President’s FY 2027 Budget Proposal and Implications for EP
April 13, 2027 – Earlier this month, the Administration released its FY 2027 budget proposal. While the President can present suggestions, this document is not binding. Congress retains full authority over appropriations, and historically most presidential budget requests are modified or simply not enacted. That said, the budget is still important as it provides insight into Administration priorities and policy direction, which can influence agency rule making, legislative negotiations, and appropriations messaging. HRA is looking at this as a directional document, not a predictive one, especially in a unique midterm election year.
Topline takeaways for HRA:
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The budget reflects a retrenchment and restructuring approach at Health and Human Services (HHS)
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The National Institutes of Health (NIH), including the National Heart, Lung, and Blood Institute (NHLBI), faces meaningful proposed cuts
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The Centers for Medicare and Medicaid Services (CMS) signals operational priorities but not payment reform
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Telehealth is present but limited in scope
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Core HRA priorities are largely absent
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Public health infrastructure changes may have indirect effects
HHS: Structural Reorganization and Funding Reduction
The proposal includes $111.1B in discretionary HHS funding, approximately $15.8B below FY 2026. A central feature is the creation of the Administration for a Healthy America (AHA), consolidating functions from Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Office of the Assistant Secretary for Health (OASH), and parts of Centers for Disease Control (CDC). This type of HHS consolidation has been proposed in various forms before but has not been implemented largely due to sizable congressional and stakeholder resistance. While the current proposal is more expansive and it is highly unlikely it would be enacted as written, it signals continued pressure toward centralization and cost control that could still materialize in smaller ways.
Implications for HRA:
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Signals a move toward centralization and cost control
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Cardiovascular priorities may be less visible within broader frameworks
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Organizational changes may temporarily disrupt programs and engagement
NIH and NHLBI: Direct Relevance to Research Advocacy
The budget proposes:
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NIH discretionary funding at $41.2B (down $3.5B)
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Program level funding down $4.8B
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NHLBI reduced by approximately $297M
The proposal would eliminate three NIH components: the National Institute on Minority Health and Health Disparities, the Fogarty International Center, and the National Center for Complementary and Integrative Health, likely redistributing or reducing funding in those areas while leaving larger institutes such as NHLBI intact but reduced.
Implications for HRA:
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Direct impact on cardiovascular and arrhythmia research funding
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Increased competition for grants
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Reinforces the need for strong NIH/NHLBI advocacy, including alignment with HEARTS Act messaging
CMS: Operational Signals Without Payment Reform
CMS is proposed at $6.8B in program-level funding, down $1.4B. Funding focuses on oversight, Medicare Advantage administration, and system modernization. The budget also proposes moving $340B oversight into CMS.
Notably absent:
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No proposal addressing Medicare physician payment stability
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No focus on remote monitoring valuation or site-of-care reform
Implications for HRA:
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Payment reform will continue to depend on Congress and rulemaking
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Reinforces current advocacy strategy targeting legislative vehicles and CMS regulations
FDA: Modest Increase and Modernization Focus
The FDA would receive $7.2B, an increase of $232M. Focus areas include food safety, AI in regulatory processes, and modernization.
Implications for HRA:
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Potential improvements in device review and surveillance
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Alignment with ongoing engagement on device safety and innovation
Telehealth: Limited but Positive Signals
The proposed budget includes:
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$20M for telehealth centers of excellence
The proposed budget is missing:
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No major expansion of telehealth flexibilities
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No direct support for remote cardiac monitoring policy
Implications for HRA:
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Telehealth remains recognized but not a major focus
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Continued advocacy needed around remote monitoring and access
Public Health Realignment: Indirect Implications
The budget proposes reductions at CDC and consolidates programs into the new AHA structure. It also reduces funding tied to digital health work in AHRQ-related functions.
Implications for HRA:
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Potential shift away from disease-specific priorities
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Risk of cardiovascular issues receiving less targeted attention
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Opportunity to emphasize sudden cardiac arrest and cardiomyopathy as high-impact areas
What This Budget Does Not Do
The proposal does not meaningfully address HRA’s core priorities:
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Medicare payment stability
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Prior authorization reform
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Remote monitoring policy
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Site-of-care reform
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Medicare Advantage oversight
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Workforce issues
These issues will continue to depend on congressional action, regulatory processes, and stakeholder advocacy, likely through 2027.
HRA’s work will:
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Continue strong appropriations advocacy, especially for NIH/NHLBI
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Maintain focus on Congress for payment and prior authorization reform
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Emphasize access and capacity in policy messaging
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Engage early on structural changes within HHS
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Continue collaboration with FDA on device-related priorities
Bottom Line
The FY 2027 President’s Budget reflects an emphasis on cost containment and structural reorganization, with selective investments in areas like FDA and telehealth. Unsurprisingly, it does not directly address the core policy challenges facing electrophysiology. For HRA, this reinforces the need to continue driving policy change through Congress and regulatory engagement while adapting to a more constrained federal health policy environment.