION people.

And 70,000 died of a drug overdose last year. 

Primary care clinicians can provide addiction care but only a small fraction do.

Sebastian landed a $2.5 million dollar from ARQH to compare traditional clinics to clinics with special training to treat addiction.

His hypothesis: make it easier for doctors like him to offer this care and save more lives. 

ST: I think there’s a huge opportunity for primary care physicians and primary care practices to be asking their patients about their substance use so that patients can increase their access to life saving treatments.

DG: In the early spring of 2025, halfway through Sebastian’s four-year trial, the Trump administration fired about half of the staff at AHRQ without warning.

In that moment of intense confusion, researchers worried about their grants.

Sebastian – who had worked at the agency during Trump 1 and under Biden – was pretty sure these layoffs were just the beginning.

ST: My spidey sense went off and I was like, it’s becoming less and less likely that we’re going to get the renewable funding for next year. That often is just automatic.

DG: He understood – with a hollowed out staff – the agency could barely function. 

ST: I just knew like there was no one processing that paperwork. So there’s just this gap where there’s no money going out.

DG: Sebastian was right.

On July 15, 2026, he got the email. His grant was cancelled.

ST: If I remember correctly, I think I was sitting in clinic between patients.

I felt really angry about it, like really angry about the situation, really the sense of despair. The fact that the people we were trying to help. We weren’t going to be able to help because of what was this seemingly arbitrary decision. 

DG: Was any rationale given to why your work was defunded?

ST: TONG: No. It was a generic form letter. And I actually got copies of other people’s generic form letters. And the only difference between the letters was like the name addressed to me at the top and my grant number.

DG: Do you have the letter?

ST: I do. 

DG: Could you read it?

ST: Yeah. This letter constitutes a notice of Non Award effective July 15th, 2026. 

The Agency for Healthcare Research and Quality is to issue continuation awards only where it is determined that continuation is in the best interest of the federal government.

DG: When you read that letter that day in your clinic, how did you feel? 

ST: I knew it was coming. But it was still devastating, right? It still made me feel angry. As scientists, we spend a long time, like months writing grants,  and then waiting to get the grant. So few grants are funded these days, right? Like it’s, I think it’s like in many cases, a 5 to 10% chance that you get a grant funded.

So it’s like, there’s this joy when you get the grant. And then it’s almost unheard of before this current administration that grants would be terminated early unless you weren’t performing well. So it is incredibly devastating to get a notice like this and to get a notice like this that doesn’t actually address what you’re doing. It doesn’t address the science, it doesn’t address the people behind the science.

DG: It doesn’t feel like it’s about the science.

ST: No, it’s feels like it is about ideologies. It feels like it is about an agenda that is beyond the people who are suffering from the diseases involved. 

DG: Sebastian and his team continue to look for funding to finish the trial. But for now, it’s closed down.

Half of the clinics in the study never got the addiction treatment training and there’s no money to analyze the little data they have collected.

Sebastian says what may have been a step forward to reducing overdose deaths turned out to be a small and expensive waste of time.

When we come back, we take a look at what the AHRQ cuts mean for health research as a whole and how to build stronger health research infrastructure for the future. 

BREAK

DG: Welcome back.

Sebastian Tong is one of more than 100 researchers to have a grant from the Agency for Healthcare Research and Quality, or AHRQ, cancelled this year by the Trump administration.

The grants covered patient safety, access to care, and lowering health care costs.

To get a broader perspective on these cuts, I’m joined now by Aaron Carroll.

Aaron is the president and CEO of AcademyHealth, a nonpartisan professional organization that represents researchers like Sebastian.

Aaron, welcome. How’s it going?

AC: Going all right. How about you?

DG: Doing okay.

DG: Aaron, we talked to you last fall and you were raising the alarm about AHRQ.

Here’s a bit of what you said then.

AC: Cuts don’t just slow research down. They dismantle capacity. For AHRQ, from what we hear, even if they wanted to get the grants out, there’s like nobody to push the button and do the paperwork and get it going.

DG: A year later, after seeing all these grants terminated, is this basically what you expected to happen?

AC: Unfortunately, yes. Except it’s even worse. You know, mid term cancellations in some ways cost more than not awarding new decisions or new awards. Years of design, recruitment, partnerships and data collection are already sunk. If you stop a study halfway, the biggest loss is the answer itself – we’ll never know whether the intervention worked. 

DG: Right? Like in Sebastian’s case, he’d spent more than $1 million on his project, and that was interrupted in the middle of the thing. And now we just don’t know. We don’t know what’s going to happen.

AC: We don’t know. And we wasted so many other people’s time. We got clinicians together to try to learn what they could do. And, and now that doesn’t matter.

I mean, that study was really gathering, if I remember correctly, a lot of patients together as well to try to get their experience. It’s now telling them, yeah, we just don’t even care, you know, we’d rather throw the money away and waste all the time and energy you put into it then find out the answer. It’s a slap in the face to all of the people who work towards trying to improve things for others. And it’s a complete waste of taxpayer money as well.

DG: Earlier this year, AHRQ director Roger Klein wrote an op ed that basically argues that starting around 2015, AHRQ put too much focus on funding research on health equity and reducing disparities.

Klein wrote, “The Trump era represents AHRQ’s abandonment of ‘woke’ advocacy and its return to its role as an independent evaluator of the health care system.”

Aaron, what’s your response to that?

AC: Look, every administration gets to set priorities. Setting priorities going forward is normal, but ending funded, half finished studies is different. The stated priorities of this administration and this AHRQ, including patient safety, antibiotic resistance, telehealth, AI, nutrition and autism, describe a ton of the grants that were canceled.

So it makes no sense. In canceling all of these grants, the rationale used was we need to focus on many of the things these grants were already focused on. So it doesn’t make any sense at all. None.

DG: What do you say to the people who sort of meet this news with some sort of shrug, or to sound very 80s big whoop. Like who cares? Why does this actually matter?

AC: Because everything that Americans hate about the health care system is what AHRQ studies. When people are angry because health care costs too much. That’s what AHRQ studies. When people are angry that they can’t get in to see a doctor or wait times are too long or they don’t have the access they need. That’s what AHRQ studies. When people say patient safety is an issue. That’s what AHRQ studies.

So everything that people hate is what AHRQ research is trying to address. This is the stuff that matters to everyday Americans. But if we don’t study how to improve the delivery of care, we won’t improve the delivery of care. 

DG: As of now, AHRQ has a bare bones staff. A review by KFF Health News found that even though Congress appropriated $345 million for fiscal year 26, the agency spent less than $15 million on grants and has not awarded a new one in over a year.

Last year, Aaron, you said to us, quote, federal funding really is irreplaceable. A year later, what has industry done? What has academia done? What has philanthropy done to fill in the gap?

AC: So I mean, I think some foundations have tried to step up their support, but it’s a drop in the bucket compared to federal funding. And so when you cancel 117 grants, if not more, they just stop. They don’t happen. So to be very honest, I think people are hoping that after the midterm elections, maybe we will start to get some oversight and with some teeth, some of the committees that are tasked with overseeing research and overseeing health will start to demand that what is law is what follows. But until then, I think everyone is in a holding pattern hoping that things will get better.

DG: There’s an old saying about not letting a crisis go to waste. You and your colleagues at Academy Health have put out a blueprint for how to rebuild the nation’s health care research infrastructure to make it “harder to disrupt and better at its job.”  

It touches on the NIH, FDA, CDC. But I think it’s fair to say that the beating heart of this utopian research future is AHRQ. No surprise, given that you are the architect. 

You propose giving it a minimum of $1 billion annually and a lot more responsibility. Sketch out the dream that is AHRQ.

AC: This isn’t just about making AHRQ bigger. We want to make sure that all of the data gathering and evidence gathering and research that the United States funds and does is independent and not subject to political whims. Policy will always be made by political actors who are accountable to the United States population. But we’ve got to do a better job of making sure that the science part of it, the part that generates data, analyzes data, and gives the answers to policymakers, is protected. 

DG: Ok, so that’s the dream, right? Let’s get into the details though. Aaron, what are the specific changes your blueprint recommends making to AHRQ?

AC: Well, I think there are actually seven. But the gist of it is, first, we need to rebuild the actual mandate for AHRQ and give it agency standing. 

It needs a director with a fixed five year term, real qualifications and for cause removal, it needs a bunch of protection and it needs more money.  

In addition to that, AHRQ is a natural convener. It should create a standing body that coordinates all the federal health evidence work. We often get all this evidence. We just don’t use it. That’s a problem.

DG: And what needs to happen to actually implement these changes? Can the administration act on its own? Does Congress need to pass a law?

AC: Well, part of it is by initially making it so that that leadership recognizes it and declares that this is the policy of science in the federal government. But the broader implications are some of this is going to need congressional law. Which is why in the full blueprint, we even have a whole legislative section with language that can be used so that any staffers who really wanted to do this important work could start getting Congress ready. Any Congress. We don’t need to wait to improve things and to codify into law the protections and enforcement that’s needed to make the evidence that we are gathering work for the American people.

DG: Can you give me a concrete example, Aaron, of how New AHRQ would fix something that was broken before 2025, right? I’m not talking about this current crisis right now. I’m talking about sort of standard issue day in day out health policy, health services research.

AC: So there’s a law from the early 1990s that tells AHRQ to review the evidence on a treatment and hand that review to Medicare before a coverage decision. That sounds really good. It’s never been fully funded or staffed. So for 30 years, it’s just sat there. Medicare’s made coverage calls worth billions of dollars, with less independent evidence than Congress intended, and the agency best equipped to supply it was sidelined. 

An agency whose work isn’t tied to anything consequential is easy to cut, and that’s why one of our specific recommendations is to tie AHRQ’s evidence to decisions that matter. We should require Medicare to formally consider AHRQ reviews in coverage decisions, fold AHRQ safety measures into Medicare’s quality program, and turn on this dormant law that funds evidence that no company is going to pay for.

DG: It sounds like, to me, the essence of your blueprint is getting the evidence into the hands of decision-makers that comes out of AHRQ. That’s really what this is about.

AC: Yes! Good evidence is necessary but not sufficient to create good policy. And we’ve got to do a better job of separating the two and making sure that the evidence side is protected in a variety of different ways from politics without limiting policymakers ability and in fact, enhancing policymakers ability to get that evidence and use it to make the best decisions possible.

DG: You’ve been in health policy long enough to have seen hundreds of blueprints that go nowhere. And my sense is this is more than just a wish list for you. 

You think this blueprint could be an actionable roadmap for people currently in Washington. This is in some ways like a culminating effort of your career.

What makes you think there is a chance that any of this actually happens?

AC: So what makes me optimistic? First of all, this is completely nonpartisan. Like this. This does not need to be done by the next administration. Trump administration can start putting this to work right now, today, in ways that I think would improve care for all Americans.

The second is that this is absolutely strictly focusing on evidence infrastructure. It is not about achieving any policy goal. Because my goal is not to achieve the policy decision that I would like, that Aaron Carroll would prefer. It’s to make sure that legislators have the best data and evidence that they need when they’re making a decision, so that they can make a better decision – what are they going to get? What are the potential downsides? So that they can do a better job of acting with knowledge than just guessing.

I think that’s achievable, and I think that the American people deserve and can have that. And that’s what the blueprint is about. It’s not about how do I get my goals as a Democrat or Republican. It’s about how do we have better infrastructure so that we can make better decisions that are going to serve Americans better?

DG: Aaron, thank you so much for taking the time to talk to us on Tradeoffs. Really appreciate it. 

AC: Absolutely.

DG: Last week, an investigation by the Government Accountability Office found that the Department of Health and Human Services illegally withheld nearly eighty million dollars in AHRQ funding in 2025.

Separately, a group of health care researchers are suing AHRQ. The suit alleges that canceling the grants was illegal, and asks that the agency revive its grantmaking program. The case is ongoing.

I’m Dan Gorenstein, this is Tradeoffs.