President Trump’s proposed budget for the U.S. Department of Health and Human Services would send spending in the department to its lowest level in nearly two decades. (Mark Wilson/Getty Images)

The Department of Health and Human Services would receive $69 billion under the president’s budget proposal, a reduction of 17.9 percent that would send spending in one of the government’s largest and most sprawling departments to its lowest level in nearly two decades.

More than a third of the $15.1 billion in cuts would affect the National Institutes of Health, the government’s main engine of biomedical research, which has long enjoyed strong bipartisan support in Congress.

The spending document prepared by the Office of Management and Budget provides only a glimpse into the new administration’s intentions for HHS. In a break with budgetary tradition, the document excludes funding for Medicare and Medicaid benefits — currently totaling about $1 trillion — the vast public insurance systems for older and poor Americans known as “mandatory” programs in federal budget parlance.

And there is no mention of certain major programs. Among them are Temporary Assistance for Needy Families, the country’s main welfare program of cash assistance, and Head Start, a program benefiting low-

income preschool children.

The proposed budget would increase spending on substance-abuse services by $500 million to help prevent and treat opioid addiction. And it would create an emergency fund to help respond to disease outbreaks, though it does not specify how much money such a fund would receive or whether the money would be diverted from other parts of the U.S. Centers for Disease Control and Prevention.

The budget would eliminate longtime targets of conservatives: the Low Income Home Energy Assistance Program as well as the Community Services Block Grant, a 1970s-era strategy to lessen poverty.

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In the Food and Drug Administration, the budget anticipates a doubling of the reliance on fees charged to companies applying for permission to sell new medical products to help cover the cost of reviewing them.

The proposed cuts to NIH represent 19 percent of its $30.3 billion budget for “discretionary” programs. The spending plan calls for a “major reorganization” of the 27 NIH institutes and centers, though it does not spell out the changes — with one exception. It would abolish the Fogarty International Center, a $69.1 million program dedicated to building partnerships between health research institutions in the United States and other countries.

The plan also would fold into NIH the Agency for Healthcare Research and Quality, a free-standing agency within HHS devoted to fostering research evidence to improve health care’s quality, safety and accessibility.

(Jenny Starrs/The Washington Post)

In addition, the summary tables of the budget document lists the 2018 budget request for HHS as $65.1 billion. The discrepancy was not explained in the document.