Last week, Politico broke the news that the White House Office of Management and Budget is set to release a report outlining a radical reorganization of the federal government, which could impact people living with HIV. This report, which is slated to be unveiled in late June, will detail the Trump administration's plans to significantly alter the structure of the federal government by lumping all safety-net programming into a single department that would spring from what is currently the Department of Health and Human Services (HHS).
Most notably, this reorganization would move the $70 billion Supplemental Nutrition Assistance Program (SNAP, i.e., food stamps) from the U.S. Department of Agriculture (USDA) into what is now HHS, pairing it with entitlement programs, such as Medicaid and Medicare, as well as programs benefiting specific populations of low-income Americans, such as the Temporary Assistance for Needy Families program (TANF) and Ryan White.
On the surface, this federal reorganization makes a good deal of sense. As it is currently arranged, the federal government houses a number of programs that serve similar populations and need areas in different government departments, which is both inefficient and potentially confusing to the people who use them. In a political vacuum, it makes a lot more sense to house SNAP and TANF under the same departmental roof, as they're both traditional welfare programs with a lot of overlap of who they serve.
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However, we do not live in a political vacuum. Unfortunately for people living with and affected by HIV, for the modern-day Republican Party, the concept of reorganizing or streamlining the federal government means little more than reducing and demolishing it, with the poorest and most vulnerable members of society almost always on the wrong end of the proverbial wrecking ball.
The Trump administration has the clear intent to use this reorganization to decimate safety-net program funding at the federal level. This intent, while easily gauged from the administration's relentless war on Medicaid, Medicare, the Affordable Care Act, Title X family planning funding, and a litany of vital safety net programs, is evident in its desire, reported by Politico, to change the name of the revamped HHS to include the word "welfare" in its title. No more glaringly obvious political dog whistles exist than calling for "welfare reform," a term that rarely fails to set off a racially motivated Pavlovian response among conservatives. To put the word "welfare" in the title of government department is akin to painting a bright red bullseye on its back, making it all the easier for Republican lawmakers to call for its funding to be cut.
If this reorganization occurred, the impact on people living with and affected by HIV could be swift and profound. Medicaid, which serves more than 40% of all people living with HIV who are engaged in care, would find itself in even greater danger, particularly from the threat of unnecessary and draconian work requirements that are already being implemented in state Medicaid programs across the country. Similarly, the pressure from Republican members of Congress to further tighten SNAP work requirements would likely increase.
The funding of the Ryan White program would likely not be directly impacted by this government reorganization, but attacks on portions of the program, such as the Secretary's Minority AIDS Initiative Fund and the AIDS Education Training Centers, would likely continue. Moreover, the Housing Opportunities for People With AIDS (HOPWA) program, which is currently in the Department of Housing and Urban Development, could be moved into the new Trump "welfare" department, although there is no evidence yet that this is under consideration.
As it stands now, it seems unlikely that the Trump Administration's federal reorganization plan will come to fruition in the manner it has been reported. Any government reshuffling as significant as what will be likely proposed in the upcoming report would require congressional action, and that isn't likely to happen. Beyond what would certainly be universal opposition from Democrats in Congress, a number of Republicans serving on committees overseeing departments that would see a vast reduction in importance -- namely, those related to the USDA -- would likely be loathe to adopt the plan, as well.
However, as with both of the Trump Administration's budgets, these disruptive and unfeasible plans for federal reorganization are more intended to plant the seeds for such changes than to achieve them in them in the short term.
It is up to HIV advocates and our allies in the myriad populations that would be devastated by such a reorganization to remain vigilant and to ensure that harmful ideas do not become tolerated and championed by those members of the Republican Party who have yet to fully abandon their responsibility to the health and wellbeing of their constituencies.