Trump Administration Set to Let Over $2 Billion in Health Funding Lapse at Midnight Tonight

Congress passed a budget. The Trump administration didn't spend the money. Now billions of dollars are set to disappear when the fiscal year closes at midnight tonight, September 30, according to reporting by The Hill, Yahoo News, and NPR.

Congress appropriated $9.4 billion for global health programs in fiscal 2026, according to The Hill and Yahoo News, which both note that figure was only about 6% below what Congress spent the prior year, a deliberate bipartisan rejection of the administration's push for much deeper cuts. Lawmakers preserved PEPFAR, the Global Fund to Fight TB, AIDS and Malaria, and HIV/AIDS programs that used to run through USAID.

But $1.3 billion of that money, earmarked for maternal and child health and for fighting HIV/AIDS, malaria, and tuberculosis, has gone unspent, per The Hill. NPR's Fatma Tanis reported the administration has three options for it: spend it as Congress directed, use it to help pay for shutting down USAID, or let it lapse through what's known as a pocket rescission. The Hill and Yahoo News both report the administration also plans to let an additional $725 million expire Wednesday rather than spend it.

Senate Appropriations Committee Chair Susan Collins, a Maine Republican, sent a letter last week pressing administration officials to spend the money as intended. It's not clear from available reporting whether she got a real answer. Collins and top Democrats are worried the $1.3 billion, along with a separate $1.2 billion in development assistance, is being redirected to fund the USAID wind-down instead of the programs Congress named.

Stephen Morrison of the Center for Strategic and International Studies told NPR this is a deliberate strategy: "They clearly want to continue to chip away at the authority of Congress to mandate spending in global health." That's a serious allegation from a named source, not proven in court, but Democratic and some Republican lawmakers are calling the withholding illegal, according to The Hill and Yahoo News, which both frame this as a direct test of whether Congress will enforce its own spending decisions.

This follows a separate move. The White House unilaterally canceled nearly $1 billion in already-appropriated funding late last week, per The Hill and Yahoo News, on top of whatever lapses Wednesday.

A domestic program got hit too. Congress approved $101 million for the Teen Pregnancy Prevention program, but HHS has spent only about $500,000 of it, according to The Hill. Conservatives have targeted TPP for years, and Trump's 2027 budget request called for killing it outright, calling it ineffective and leftist. He signed the fiscal 2026 budget that funded it anyway. In June, HHS abruptly cut 53 grants worth $67 million to nonprofits, universities, and health departments, two years before they were set to expire.

There's a legitimate case for the administration's broader strategy here. Under its "America First" foreign aid approach, the U.S. has struck bilateral deals with 35 low-income countries, committing roughly $15 billion over five years while those countries put up matching money, according to NPR. The goal is weaning countries off permanent American subsidy. NPR reported that many global health experts consider this pragmatic and the right direction, even as Jocilyn Estes of the Center for Global Development told NPR the rollout has been rocky.

Redesigning foreign aid so partner nations carry more of the load is a policy choice Congress can debate. Simply not spending money Congress already told you to spend, on programs Congress explicitly preserved this year, is a different thing entirely, and it's the piece even some Republicans are calling out.

Medicare's Own Waste Problem

While Congress and the White House fight over withheld dollars, Medicare is hemorrhaging money on treatments that don't work. Reporting from Epoch Times found the government spends roughly $1 billion a year on urine tests for seniors with no symptoms of infection, a practice a 1996 expert task force said has "no benefit." More than a third of Medicare beneficiaries receive some form of "low-value care" every year, per the same reporting, costing taxpayers several billion dollars combined.

Donald Berwick, who ran CMS under President Obama, called this "waste that comes from subjecting patients to care that, according to sound science and the patients' own preferences, cannot possibly help them," in a 2012 study cited by Epoch Times.

The HHS secretary has had legal authority since 2010 to ban 21 specific categories of low-value care from Medicare coverage. Not one secretary has used it, including current Secretary Robert F. Kennedy Jr. Current CMS Administrator Dr. Mehmet Oz has launched a voluntary pilot to reexamine some of this coverage, but when the idea came up in the House Appropriations Committee in June, it drew unanimous bipartisan pushback, per Epoch Times.

The Treasury Department's annual report, cited by Epoch Times, projects Medicare heading toward insolvency by 2033, with a $60.4 trillion shortfall over the next 75 years absent reform.

So the government is simultaneously sitting on billions in appropriated funds Congress told it to spend on maternal health and disease prevention, while refusing to touch billions in provably wasteful Medicare spending it already has the power to cut. Collins is still waiting on answers about the $1.3 billion. Nobody in either party has moved to use the low-value care authority sitting on the books since 2010. Both problems have a September 30 or ongoing deadline attached, and both remain unresolved as the fiscal year closes tonight.