Billions of dollars Congress appropriated for health programs remain unspent as the fiscal year ends Wednesday. Some funds will expire if the Trump administration doesn't act. Democrats call the holdback illegal. Some Republicans do, too.
That bipartisan objection carries weight. It comes after the White House canceled nearly $1 billion in congressionally appropriated funding late last week, acting on its own.
The Power of the Purse
Congress appropriated $9.4 billion for global health programs for fiscal 2026. The funding preserved the President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight TB, AIDS and Malaria, and HIV/AIDS programs previously run through the U.S. Agency for International Development (USAID). The administration had proposed deeper cuts. Lawmakers rejected them.
The administration hasn't spent $1.3 billion intended to protect maternal and child health and counter infectious diseases, including HIV/AIDS, malaria and tuberculosis. Congressional leaders had warned for more than a month that the administration was holding the money back.
Sen. Susan Collins (R-Maine), chair of the Senate Appropriations Committee, urged administration officials last week to spend the money as intended. She and top Democrats worry the administration is diverting the $1.3 billion, along with $1.2 billion for development assistance, to pay for shutting down USAID. Lawmakers said another $725 million would expire Wednesday rather than go toward its intended purpose. Collins asked how officials planned to use the money. She didn't get a clear answer.
The administration has described a different approach. Under its "America First" foreign aid program, the United States is entering bilateral agreements with individual countries so they can eventually rely less on U.S. funding.
Domestic Programs and the Courts
Congress approved $101 million for the Teen Pregnancy Prevention (TPP) program, created in 2010. The Department of Health and Human Services (HHS) has spent only about $500,000. Conservatives have long targeted the program. President Trump's 2027 budget request proposed eliminating it, calling it leftist and ineffective. Still, he signed the fiscal 2026 budget into law with the funding included.
In June, HHS ended 53 grants worth about $67 million, two years before their scheduled expiration. The agency said the grants no longer matched its priorities, and the administration wanted to reshape TPP into abstinence-only curricula. A list seen by The Hill said HHS ended most grants because it claimed they normalized or promoted sexual activity for minors.
The dispute is now before a court. In August, a federal judge blocked the administration's changes to TPP while a lawsuit proceeds. U.S. District Judge Christopher Cooper said he wasn't sure he had authority to reinstate the canceled grants, and that question remains pending. Ninety-two House and Senate Democrats, led by the Democratic Women's Caucus, wrote that officials hadn't restored any of the funding and that local programs had halted work. "HHS's only options are to either return the funding to the communities and teens who rely on it or let it go to waste," they wrote.
Research Dollars in Dispute
The Agency for Healthcare Research and Quality (AHRQ) received about $345 million this year. Supporters estimate its research over 27 years has saved thousands of lives and billions of dollars. In July, the agency told researchers it would halt at least 104 grants across 32 states.
Sens. Patty Murray (Wash.) and Tammy Baldwin (Wis.) said HHS told them it planned to award just 90 grants this year and sought to transfer $100 million specifically appropriated for AHRQ to other agencies. HHS deputy secretary nominee Chris Klomp painted a different picture at his Sept. 16 confirmation hearing. He told senators AHRQ was "on track to expend 97 percent of its appropriated funds by the end of the fiscal year." That figure apparently didn't include research grants.
Aaron Carroll, chief executive of AcademyHealth, said, "We've seen almost no money go out the door, and so unless they actually somehow manage to ship it all out today or tomorrow, there's going to be a massive impoundment at AHRQ." The White House had already impounded $80 million after it failed to award fiscal 2025 grants.
Medicaid Changes Take Hold
Another deadline arrives Oct. 1. State data shows hundreds of thousands of immigrants with legal status risk losing government health coverage. The One Big Beautiful Bill, signed July 4, 2025, ends Medicaid eligibility for refugees, asylees, trafficking victims and others. The impact may exceed initial predictions. According to the KFF Health News report, the law cuts more than $900 billion in Medicaid spending through 2034.
Why This Matters: Two separate questions are tangled together here, and they deserve separate answers. One is whether a president can refuse to spend money Congress has appropriated. Collins' objection shows the concern crosses party lines, and the courts may ultimately set the boundary. The other is whether federal health spending should shrink. That's a legitimate policy debate. The Medicaid law, which cuts more than $900 billion through 2034, shows the administration can pursue spending restraint through legislation. Budgeting works best when lawmakers make spending decisions openly and put them in law, not when officials delay as a deadline passes. Lawsuits and expired funds create uncertainty for grant recipients, researchers and taxpayers alike. Lawmakers who want lower spending have a clear path: vote for it.