The NIH budget is on a fast track to disaster
An NIH insider explains what Republicans are likely to do next, and what we can do
Note from Don: This essay comes from an employee at the National Institutes of Health. Given the current pattern of retribution against critics of the Trump administration, I have respected their wish to remain anonymous. This feels like a critical time to share the voices of those who know these agencies well and are willing to be honest with the public about what is happening.
A Trump administration budget proposal leaked a few days ago specifies a massive budget cut for NIH — 44%, for over $20 billion in cuts. Reporting on that leaked proposal notes that this is just an opening bid from the Trump White House. Any NIH budget cut must pass Congress, which historically has had strong bipartisan support for NIH. Congress also rejected large proposed cuts during the first Trump administration.
In 2025, though, things are different. Republicans in the House and Senate have signaled their support for the Trump and DOGE program to tear up many aspects of government. The budget process this year is also likely to be affected by obscure procedural moves in Congress, and influenced by what DOGE has already done. Things are moving fast. So far the response from scientists and the public has not proved strong enough to stop the worst DOGE attacks on NIH.
Bringing the fight to Congress is one tool to slow things down. But that’s not enough: it’s critical that several things change inside NIH. As someone working at NIH, I lay out the insider view of what Republicans seem to be doing, what could play out in Congress, how changes within NIH are designed to produce budget cuts, and how people who care about medical treatments and cures might now respond.
The devious Republican plan to cut NIH’s budget
The core strategy Republicans seem to be employing is to slow NIH spending as much as possible to generate budget surpluses, and then use those surpluses as justification for slashing the NIH budget.
There’s a few details that are important. Musk and DOGE and HHS political appointees from the MAGA world have, for months, been using a set of changing procedural tools inside NIH to slow spending. On the grantmaking (extramural) side, one big move has been a Trump-imposed ban on postings to the Federal Register. This ban has caused the cancellation or postponement of hundreds of study sections, the panels that are required by law to provide peer review of grants before they can be funded. Firing institute leadership and grants management staff has also created obstacles to paying out grants.
On the in-house (intramural) research side, credit card restrictions and firings of procurement staff have blocked research spending, and removal of employees and hiring freezes have reduced spending on salaries.
Let’s play out one scenario for how this could go. Let’s say the spending interference continues apace. By June or July, due to the various means to slow down grants review, NIH will be in a position where they do not have enough well-scored grants to fund. NIH could well have a $20 billion budget surplus by then (see Jeremy Berg’s excellent charts comparing NIH spending to last year).
That unspent budget won’t be because NIH doesn’t have good science to spend money on. It will be because the Trump administration has blocked spending. On top of the general slowdowns in spending, the cancelled grants and funding pauses — for DEI programs, women’s health studies, grants to Ivy League universities — all that is just more spending interference that keeps NIH from getting money out the door.
When that surplus comes to public attention, the Democratic legal and political world is going to strongly push NIH to get the money out the door to avoid impoundment. That is the unconstitutional action where the executive branch unilaterally decides to leave money unspent. But at that point, in mid- to late-summer, Trump can throw up his hands and say that there are not enough reviewed grants, enough time, and enough remaining employees to do that spending. And that’s where Republicans in Congress can come in and finalize a big NIH budget cut.
Using the rescission process, which requires only a simple majority in the Senate, the Republican majorities in the Senate and House can vote to return the unspent funds. That will avoid impoundment and lop billions off the NIH budget. That new shrunken NIH budget for this year (FY25) could then be used by Republican-majority appropriators as a benchmark to set the NIH budget at this new smaller level for next year (FY26) and future years. (Good explainer on rescission if you want to dig deeper).
That’s the scary scenario for US biomedical science, and from inside NIH it looks very plausible. This is where we are headed if the NIH science funding blockades are not stopped.
There are some other details and other scenarios worth listing too. After covering those, we end with what we can all do now to fight back.
Other things to know: fiscal years, deadlines, and the possible role of reconciliation
Some wonky detail about the NIH budget and the Congressional budget process:
The government fiscal year ends September 30th. That’s a big deal: it means that basically all NIH money must always be spent by this date. Yes, many NIH grants are awarded for 2 to 5 years. From a university, as a grantee, it looks like grants last over several years. But NIH grants management and budget officials do a fancy dance each fiscal year, doing substantial long-term planning, for grants to begin and end at different times and holding money in reserve until budgets are known. They do this so they can spend the budget down to zero by Sept 30.
The appropriations process is how Congress sets the budget each year. Unusually, this year, (FY2025) the budget process was effectively skipped. In lieu of appropriations for FY25 in the face of a presidential election, the House and Senate just moved past it by passing a continuing resolution that expires Sept 30. The FY25 budget was set largely at last year’s (FY24) levels via the CR.
The House Republican majority is very narrow. They barely held together to pass the CR in March. NIH remains very popular with the public: cutting cancer research isn’t something most House members want to be associated with. So on its face, it seems like the NIH budget should be relatively safe from Congressional cuts.
But… the rescission trick explained above can be used to create a huge NIH budget cut, and a cut that is more politically palatable for swing Republican House members. Instead of voting to cut cancer research, Congressional Republicans can spin their vote for NIH rescission by saying “well, NIH didn’t spend the money, what can I do?!” That’s the combination of DOGE actions and Congressional procedure that is likely the biggest threat to the NIH budget.
And perhaps worse, it might be that Trump and HHS do have a plan to spend the NIH budget surplus when crunch time hits over the summer. That could be done with a big contract to Palantir to provide a huge medical data surveillance registry. It could be a massive grant to Musk’s Neuralink. There are lots of ways for the Trump administration to push out bad contracts or grants from NIH. And if we let the budget surplus build up at NIH, if spending does not restart wholesale, Trump will have US science over a barrel: there won’t be any other way to spend the money than issuing big, rushed contracts. It looks like the Trump administration has been preparing for this by consolidating contracting functions into HHS or atop NIH where they are more directly under political control.
The other Congressional action to pay attention to is reconciliation. Reconciliation allows effectively one budget- and spending-related bill to pass each year by a majority vote in the Senate, bypassing the filibuster. Republicans could try to use reconciliation to cut the NIH budget — and it would be a cut over the next ten years, because this year’s reconciliation package is aiming to set budgets for the next decade. On the one hand, NIH is in the same reconciliation lane as Medicaid, and so NIH could emerge from reconciliation with a cut, as money is moved to other health programs. On the other hand, a big NIH cut through reconciliation means House members have to take a vote on “cutting cancer research.” So while NIH could be cut in reconciliation, from here it seems more likely to happen via a rescission bill at the end of the summer.
In sum, the plan to cut NIH depends on what DOGE/MAGA is currently doing — blocking NIH spending by breaking agency functions — and ends with a rescission bill.
The major leverage we have is to bring all this to the public’s attention, and do whatever it takes to get NIH set up to start spending again and get money out the door soon. If we wait to fight the rescission bill in Congress, it will be too late. DOGE will have created a fait accompli.
One other budget move seems possible. Republicans may try to slip NIH cuts into this year’s reconciliation bill. If that happens, the fight turns to the House. There, the thin Republican majority and divided caucus means that Republicans may balk at voting against cancer cures and harming red state economies.
What do we do?
First, there are things that need to happen inside NIH.
NIH must do everything it can to spend its budget, and do so responsibly. On the grants side, study sections are partially restarting, but there is still a massive backlog of reviewed grants. Institute leadership should have a plan to push out grant awards through councils on short notice if needed and make sure grants management staff are available to make the awards. If this is not the case, NIH insiders need to get information to Democrats in Congress, confidentially, about what’s happening and what NIH needs to get this done.
On the in-house research side, NIH needs to reconstitute its contracting offices fast. Many contracting officers are due to be removed via RIF in early June. That needs to be reversed. Also, there are deadlines to issue contracts — large contracts cannot usually be initiated after April — and these deadlines must be removed this year to get money out the door in service of high-quality science.
It’s a mess inside NIH right now, and the staff needs public support and help. The top of NIH has been lopped off, with almost all senior leadership, from former acting director Larry Tabak to head of HR Julie Berko, removed via forced retirements or RIFs. Thousands of staff, from grants program officials to fellows to scientists, have been removed via possibly illegal means, and are not working.
Morale is uneven. In a personal conversation earlier this week, one senior employee said to me “NIH is dead right now. Unless things change dramatically soon, NIH is finished as a funder of high-quality science.” Scientists go through a lot of rejection in a career, and so they are resilient. Thanks to that resilience, some NIH’ers are keeping hold of the mission of supporting US science, staying positive, and rolling with the punches. But there are widespread fears the agency is in a state of collapse.
Scientific societies, patient groups, and Democrats in Congress all need to call for NIH spending to start back up unhindered. NIH must be allowed to spend its budget. It’s going to take a serious push to get Trump’s hands off NIH and rebuild capacity to perform critical functions. This will be an all hands on deck effort, and the sooner we start, the better chances we have of success. If NIH budget money, designated by Congress to be spent on medical cures, doesn’t go out over the next few months, all US scientists are looking at budget cuts that will not just take away cures but harm local economies.
How scientists and the public can help
The work that NIH does is enormously popular. That is a huge strength to lean into. More than 70% of independent or swing voters are concerned about Trump and Musk shutting down research into disease cures.
What are concrete things you can do now?
Public outreach: Get word to the public about how Musk and Trump are blocking NIH from funding important cures for disease. Tell the public what Republicans are planning. Talk about how rescission or reconciliation can write into law the cuts that Musk and Trump have created using underhanded and illegal means. Consider recording a short video for social media. Some groups can help you do this, groups like Science Homecoming, and InvestNScience.
Congressional outreach: Yes, even if you have only Democratic Congressional representation it is still important to reach out to them.
Call, visit, and pressure your Democratic Senators to use their procedural tools, like objecting to unanimous consent, to stop Senate business until the NIH interference — the cancer cure interference — is stopped. Democrats can and should do far more. Sen. Cory Booker’s one-day speech drove attention; Sen. Chris van Hollen’s trip to visit Kilmar Abrego Garcia did too. More Senate Democrats should be doing things that are not business as usual. The same holds true for House Democrats: they can be doing more and you can read this playbook to them.
Pressure your Republican Senators and Representatives. Probably the best way to create pressure is to go to the media: go to a townhall and ask a question that gets out to TikTok or YouTube. Or write to your local paper. Visit them and their staffers too, and push them to act.
The ask is “Leave NIH funding at last year’s (FY24) level. No DOGE cuts. No rescission to codify cuts. Hands off NIH.”
As Sen. Patty Murray said in February, “The Trump administration is working to destroy medical research as we know it.” They’re doing that by using a set of underhanded methods. We can stop them. Sunlight is the best disinfectant. Let’s get public and Congressional attention focused on what’s happening to medical research in America.
For more on NIH and attacks on science:
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Clear and concise explanation of the games that Republicans are playing right now, as well as the horrific consequences of these actions. Thank you for explaining the budget tricks and what actions we can all take to try and stop this.