The Trump administration is holding back billions of dollars Congress appropriated for health programs, and some of that money could expire Wednesday when the fiscal year ends. Democratic lawmakers and some Republicans say the move is illegal. It follows the White House’s unilateral cancellation of nearly $1 billion in congressionally appropriated funding late last week.
The Money Congress Approved, and Didn’t Get Spent
Congress set aside $9.4 billion for global health programs for fiscal 2026. That preserved the President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight TB, AIDS and Malaria, and HIV/AIDS programs once run through the U.S. Agency for International Development (USAID). The administration had proposed deeper cuts. Lawmakers didn’t go along.
Still, the administration hasn’t spent $1.3 billion meant 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 officials were holding back the money.
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 that $1.3 billion, plus $1.2 billion for development assistance, to pay for shutting down USAID. Lawmakers said another $725 million was due to expire Wednesday rather than be spent. Collins asked officials how they’d use the money. It wasn’t clear whether she got an answer.
Under the administration’s “America First” foreign aid program, the United States enters bilateral agreements with individual countries so they can eventually rely less on U.S. funding.
Teen Health and Patient Safety Research Left Stranded
The same pattern shows up at home. Congress passed $101 million for the Teen Pregnancy Prevention (TPP) program, yet the Department of Health and Human Services (HHS) has spent only about $500,000. Created in 2010, TPP is a national, evidence-based program that funds organizations helping young people make healthy decisions, reduce sexual risk behavior, and decrease sexually transmitted infections and unintended teen pregnancy.
Conservatives have long targeted it. President Trump’s 2027 budget request proposed eliminating the program and called it leftist and ineffective. But he signed the fiscal 2026 budget into law with the funding included.
In June, HHS abruptly terminated 53 grants to nonprofits, universities and health departments, worth about $67 million, two years before they were due to expire. The agency said the grants no longer aligned with its priorities, and the administration wanted to reshape TPP into abstinence-only curricula. A list seen by The Hill said HHS terminated most grants because it said they normalized or promoted sexual activity for minors.
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. That decision is pending. Meanwhile, a letter from 92 House and Senate Democrats, led by the Democratic Women’s Caucus, said recipients hadn’t received any of the funding back, and 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,” the lawmakers wrote.
The Agency for Healthcare Research and Quality (AHRQ) faces its own squeeze. The relatively small agency works to make health care safer, more affordable and more effective, and it’s estimated to have funded research that saved thousands of lives and billions of dollars over the past 27 years. Congress appropriated about $345 million for it this year. In July, AHRQ told researchers it was halting at least 104 grants across 32 states, many aimed at improving patient safety.
Sens. Patty Murray (Wash.) and Tammy Baldwin (Wis.), top Democratic appropriators, said HHS told them it planned to award just 90 grants this year and wanted to transfer $100 million specifically appropriated for AHRQ to other agencies. At his Sept. 16 confirmation hearing, Chris Klomp, nominee for HHS deputy secretary, 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 reflect research grants.
“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, and likely the result will be lawsuits or hopefully further congressional action,” said Aaron Carroll, chief executive of AcademyHealth, a health services research group that supports AHRQ’s work. The White House had already impounded $80 million after failing to award grants from fiscal 2025.
“Everything that Americans hate about healthcare in the United States, that’s what AHRQ is supposed to be studying,” Carroll said. “They hate that they can’t get in to see a physician … they hate that they feel like they’re not getting the quality that they should, or they hear about these amazing things that are happening, but they can’t get them … that’s what AHRQ studies.”
Immigrants With Legal Status Face Coverage Loss
Separately, state data shows that hundreds of thousands of immigrants with legal status risk losing government health coverage starting Oct. 1. The One Big Beautiful Bill ends Medicaid eligibility for refugees, asylees, trafficking victims and others, and the effect may be greater than initially predicted. President Donald Trump signed the law on July 4, 2025. It cuts more than $900 billion in Medicaid spending through 2034. Phil Galewitz, Andrew Jones and Claudia Boyd-Barrett of KFF Health News wrote the report.
Why This Matters: Congress writes the spending rules, and the money at stake here funds concrete services: HIV and malaria programs abroad, teen health education, patient safety research. When appropriated dollars go unspent, the people those programs serve bear the cost, from teens in communities where local programs have halted work to patients who benefit from safety research. Republicans like Collins are raising alarms alongside Democrats, suggesting the dispute goes beyond party lines to a question of who controls federal spending. Courts and lawsuits may decide some of it. Meanwhile, the Oct. 1 Medicaid change could leave hundreds of thousands of legally present immigrants without coverage, adding another layer of uncertainty for families already watching public health support shrink.