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Though it’s preliminary, the draft gives as it prepares its 2026 fiscal year . It comes amid massive funding and job across much of the federal government.

The HHS plan lays out a reorganization of its many agencies and offices and calls for eliminating or whittling away dozens of programs. Among them: Head Start, a development program for more than half a million of the country's neediest children, as well as programs focused on teen pregnancy and family planning, Lyme disease, and global health.

The National Institutes of Health — the world’s largest funder of biomedical research, and long called the government’s crown jewel – would see its budget shrink to $27.3 billion, from $48.5 billion. Beyond the monetary cuts is a proposed restructuring, reducing the NIH's 27 institutes and centers to eight. Many institutes that specialize in distinct diseases — involving, for example, the heart and lungs, diabetes, and skeletal and skin conditions — would be combined.

NIH-funded research has played a part in the development of most treatments approved in the U.S. in recent years, and until recently, had strong bipartisan support. It’s not clear whether Congress would go along with the proposed changes. During the first Trump administration, Congress rejected a major cut to NIH’s budget.

“I just have not heard anybody say, ‘We wish the government would spend less money trying to cure cancer or trying to deal with Alzheimer’s,’� said Jeremy Berg, a University of Pittsburgh professor and former director of an NIH institute.

Yet that’s what the $20 billion budget cut will mean, he said, adding that restructuring will cost time and money, too.

The budget of the Food and Drug Administration would be cut by nearly half a billion dollars, to $6.5 billion, in part by eliminating some longtime agency responsibilities and shifting them to states. For example, the FDA would no longer handle routine food inspections. It already contracts with state inspectors for some of that work and would now do so to cover “100 percent of all routine foods,� according to the document.

The Centers for Disease Control and Prevention's core budget would be slashed to about $5 billion, from more than $9 billion, with a number of programs eliminated and some transferred into a proposed new agency to be called the Administration for a Healthy America.

The cuts include the complete elimination of the agency's National Center for Chronic Disease Prevention and Health Promotion, which had 1,000 employees at the beginning of this year. That center houses CDC programs on adolescent health, reproductive health, cancer prevention, heart disease and stroke prevention, and smoking prevention, as well as nutrition, physical activity and obesity.

The draft was not officially released or confirmed by the Trump administration, and it’s not clear what will make it into the final budget proposal. “But it’s an important indication about what the administration is thinking about,� said David Harvey, executive director of the National Coalition of STD Directors, an association that represents people running health department programs to track and prevent sexually transmitted infections. “We are taking it very seriously.�

The proposal was first reported by The Washington Post. The Associated Press saw a copy of the 64-page document, dated April 10.

The draft is the result of discussions between HHS and the White House Office of Management and Budget. It's called a “passback� document — it's what OMB passed back to HHS after both had input.

An HHS spokesman did not respond to an AP request for comment Thursday.

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AP reporters Lauran Neergaard and Matthew Perrone in Washington, D.C., contributed to this report.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.