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"They're happy to give even more to the wealthiest with giant tax breaks," said Rep. Mark Pocan, "but when it comes to helping people in need, there's never enough to go around."
House Republicans have struck down a pair of amendments to fully fund the Meals on Wheels program and AIDS prevention as part of this week's markup process for the fiscal year 2026 US Department of Health and Human Services (HHS) budget.
The amendments were proposed by Rep. Mark Pocan (D-Wis.) to the bill recently released by the House Appropriations Committee, which proposes to cut HHS funding by 6%.
Part of that funding comes from Meals on Wheels, the charity that provides an estimated 250 million meals each year to senior citizens unable to cook for themselves. The charity says that 9 in 10 of its providers receive some amount of federal funding and that for 60% of them, it represents more than half their operating budget.
According to Pocan, who spoke Monday on the House floor, the Republican bill underfunds the food assistance program by $600 million, which he says is likely to cost 1.9 million people their access to food.
"Republicans in the appropriations process are leaving seniors to starve," Pocan said.
Combined with the $187 billion already cut from the Supplemental Nutrition Assistance Program (SNAP) by the "One Big Beautiful Bill Act," which Republicans passed in July, Pocan said it amounts to "the largest cut to food assistance in our nation's history."
Pocan juxtaposed these cuts with the "extravagant dinner" hosted this weekend at Trump's new, private White House "Rose Garden Club," which White House social media shows featured "steak and a fudge-filled seven-layer cake."
"I guess the theme of the White House event was 'let them eat cake,'" Pocan joked.
When he proposed the amendment as part of the markup process on Tuesday, Pocan spoke about his elderly mother's experience relying on the Meals on Wheels program when she dealt with mobility issues.
"I would hope that this is something where we could get together and say, 'Yeah, this should be a priority... We respect our seniors and we're going to show that through Meals on Wheels," Pocan said before his House colleagues.
Every single Republican on the Appropriations Committee voted against the amendment.
Republicans also unanimously struck down Pocan's amendment to restore nearly $2 billion for AIDS prevention cut from the House GOP bill, which makes up 25% of the total budget cuts to HHS.
In June, the Foundation for AIDS Research projected that Trump's proposal to cut $1.3 billion worth of HIV prevention funds "could cause an additional 144,000 new HIV diagnoses, 15,000 deaths, and 128,000 more people living with HIV in the US by 2030."
The Appropriations Committee budget goes even further than Trump's proposed budget released earlier this year, cutting over $1.7 billion worth of AIDS prevention funding.
It calls for the total elimination of Centers for Disease Control and Prevention funding to combat HIV and cuts $220 million allocated to Trump's own Ending the HIV Epidemic (EHE) initiative. It also eliminates $525 million from the Ryan White Program, which provides grants to over 400 HIV/AIDS clinics providing care and treatment.
"This is not a bill for making America healthy again, but a disastrous bill that will reignite HIV in the United States," said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. "Eliminating all HIV prevention means the end of state and local testing and surveillance programs, educational programs, and linkage to lifesaving care and treatment, along with PrEP. It will translate into an increased number of new HIV infections, which will be costlier to treat in the long run."
After Republicans voted down his amendment to reverse these "devastating" cuts, Pocan wrote on X, "They're happy to give even more to the wealthiest with giant tax breaks, but when it comes to helping people in need, there's never enough to go around."
"There will be an additional 6 million newly infected persons in the world," said the United Nations' top AIDS prevention official recently. "That has started already."
The U.S. program credited with saving an estimated 26 million lives and preventing millions of new HIV infections has not sufficiently provided a direct benefit to the United States, suggests Trump State Department planning documents for the George W. Bush-era initiative.
Congress rejected cuts to the President's Emergency Plan for AIDS Relief (PEPFAR) last week, even as Republicans pushed through nearly $8 billion in foreign aid cuts; the program has long had robust bipartisan support as it has enabled 5.5 million babies to be born without HIV to HIV-positive mothers, provided support to 7 million orphans, and driven a decline in new HIV infections in young women in every geographic area that implements its prevention program.
But as The New York Times reported Thursday, a draft plan at the State Department details proposals for "transitioning" low-income countries away from PEPFAR, with the Trump administration imposing what it calls "bilateral relationships" with the aim of ostensibly prioritizing public health in the United States.
Countries in the Global South would be asked to focus efforts on "the detection of outbreaks that could threaten the United States and the creation of new markets for American drugs and technologies," reported the Times.
The administration appears to be approaching PEPFAR with the logic, said journalist Ben Krauss, that the program "needs to be remade to exclusively serve American interests."
"Saving 25 million lives over the past two decades and pulling off one of the greatest humanitarian feats of the century was already serving American interests," said Krauss. "This is just evil."
The State Department documents also say the Trump administration believes "that the transition of PEPFAR can become the premier example of the U.S. commitment to prioritizing trade over aid, opportunity over dependency, and investment over assistance."
PEPFAR-funded programs in low-income countries have already struggled to stay afloat this year following President Donald Trump's foreign aid funding freeze soon after he took office in January. A stop-work order forced some programs to halt services like the provision of antiretroviral therapy and to lay off thousands of staffers.
A waiver issued in February allowed PEPFAR to continue certain programs, but the administration's cuts to and elimination of the U.S. Agency for International Development, which has implemented PEPFAR since its inception in 2003, has also impacted the initiative.
Under the plan outlined in the documents—which a spokesperson denied were "reflective of the State Department's policy on PEPFAR"—countries would be required to spend far more of their own funds on fighting the spread of HIV/AIDS. Countries that are close to controlling the epidemic, such as Vietnam and Botswana, would see an end to PEPFAR within two years, while countries that still have high rates of infection and receive significant amounts of U.S. funding, including Kenya and Zimbabwe, would have up to four years.
"There will be some countries that can manage where the PEPFAR investment is not as heavy or as large a proportion of their total effort," Robert Black, a professor at Johns Hopkins Bloomberg School of Public Health, told the Times. "But some of the African countries with enormous HIV problems and national financial problems, debt, and other development issues—I cannot see that they are going to be able to pick up all or even a large proportion of the costs in that kind of time frame."
Winnie Byanyima, the executive director of UNAIDS, the United Nations AIDS prevention agency, said earlier this month that the threats Trump has already made to AIDS relief programs across the globe have begun a "deadly funding crisis."
"Personally I am devastated," she said of the U.S. funding cuts at a U.N. summit in Seville, Spain. "Appalled. Shaken and disgusted. I don't have the English words to use."
Byanyima emphasized that HIV/AIDS prevention funding through PEPFAR and similar programs represents "a drop of money that is nothing in one of these rich G7 countries."
PEPFAR is funded through discretionary spending in the federal budget and accounts for less than .08% of U.S. spending.
"To create such crisis, such pain, and such anger on the ground," said Byanyima. "This cut, that's dedicated people losing jobs, loyal support gone, research ended, vulnerable people abandoned. And it is deaths. What went away immediately was prevention services, so we are very worried about the new infections and about deaths... There will be an additional 6 million newly infected persons in the world. That has started already."
Salim Abdool Karim, chair of the Africa CDC's emergency consultative group, has called Trump's "abrupt closure of USAID support for the mpox control effort in Africa" a "major blow."
Nearly 800,000 doses of the mpox vaccine, which were initially promised to fight the epidemic in Africa, are set to go to waste due to Trump's cuts to the U.S. Agency for International Development.
According to Politico, which quotes the Africa Centres for Disease Control and Prevention, the vaccine doses cannot be shipped because they are too close to their expiration date.
"For a vaccine to be shipped to a country, we need a minimum of six months before expiration to ensure that the vaccine can arrive in good condition and also allow the country to implement the vaccination," said Yap Boum, an Africa CDC deputy incident manager.
In September, the Biden administration pledged that the U.S. would provide more than 1 million doses to fight the epidemic in Africa, which has killed nearly 2,000 people, many of them children.
However, Politico reports that just 91,000 of them were delivered, and only 220,000 of them still have a long enough shelf life to be used if the Trump administration signs off on them.
The continent is already facing a dangerous shortage of mpox immunizations. As Science reported last month:
In September 2024, Africa CDC and the World Health Organization (WHO) jointly issued an mpox "continental preparedness and response plan" that called for vaccinating 10 million people in Africa within 6 months. An updated version of the plan, issued in April, narrowed who should be offered the vaccine and scaled back the target to 6.4 million people by August.
But according to a May 29 WHO situation report, only 720,000 people in seven African countries have received mpox vaccines. Doses are scarce, vaccination teams are short on health workers and transportation, and identifying who might have been exposed to the mpox virus and should get the vaccine first is a challenge.
Salim Abdool Karim, chair of the Africa CDC's emergency consultative group, called Trump's "abrupt closure of USAID support for the mpox control effort in Africa" a "major blow, especially since it played a key role in the logistics of vaccine storage and distribution."
A June report by Public Citizen put the striking shortfall of doses into even greater perspective. The group reported that Africa had nearly six times fewer doses of the vaccine than the United States had during the 2022-23 outbreak, which was markedly less severe than what Africa currently faces.
Graphic: Public Citizen www.citizen.org
They pointed to high prices charged by the vaccine's manufacturer, Bavarian Nordic. The company has sold the vaccines to UNICEF for $65 per dose, making them the second most expensive drug UNICEF pays for.
UNICEF called for Bavarian Nordic to quarter the price of the drug and increase doses available to fight the crisis, but the company did not respond to the request. As a result, UNICEF fell 350,000 doses short of the one million that it had hoped to commit.
This shortfall was made worse by the actions taken by the Trump administration. While halting USAID operations, the U.S. also ceased cooperation with the World Health Organization (WHO), which is a major player in organizing the allocation of vaccines.
The Trump administration's actions, the report said, have "prompted a concurrent crisis of disrupted care and severe funding shortfalls across a range of disease areas and health services."
Mpox vaccines are not the only form of international aid going to waste as a direct result of the Trump administration's cuts to USAID.
On Monday, Hana Kiros reported in The Atlantic that the Trump administration had given the order "to incinerate food instead of sending it to people abroad who need it":
Nearly 500 metric tons of emergency food—enough to feed about 1.5 million children for a week—are set to expire [Tuesday], according to current and former government employees with direct knowledge of the rations. Within weeks, two of those sources told me, the food, meant for children in Afghanistan and Pakistan, will be ash.
The Trump administration formally shut down USAID on July 1, after cancelling 83% of its programs at the beginning of Trump's term.
On the same day, a study was published in The Lancet, revealing that the organization's efforts over the past two decades had saved over 90 million lives, with the biggest reductions in mortality coming from its work to prevent HIV/AIDS, malaria, and other tropical diseases.
"Is [USAID] a good use of resources? We found that the average taxpayer has contributed about 18 cents per day to USAID," James Macinko, a health policy researcher at UCLA and study co-author, told NPR. "For that small amount, we've been able to translate that into saving up to 90 million deaths around the world."
According to Impact Counter, a database created by Brooke Nichols, associate professor of global health at the Boston University School of Public Health, nearly 250,000 children and 120,000 adults already had died over less than six months as a result of cuts to these programs, as of June 26.
According to the Lancet study, if those cuts extend into 2030, 14 million people who might otherwise have lived—including millions more children—might die.
"These deaths will not be the result of droughts, earthquakes, pandemics, or war," said Olivier De Schutter in a piece published Friday in Common Dreams. "They will be the direct consequence of a single, lethal decision made by one of the wealthiest men to ever walk this planet."