CAGW Recommendations for Trump Administration's Nickel Plan- HHS

November 1, 2018

The Honorable Alex M. Azar, II
Secretary, Department of Health and Human Services
330 C Street, S.W.
Washington, D.C. 20416

Dear Secretary Azar,

During a meeting on October 17, 2018, President Trump directed you and other members of his Cabinet to cut their department budgets by 5 percent in fiscal year (FY) 2019.  With a national debt of more than $21 trillion and the budget deficit soaring to its highest level since 2012, President Trump’s initiative will help to improve fiscal responsibility.

Since 1993, Citizens Against Government Waste (CAGW) has annually published Prime Cuts, a comprehensive account of options the federal government possesses to reduce waste, fraud, abuse, and mismanagement.  The 2018 edition has 636 recommendations that would save $429.8 billion in the first year and $3.1 trillion over five years.  Since CAGW was established in 1984 following the release of the Grace Commission report under President Reagan, the implementation of recommendations similar to those in Prime Cuts has helped save taxpayers $1.8 trillion.

I urge you to consider the following recommendations for President Trump’s 5 percent spending cut directive that are included in Prime Cuts 2018, as well as proposed in whole or in part in the President’s Major Savings and Reforms for FYs 2018 and 2019.

  • Eliminate health professions training programs that lack evidence of significantly improving the nation's health workforce

                  1-Year Savings: $451 million                  5-Year Savings: $2.3 billion

  • Consolidate the activities and research of the National Institute for Occupational Safety and Healthy within the National Institutes of Health

                  1-Year Savings: $135 million                   5-Year Savings: $675 million

  • Restructure the Office of the National Coordinator for Health Information Technology

                  1-Year Savings: $22 million                     5-Year Savings: $110 million

  • Medicaid: drug pricing and payment improvements

                  1-Year Savings: $26 million                     5-Year Savings: $170 million

  • Medicaid: strengthen operations and increase state flexibility

                  1-Year Savings: $283 million                  5-Year Savings: $2.3 billion

  • Medicare and Medicaid: increase oversight of opioid prescriptions and expand treatment options

                  1-Year Savings: $25 million                     5-Year Savings: $295 million

  • Medicare: address fraud and abuse

                  1-Year Savings: $42 million                    5-Year Savings: $361 million

  • Medicare: drug pricing and payment improvements

                  1-Year Savings: $244 million                   5-Year Savings: $2.5 billion

  • Medicare: eliminate wasteful federal spending

                  1-Year Savings: $2.9 billion                     5-Year Savings: $78.3 billion

  • Reduce the grace period for exchange premiums

                  1-Year Savings: $975 million                   5-Year Savings: $1.3 billion

  • Strengthen the Child Support Enforcement Program

                  1-Year Savings: $45 million                    5-Year Savings: $265 million

  • Reform Temporary Assistance for Needy Families

                  1-Year Savings: $1.7 billion                    5-Year Savings: $10.2 billion

  • Eliminate the Low Income Home Energy Assistance Program (LIHEAP)

                  1-Year Savings: $3.4 billion                    5-Year Savings: $17 billion

  • Consolidate the Agency for Healthcare Research and Quality’s activities in the National Institutes of Health

                  1-Year Savings: $324 million                   5-Year Savings: $1.6 billion

  • Eliminate the Social Services Block Grant

                  1-Year Savings: $1.4 billion                    5-Year Savings: $8.2 billion

Secretary Azar, thank you for your efforts to be a responsible steward of the taxpayers’ money.  Your work to fulfill President Trump’s 5 percent cut directive will show taxpayers that your department stands with them in rooting out wasteful spending in the federal government.

Sincerely,

Tom Schatz
President, CAGW

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