In early October, President Donald Trump shared a satirical music video on social media that portrayed his budget director, Russell Vought, as the Grim Reaper targeting Democrats in Congress. This depiction resonated with public health workers who see a troubling reality in Vought's significant influence over government spending this year. Vought has taken control of budgetary decisions, often overriding Congress's authority on financial matters.

His recent push for additional layoffs during the government shutdown is the latest in a series of actions that have included firings, canceled grants, and withheld funds. Health officials, nonprofit leaders, and federal agency staff have reported that the Trump administration's cuts and freezes to public health funding are undermining critical services. These reductions threaten medical care, outbreak responses, housing assistance, and research efforts across the United States.

Most federal public health funds are allocated to states, which means Vought's actions rival those of Health and Human Services Secretary Robert F. Kennedy Jr. in disrupting government initiatives aimed at maintaining public health. For instance, in Texas, funding from the Centers for Disease Control and Prevention to address a measles outbreak was not available until after the crisis had passed, resulting in the deaths of two children. In Alabama, a project designed to protect residents from raw sewage and hookworm was abandoned. Additionally, people living with HIV have faced delays in medical care as clinics reduce their hours, and critical surveys on HIV and maternal mortality have been halted.

Food banks have canceled events, tobacco prevention programs have lapsed, and initiatives to safeguard older adults from falls have been compromised. Regardless of the budget Congress ultimately approves for the upcoming year, the Trump administration may continue to obstruct financial support for these essential programs, potentially harming public health.

Gillian Metzger, a constitutional law professor at Columbia University, stated, "The White House has shown that they are willing to unilaterally exert control over funding. This is a huge deal because the power of the purse is central to Congress' ability to shape and direct policy."

Before his appointment to lead the Office of Management and Budget, Vought outlined strategies in Project 2025, a conservative blueprint from the Heritage Foundation, aimed at shifting power from Congress and federal agencies to the executive branch. His tactics have included sudden grant cancellations, strict spending constraints, and excessive layers of review in the grantmaking process, according to agency officials.

Layoffs have further complicated the distribution of funds, particularly in offices responsible for chronic disease prevention, HIV, and maternal mortality. Abigail Tighe, executive director of the National Public Health Coalition, emphasized the need for congressional action, stating, "We want Congress to act because this is preventing states and communities from doing critical public health work to keep our country safe. If they don't have capacity, we all collectively suffer."

Democrats on the House Appropriations Committee have called for transparency regarding the unspent public health funds appropriated for 2024 and 2025 due to the administration's disruptions. Robert Gordon, a public policy expert at Georgetown University, described the situation as a "sophisticated strategy to cause money to lapse and then say, 'If they can't spend it, they don't need it.'" He added, "No one thought this was possible or legal, but that is what's happening."

The details surrounding how the administration has affected health spending have not received significant attention, raising concerns among public health advocates about the future of essential health services in the U.S.