Trump Aims to Cuts Program Used to Help Hospitals Evacuate During Disasters

Scientific American

09-05-2025

CLIMATEWIRE | When the McBride wildfire erupted in New Mexico three years ago, David Merritt had a math problem.
The fire was closing in on a Lincoln County hospital with 11 admitted patients, but the ambulance drivers who would normally evacuate those patients were busy fighting the blaze. High winds ruled out air evacuations. There were also only two ways out of the town of Ruidoso, and the way leading to the next-nearest hospital was in the evacuation zone.
Merritt, who is a federal health care preparedness coordinator, needed to not only find drivers — but ones who could move the patients an hour away. And he did, by calling in people and resources throughout the state.
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But the next time there's a fire, Merritt might not be there to help.
President Donald Trump has asked Congress to eliminate funding for the Department of Health and Human Services' Hospital Preparedness Program, which fully funds Merritt's salary.
That could halt work Merritt is doing this year to ensure local officials have a plan to prevent measles from spreading in evacuation shelters used during wildfires.
'My whole job is to figure out all the things that are going to go wrong and figure out how to cooperatively work together to solve those problems, but I may not be here,' said Merritt. 'If HPP goes away, none of that work is done now.'
The Hospital Preparedness Program isn't just for hospitals. Created after the Sept. 11, 2001, terrorist attacks, the program also funds training for emergency managers and emergency responders to make sure every aspect of a region's health care system has a plan for and is able to communicate during disasters, whether they are pandemics, cyberattacks, mass shootings, wildfires or hurricanes.
The program has paid for unified communications systems between hospitals and emergency responders, and chemical decontamination supplies, too. It also provides the salary for regional coordinators throughout the United States to help run trainings and respond to events.
Trump's fiscal 2026 budget request to Congress asks lawmakers to zero out all $240 million in funding for the program, which is part of HHS' Administration for Preparedness and Response. The budget justifies the request by saying the HPP 'has been wasteful and unfocused.'
'This proposal remedies those flaws by allowing States and Territories to properly scope and fund hospital preparedness,' it says. HHS referred questions asking for more details on those "flaws" to the Office of Management and Budget, which did not respond to POLITICO's E&E News by press time.
Coordinators who are funded by for the program say it provides critical support to states and territories.
'You're taking down a system that brings multiple agencies together beforehand to respond to disasters, you're cutting down a lot of networking and a lot of preparedness, a lot of training and a lot of resources that we get beforehand to allow us to be able to respond proactively to disasters,' said T.L. Davis, who was the readiness and response coordinator for the Northeast Arkansas Preparedness and Emergency Response Systems until 2022.
In June 2021, his office jumped into action when multiple tornadoes ripped through Northeast Arkansas, flattening not one but two nursing homes. Local emergency responders were already swamped with calls, so Davis' coalition sent out an Ambubus, a vehicle that looks like a school bus but is equipped like an ambulance to treat multiple injured people. The Ambubus, which had been purchased with HPP funds, helped evacuate and care for more than 100 patients from the nursing homes.
'If we had not had that HPP funding, we wouldn't have been able to do that, the response times would have been much longer and we could have had casualties,' Davis said.
Tom Cotter founded the Health Response Alliance, a nonprofit that advocates resilience in health care systems. He said HPP and the coordinator positions it funds are particularly invaluable in mass-casualty medical events.
'When something happens, you want the system to be able to work together as a whole rather than have disjointed units working on their own in a silo,' Cotter said. 'The Hospital Preparedness Program helps make that happen.'
That's what happens in North Carolina during hurricanes. During both Hurricanes Florence and Helene, the Duke Healthcare Preparedness Coalition, funded by HPP, was tasked with running specialty shelters for patients with unique medical needs, like those who require at-home dialysis or ventilators.
'These are people who need 24-hour care, and if we didn't have these shelters, they would have to go to hospitals during disasters when you want to keep the load out of hospitals,' said J. David Marsee, the health care preparedness coordinator for the coalition. 'When we show up, we are working closely with the local agencies to help take that load off.'
During disasters, Marsee's coalition relies heavily on volunteer staff from Duke University and its health care system. The university is now 'working through different alternatives' for what could happen if the HPP is defunded, he said.
'We are not sure how well prepared for the next disaster we may be,' Marsee said.
Florida Hospital Association President Mary Mayhew said the HPP has been critical to helping train health care groups in her state around hurricane-related evacuations. That was particularly true last fall during Hurricane Michael, when more than 300 health care facilities, including hospitals and nursing homes, had to be evacuated in advance of a storm predicted to cover a large swath of the state.
'We keep getting tested over and over again with different and more complex challenges and this work is foundational to supporting all of the efforts that occur in the midst of a disaster response,' she said.