The Trump Administration's 2019 budget proposal would make steep cuts to the U.S. Departments of Health and Human Services, the Office of the National Coordinator and the Office of Civil Rights, even as he doubles down on the government's efforts to combat the growing opioid crisis.

Under the proposal, the discretionary budget for HHS would be slashed by 21 percent, removing a wide range of workforce training and anti-poverty initiatives and cutting Medicare and Medicaid funds by billions of dollars.

[UPDATE: Trump earmarks $1.2 billion for VA-Cerner EHR project in proposed budget]

Further, the budget proposal would cut ONC's staffing from 185 to 162 and slash the budget to $38 million, more than one-third. Similarly, OCR's budget would be reduced from $39 million to $31 and would lose five staff members, despite the agency's Director Roger Severino recently announcing his plan for a new Conscience and Religious Freedom Division.

As for the winners, the opioid epidemic, the National Institutes of Health and the Food and Drug Administration will be getting a boost.

[UPDATE: What Trump's budget proposal means for hospitals]

Trump proposes providing HHS about $10 billion in new discretionary funding for the opioid epidemic and serious mental illness. The funding, according to a letter accompanying the budget, would aim to "help those who abuse opioids get access to overdose reversal drugs, treatment, and recovery support services."

Further, the proposed budget would give the NIH $9.2 billion, or a $1.4 billion increase from last year. This includes $750 million from the $10 billion given to HHS to fight the opioid epidemic and address mental illness.

[Also: Trump signs spending bill into law: Here are health IT's biggest wins]

"The Budget reflects a solemn and unshakable commitment to liberate communities from the scourge of opioids and drug addiction," the budget reads.

Congressional Democrats recently called on Trump to increase funding for the epidemic, and report on the progress the Trump administration has made since declaring the opioid crisis a public health emergency. The budget reflects those plans.

Meanwhile, Trump proposes giving the FDA an additional $190 million for new user fee funding. However, it requires Congress create new user programs, including one for over-the-counter drugs, and increase the fees for programs already authorized.

The FDA will also get $10 million of the HHS' $10 billion in funding for the opioid crisis.

The funding requests for FDA and NIH were already boosted by last week's spending bill signed into law by Trump. The resulting additional $9.17 billion for NIH and $500 million to the FDA stemmed from higher discretionary spending levels.

Lastly, Trump proposes folding the Agency for Healthcare Research and Quality, the National Institute on Disability, Independent Living and Rehabilitation Research, and the National Institute for Occupational Safety and Health into the NIH.

AHRQ is tasked with providing research into the healthcare system, including health IT. The Trump administration made a similar proposal in 2017, but Congress instead just slashed the budget by about 10 percent.

If folded into the NIH, AHRQ would be renamed the National Institute for Research on Safety and Quality, with a budget of $256 million, compared to last year's $322 million. Initially, the three organizations would retain separate offices, but eventually would be dissolved into the NIH.

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com