The U.S. House passed President Donald Trump's "Big Beautiful Bill" Thursday afternoon across party lines, save a couple votes. Passage in the Senate earlier this week secures the bill's future.

Meanwhile, legislators are still in the process of finalizing next year’s federal budget, which could have major implications for public health.  

Former directors of the Atlanta-based Centers for Disease Control and Prevention are raising the alarm ahead of budget talks.  

“The current budget leaves the American people to pay the price tag with both their lives and money,” said Brian King, former director at the Food and Drug Administration and at the CDC’s Office on Smoking and Health, during a recent press call.  

Aside from the reconciliation bill, Trump’s proposed budget would replace the Department of Health and Human Services with the Administration for a Healthy America, or AHA, eliminating many departments and slashing budgets. 

 

Proposed cuts are widespread

Secretary of the Department of Health and Human Services Robert F. Kennedy Jr. had initially proposed laying off 10,000 people across HHS departments as part of the reorganization.  

That includes an almost-total elimination of the National Centers for Chronic Diseases Prevention and Health Promotion, Environmental Health and Injury Prevention and Control. Language in the fiscal year 2026 budget proposal calls those centers, currently under the CDC, “unnecessary.”  

Consolidations are also expected under the Health Resources and Services Administration, National Institutes of Health and Substance Abuse and Mental Health Services Administration.  

Georgia could lose $382 million in grants once the budget is said and done, according to a public database put together by a coalition of fired and retired CDC staff. That’s money used to fight HIV, drug use and fund disease research at universities.  

The Georgia Department of Public Health already started ending contracts this spring with groups doing disease prevention work that had been slated to last through the end of next year.  

Some CDC employees told NPR that grants still expected by states have been largely put on hold as the department itself waits for the entirety of its 2025 budget.  

Thomas Farley, a pediatrician and epidemiologist with experience working in public health, said local public health departments rely on the CDC not only for funding but for expertise. 

“True national experts in their topics ... Those experts don't exist in state and health departments,” Farley said. “The state and the local health department look to folks at CDC for guidance as to how they should strategically orient prevention programs.” 

 

Public health workers left in uncertainty 

Over the past six months, thousands of federal employees have been fired — and some rehired — in a flurry of presidential actions.  

On Tuesday, a U.S. District Court judge in Rhode Island ruled to block further disruption and consolidation of four departments under the HHS, including the CDC. Representatives from 19 states and D.C. had sued the federal government over the firings.  

In her decision, the judge writes that “the States have shown a likelihood of success on their claims that the HHS’s action was both arbitrary and capricious as well as contrary to law.” The states suing suggest violations of the Administrative Procedure Act. 

Even though the majority of CDC employees are in Georgia, and the agency has a huge economic impact, Eric Segall, a constitutional law professor at the Georgia State University College of Law, says it’s unclear whether the decision will apply to staff at the Atlanta headquarters, because Georgia was not a plaintiff in the case.  

It also comes after a decision by the U.S. Supreme Court to ban nationwide injunctions by judges.

“Two months ago, even a month ago, maybe even a week ago, this decision would have stopped President Trump entirely from cutting the 20,000 people or so that he wanted to cut from HHS,” Segall said. “But I don't think anybody really truly knows the answer to that question now.” 

Still, Segall called the decision out of Rhode Island “very careful” and “correct.”  

“If the appellate court and the Supreme Court pays attention to the facts and the details and the law of this subject, it should be upheld,” Segall said.  

Meanwhile, John Brooks, former medical officer at the CDC, said all the back and forth means an “unsettling and uncertain” daily reality for staff at the agency, including those who had been cut as part of the initial “reduction in force” earlier this year but have since been reinstated.  

“We don't know how long they're going to be un-RIFed,” Brooks said. “Is it until the end of the current fiscal year or are they going to somehow be moved into AHA?”  

Even those with jobs, there’s a question of whether their work will continue if money for it is lost.  

“There are other people though who are being brought back and the project that they were working on has been ended,” Brooks said.  

U.S. House committee members will review the federal budget in several appropriations meetings this month. 

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