Signals Brief: What a Proposed $40B Cut to HHS Means for Kidney Care

Last week, the Washington Post reported on a leaked FY2026 budget document showing dramatic cuts to HHS. To help make sense of what’s in the proposal—and what it could mean for kidney care—I invited Miriam Godwin, Vice President of Health Policy at the National Kidney Foundation, to join me for a quick brief.¹

What Happened: An FY2026 budget document shared between the White House Office of Management and Budget and the Department of Health and Human Services was leaked last week. The proposed budget includes a significant $40 billion cut to HHS—about one-third of its discretionary funding. The plan outlines a sweeping reorganization that could reshape how kidney health is funded, researched, and governed. It also comes on the heels of major turnover at HHS, including mass layoffs and resignations.

Why It Matters: This isn’t just a reshuffling—it’s a realignment of federal priorities. The budget proposal would consolidate major agencies, eliminate entire institutes, and channel funding under a new umbrella of “innovation and efficiency.” The most noticeable changes for the kidney community include:

• Consolidation of NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) into a new National Institute on Body Systems.

• Dissolution of the National Center for Chronic Disease Prevention, which, through its nine divisions – including Diabetes, Heart Disease, Nutrition, Population Health, and Cancer – work to reduce the risk factors for chronic conditions and help people manage their conditions to avoid serious complications. FY24 appropriations included $4.5 million for the CKD program at CDC. This funding has been eliminated. Ninety percent of the nation's $4.5 trillion in annual health care expenditures are for people with chronic and mental health conditions. Interventions to prevent and manage these diseases can have significant health and economic benefits.

• Elimination of KidneyX, the $25 million public-private innovation accelerator launched in 2018. KidneyX backed over 80 solutions—including Venostent, Qidni Labs, and Alio—through its challenge prize model. Its removal signals a departure from the venture-style, problem-focused approach to federal innovation that spurred similar programs for other unmet needs like PandemicX, LymeX, and CancerX.²

• Elimination of minority and nursing research institutes, which support workforce diversity and community-specific disparities research in kidney care.

Key Budget Proposals

1. New Administration for a Healthy America (AHA):

   1. $500M allocated to activities to support the Make America Healthy Again (MAHA) Commission, which will initially target childhood chronic disease and is expected to broaden its scope to encompass the root causes of chronic disease generally.

   2. The Organ Transplantation program is moved here, with a proposed $54M budget.

2. Office of the Secretary Reorganization:

   1. Establishes a new Assistant Secretary for Innovation, consolidating ARPA-H, BARDA, and the National Center for Advancing Translational Sciences. Total budget: $3.235B (including $945M for ARPA-H).³

   2. Launches a new Office of Strategy, folding in the Agency for Healthcare Research and Quality (AHRQ) and the Assistant Secretary for Planning and Evaluation (ASPE). KidneyX is eliminated under this restructuring.

3. CDC Refocused on Infectious Disease:

   1. Chronic disease prevention is deprioritized, with the Prevention and Public Health Fund discontinued. This fund was established in 2010 under Section 4002 of the Affordable Care Act as the nation’s first mandatory funding stream dedicated to improving our nation’s public health system.

   2. The National Center for Chronic Disease Prevention and Health Promotion is eliminated, removing a major artery of kidney-relevant funding.⁴

4. NIH Reorganization:

   1. NIDDK merges with NHLBI and NIAMS, forming a broader but potentially less kidney-focused National Institute on Body Systems.

   2. Eliminates the National Institute on Minority Health and Health Disparities, Nursing Research, and the Fogarty International Center.

What’s Next

• These changes are not final and are likely to face opposition, especially from public health and disease-specific communities.

• Congress rarely pays attention to the content of the President's Budget, however some shifting among the top line budget figures is likely as Members of Congress who have seniority on key committees will protect their top priorities.

• Advocacy groups are expected to mount responses and mobilize stakeholder engagement.

What To Watch

• Will Congress support or reject these chronic disease prevention efforts?

• How will the reorganization of research institutes affect disease-specific funding and innovation pipelines?

• Could the elevation of the Division of Transplantation within HHS spark new care models or payment innovation?

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Discussion

Thanks for reading and listening. This is an rapidly evolving and fluid situation, so I’m grateful for people like Miriam who can help us navigate what’s happening, why it matters to the kidney community, and what we should be keeping an eye on.

What’s your read on this? What else should we know or ask? What are you watching and what do you want policymakers and other kidney stakeholders to know? Join the discussion in Slack to talk about it and let us know what you think.

1. The 64-page HHS restructuring proposal outlines sweeping cuts to US public health. Read the full proposal and comments on Dr. Jeremy Foust’s Substack newsletter (Inside Medicine).

2. ASN Executive Vice President's Update: Assessing KidneyX After Five Years. In Tod Ibrahim’s 2023 update, he pointed out the public-private partnership launched during Trump’s first term aimed to highlight unmet needs, support innovation, advance solutions, and build community to overcome challenges that private markets and government agencies cannot solve alone. The KidneyX model was used to spur similar programs like PandemicX, LymeX, PreventionX, and CancerX.

3. How to Invest Federal Funds Like a VC (Statecraft). To appreciate this change, it’s worth reading or listening to this conversation with Sandeep Patel on Statecraft, who co-founded KidneyX and served as the Director of BARDA’s Division of Research, Innovation, and Ventures (DRIVe) from March 2020 to March 2024. He talks about the web of organizations within the government that fit into the biomedical funding landscape, and where venture capital-style investing fits within a public framework.

4. Labor, Health and Human Services, Education, and Related Agencies Appropriations (LHHS). Congress holds the constitutional "power of the purse," and the annual LHHS appropriations bills are the primary source for detailed agency-by-agency funding decisions affecting HHS, NIH, CDC, and kidney health priorities. The latest texts, summaries, and committee reports can be found on the House Appropriations Committee and Senate Appropriations Committee websites.

Budget of the United States Government (Office of Management and Budget). The OMB releases the President’s Budget, outlining the administration’s funding proposals, priorities, and justifications for the coming fiscal year. While Congress ultimately controls appropriations, OMB proposals set the policy direction and are especially influential under the current administration.