特朗普政府突然削减数十亿美元的州卫生服务经费

【中美创新时报2025 年 3 月 26 日编译讯】（记者温友平编译）美国卫生与公众服务部突然取消了向各州提供的超过 120 亿美元的联邦拨款，这些拨款原本用于追踪传染病、精神卫生服务、成瘾治疗和其他紧急健康问题。各州已被告知，他们不能再使用资助传染病管理和成瘾服务的拨款。对此，《纽约时报》记者阿普尔瓦·曼达维利、玛格特·桑格-卡茨和扬·霍夫曼作了下述报道。

经费削减可能会进一步拖累州卫生部门，这些部门已经资金不足，而且还在努力应对慢性病、梅毒等复发感染以及禽流感等新出现的威胁。

州卫生部门于周一晚间开始收到通知，称在新冠疫情期间拨付的资金将被终止，立即生效。

通知称：“不得开展与这些资金相关的任何额外活动，也不得产生任何额外费用。”

对于一些人来说，效果是立竿见影的。

据德克萨斯州拉伯克市公共卫生主任凯瑟琳·韦尔斯称，该市公共卫生官员已收到命令，停止由三项拨款支持的工作，这些拨款用于资助应对当地日益扩大的麻疹疫情。

周二，一些州卫生部门准备裁掉数十名流行病学家和数据科学家。包括德克萨斯州、缅因州和罗德岛州在内的其他州仍在努力了解裁员的影响，然后再采取行动。

在采访中，州卫生官员预测，全国范围内数千名卫生部门员工和合同工可能会失业。一些人预测，一些传染病团队的工作人员流失率将高达 90%。

“现实情况是，当我们从公共卫生系统撤出资金时，这些系统就没有能力了，因为几十年来它们一直处于资金不足的状态，”曾担任华盛顿州卫生部长至今年 1 月份的乌迈尔·沙阿 (Umair Shah) 博士说。

裁员消息最先由 NBC 报道。

停止的拨款包括来自疾病控制和预防中心的约 114 亿美元，以及来自药物滥用和精神健康服务管理局（SAMHSA）的约 10 亿美元

作为新冠疫情救济法案的一部分，国会批准了用于州公共卫生项目的资金。这些资金最初确实用于新冠病毒检测和疫苗接种，以及解决高危人群的健康差距。

但去年，  这笔钱还被允许用于其他紧迫的公共卫生问题，包括对其他呼吸道病毒的检测和监测、为儿童或没有保险的成人接种一系列疫苗以及应对突发卫生事件。

周二，联邦卫生与公众服务部发言人安德鲁·尼克松在一份声明中表示：“新冠肺炎疫情已经结束，卫生与公众服务部将不再浪费数十亿美元的纳税人资金去应对美国人多年前就已经摆脱的根本不存在的疫情。”

特朗普政府取消政府各部门的拨款和合同，已引发多起州和非营利组织的诉讼，这些诉讼尚处于初期阶段。涉案医疗拨款由国会批准和拨款，终止这些拨款可能会引发新的诉讼。几个州表示，他们正在探索法律途径。

马萨诸塞州州长莫拉·希利在一份声明中表示：“我们将继续评估全部影响，并与总检察长办公室和其他 49 个面临类似挑战的州保持联系。”

这些剩余资金对于资金短缺、试图实现体系现代化的公共卫生部门来说是一个福音。

例如，阿拉斯加州已将部分资金用于购买实验室设备和更新电子记录，这样该州的流行病学家就无需再手动填写患者详细信息。其他州正在建立系统，将医院和实验室的监测数据与卫生部门联系起来。

陈旧的数据系统阻碍了许多州对 Covid 和 mpox 疫情的应对。

8 月份卸任阿拉斯加首席医疗官的安妮·辛克 (Anne Zink) 博士说：“我们有机会更新一些迫切需要更新的内容，以便做出更有效的公共卫生应对。”

但现在，由于拨款削减，该项目将无法完成，迄今为止投入的税收资金可能会被浪费，她说。

在一些州，这些资金还用于研究慢性病，慢性病的存在会增加因冠状病毒导致严重后果和死亡的风险。

SAMHSA 的资金并非专门用于 Covid 项目，而是用于解决心理健康和药物滥用问题。疫情导致人们普遍感到孤独、无聊和焦虑，这些因素导致药物过量死亡人数激增，2022 年达到 11.1 万多人，高于 2019 年的约 7 万人。

根据最新的联邦数据，截至 10 月份的 12 个月内，药物过量人数的峰值下降至约 87,000 人。其中下降幅度最大的是西弗吉尼亚州、密歇根州和田纳西州，这些州在总统大选中都大力支持特朗普总统。

全国州心理健康项目主任协会执行主任布莱恩·赫本表示，许多州也已动用资金建立 988 条自杀救助热线和其他危机服务。但他表示，各州明白资金受时间限制，因此很少有州将其用于资助持续服务。

在科罗拉多州，新冠疫情期间的补充资金支持了大约 60 个项目，包括危机应对小组的项目、针对患有严重精神疾病的成年人和早期精神病发作的年轻人的服务，以及为戒毒和戒酒者提供的同伴支持咨询服务。科罗拉多州已承诺将剩余的 3150 万美元拨款用于支持这些服务的提供者。

科罗拉多州行为健康管理局局长丹妮特·R·史密斯 (Dannette R. Smith) 表示：“在很多情况下，这些都是拯救生命的项目和服务，我们担心那些依赖这些支持的人的健康。”

SAMHSA 提供的一些资助原定于 9 月到期，但 CDC 提供的一些 Covid 资助原本将持续到 2026 年和 2027 年。

各州当时正在为补助金到期做准备，但“提前到期且没有任何通知，显然会造成极大的混乱”，一位州公共卫生官员表示。由于无权对媒体发言，这位官员要求不具名。

肯塔基州和南卡罗来纳州等一些州严重依赖联邦资金来运行其卫生项目，而新泽西州和加利福尼亚州等其他州则较少依赖联邦资金。尽管如此，大多数追踪疾病爆发的人员和数据系统都由疾控中心资助

一位了解该决定影响的官员表示，这一突然决定“导致人们没有机会转岗，甚至没有机会让州政府说，‘在下一个预算周期，我们将增加 X 个职位’”。这位官员要求不透露姓名，因为他们担心遭到特朗普政府的报复。

“已经花费了数百万美元，但这些项目实际上永远无法完成，”这位官员说。“这就像把钱扔出窗外，完全是浪费。”

题图：上个月，德克萨斯州拉伯克市一家 MMR 疫苗接种诊所爆发麻疹疫情。信用…罗纳尔多·施密特/法新社——盖蒂图片社

附原英文报道：

Trump Administration Abruptly Cuts Billions From State Health Services

States have been told that they can no longer use grants that were funding infectious disease management and addiction services.

An MMR vaccination clinic in Lubbock, Texas, last month amid a measles outbreak.Credit…Ronaldo Schemidt/Agence France-Presse — Getty Images

By Apoorva Mandavilli Margot Sanger-Katz and Jan Hoffman

March 26, 2025

The Department of Health and Human Services has abruptly canceled more than $12 billion in federal grants to states that were being used for tracking infectious diseases, mental health services, addiction treatment and other urgent health issues.

The cuts are likely to further hamstring state health departments, which are already underfunded and struggling with competing demands from chronic diseases, resurgent infections like syphilis and emerging threats like bird flu.

State health departments began receiving notices on Monday evening that the funds, which were allocated during the Covid-19 pandemic, were being terminated, effective immediately.

“No additional activities can be conducted, and no additional costs may be incurred, as it relates to these funds,” the notices said.

For some, the effect was immediate.

In Lubbock, Texas, public health officials have received orders to stop work supported by three grants that helped fund the response to the widening measles outbreak there, according to Katherine Wells, the city’s director of public health.

On Tuesday, some state health departments were preparing to lay off dozens of epidemiologists and data scientists. Others, including Texas, Maine and Rhode Island, were still scrambling to understand the impact of the cuts before taking any action.

In interviews, state health officials predicted that thousands of health department employees and contract workers could lose their jobs nationwide. Some predicted the loss of as much as 90 percent of staff from some infectious disease teams.

“The reality is that, when we take funding away from public health systems, the systems just do not have the capacity, because they’re chronically underfunded over the decades,” said Dr. Umair Shah, who served as Washington State’s health secretary until January.

The news of the cuts was first reported by NBC.

The discontinued grants include about $11.4 billion from the Centers for Disease Control and Prevention, as well as around $1 billion from the Substance Abuse and Mental Health Services Administration, known as S.A.M.H.S.A.

Congress authorized the money for state public health programs as part of Covid relief bills. The funds were indeed initially used for testing for and vaccination against the coronavirus, as well as to address health disparities in high-risk populations.

But last year,  the money was also allowed to be put toward other pressing public health concerns, including testing and surveillance of other respiratory viruses, an array of vaccines for children or uninsured adults and preparedness for health emergencies.

On Tuesday, Andrew Nixon, a spokesman for the federal Department of Health and Human Services, said in a statement: “The Covid-19 pandemic is over, and H.H.S. will no longer waste billions of taxpayer dollars responding to a nonexistent pandemic that Americans moved on from years ago.”

The Trump administration’s cancellations of grants and contracts throughout the government has led to numerous lawsuits from states and nonprofit groups, which are still in their early stages. The health grants in question were authorized and appropriated by Congress, and their termination may lead to new lawsuits. Several states said they were exploring legal options.

“We will continue to assess the full impacts and are in touch with the Attorney General’s Office and the 49 other states facing similar challenges,” Governor Maura Healey of Massachusetts said in a statement.

The surplus funds had been a boon for cash-strapped public health departments seeking to modernize their creaky systems.

For example, Alaska had been applying some of the funds toward purchasing lab equipment and updating electronic records, so that state epidemiologists would no longer need to fill in patient details manually. Other states were building systems to link surveillance data from hospitals and labs to health departments.

Antiquated data systems hampered the response in many states to the Covid and mpox outbreaks.

“We had the opportunity to update some of these things that desperately needed to be updated to have a more efficient public health response,” said Dr. Anne Zink, who stepped down as Alaska’s chief medical officer in August.

But now, with grants cut, the project will remain unfinished, and the tax dollars invested so far may go to waste, she said.

In some states, the funds have also helped study chronic diseases, whose presence increases the risk of severe outcomes and death from the coronavirus.

The funds from S.A.M.H.S.A. were not earmarked for Covid programs, and they were intended to address mental health and substance use issues. The pandemic led to widespread loneliness, boredom and anxiety, factors that contributed to a surge in overdose deaths that reached just over 111,000 in 2022, up from about 70,000 in 2019.

The peak overdose numbers dropped to about 87,000 in the 12-month period that ended in October, according to the most recent federal data. Some of the sharpest declines were in states such as West Virginia, Michigan and Tennessee, all of which strongly supported President Trump in the presidential election.

Brian Hepburn, the executive director of the National Association of State Mental Health Program Directors, said many states had also applied their funds to build out their 988 suicide lifelines and other crisis services. But states understood the funding was subject to time constraints, so few used it to fund ongoing services, he said.

In Colorado, Covid-era supplemental funds supported about 60 programs, including those for crisis response teams; services for adults with severe mental illness and for young adults with early onset of psychotic disorders; and peer support counselors for people in recovery from drug and alcohol addiction. Colorado had committed its remaining $31.5 million in grant money to support the providers of these services.

“In so many cases, these are lifesaving programs and services, and we worry for the well-being of those who have come to count on this support,” said Dannette R. Smith, the commissioner of Colorado’s Behavioral Health Administration.

The grants from S.A.M.H.S.A. were scheduled to expire in September, but some Covid grants from the C.D.C. were meant to last until 2026 and 2027.

States were preparing for the grants to expire then, but “to have it happen early and with no notice is obviously extremely disruptive,” said one state public health official, who asked not to be identified because they were not authorized to speak to the media.

Some states, like Kentucky and South Carolina, rely heavily on federal funding to run their health programs, while others, such as New Jersey and California, depend on it less. Still, most of the people and data systems that track disease outbreaks are funded by the C.D.C.

The abruptness of the decision left “no opportunities to transition people into other means, no opportunities even for a state government to say, ‘In our next budget cycle, we’re going to add X number of positions,’” said one official with close knowledge of the impact, who asked not to be named because they feared retaliation from the Trump administration.

“There’s millions of dollars that have been spent that essentially, the projects will never be able to be finished,” the official said. “This is just like throwing money out the window; it’s a total waste.”