This is a KFF Health News story. When President Donald Trump posted a satirical music video on social media in early October depicting his budget director, Russell Vought, as the Grim Reaper lording over Democrats in Congress, public health workers recognized a kernel of truth. Vought has exerted extraordinary control over government spending this year, usurping congressional decisions on how the nation's money is used. His push for more layoffs during the government shutdown is only the latest blow, following months of firings, canceled grants and withheld funds. By cutting and freezing public health funds, in particular, the Trump administration has already begun to undercut efforts to provide medical care, outbreak response, housing assistance and research across the U.S., according to

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