TRUMP BUDGET CUTS NIH BY $6 BILLION, CONSOLIDATES AHRQ — The president’s budget, which was released this morning, includes a 20 percent cut to NIH, wiping out recent funding increases and negating a major boost from last year's 21st Century Cures Act.

The cut will likely encounter strong opposition from Republicans, as well as Democrats, who want to continue raising the medical research center’s budget. “[Trump's] cut to NIH funding by approximately $6 billion will turn back the clock on lifesaving biomedical research that has the power to change lives,” warned Rep. Rosa DeLauro, the ranking member of the House Labor-HHS appropriations committee.

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The budget also calls for the NIH to absorb the Agency for Healthcare Research and Quality, sources told POLITICO. Republicans have often eyed the agency for major cuts and two years ago tried eliminating it altogether. More for Pros. Trump's also proposing a major reorganization of NIH's many institutes and centers, including eliminating the Fogarty International Center, which focuses on global health.

Overall, HHS faces a $15 billion cut under the proposal. That's per documents obtained by The Washington Post. Besides the $6 billion cut to NIH, it's unclear exactly how other HHS agencies such as FDA or CDC would fare but the proposal offers a few hints, including plans to:

— Double the amount of medical product user fees paid by industry to $2 billion in 2018 so that FDA wouldn't need new taxpayer dollars associated with the review of new drugs and devices. The administration's also proposing steps to increase "regulatory efficiency" and speed up the review of medical products.

— 'Reform' CDC by creating a $500 million block grant, designed to "increase state flexibility" to focus on public health challenges by region.

— Cut $403 million in health professions and nurse training programs.

Meanwhile, other areas could get a funding hike: The budget would create a new federal emergency response fund to respond to public health emergencies like Zika, and it also includes a $500 million increase over 2016 enacted levels to expand opioid misuse prevention efforts and treatment for addiction.

BUT BUDGET LEAVES MEDICARE, SOCIAL SECURITY ALONE — The proposal only addresses discretionary spending and won't include cuts to Medicare and Social Security.

The president will “keep his promises” to not touch those programs in fiscal year 2018, OMB Director Mick Mulvaney told reporters in an embargoed briefing on Wednesday. "This is the 'America First' budget," Mulvaney said. "In fact, we wrote it using the president’s own words." More for Pros.

Meanwhile, Republicans' push to repeal and replace the Affordable Care Act continues.

A BLOW-UP IN THE BUDGET COMMITTEE? — Today's budget committee vote on the American Health Care Act, which Republican leaders had spent days viewing as a formality, got a little stickier after Rep. Dave Brat (R-Va.) on Wednesday said he'd oppose the bill.

The House Budget Committee can't actually make substantive changes to the bill — a key reason why Brat, a member of the conservative Freedom Caucus, said he can't vote for a bill that he believes doesn't go far enough to repeal Obamacare.

"It's a tough vote in committee," Brat told POLITICO's Kyle Cheney. "It's going to be close, but I don't know where the votes are right now." More.

— If three more Republicans join Brat, the bill stops in its tracks. Two other Freedom Caucus members, Reps. Mark Sanford (R-S.C.) and Gary Palmer (R-Ala.), serve on the committee, and Sanford has spoken out about his concerns that Congress is "backtracking." But there's no sign yet that they'll take the vote against AHCA.

Rep. Mark Meadows (R-N.C.), the Freedom Caucus chairman, said he isn't pushing caucus members to vote against the bill in committee today. "We have three members and we have not pushed them to vote no," Meadows told POLITICO's Jen Haberkorn. "I think it passes out of Budget."

— The markup will start at 10 a.m. but probably won't end until mid-afternoon. Committee leaders have agreed to seven "motions" per side, Pro's Budget team reports, and Democrats are expected to use all of theirs.

While today's markup is narrow in scope, it may give wary Republicans a chance to offer policy changes before taking a vote on a still-fluid bill. It also could end up being another platform for Democrats to raise concerns about the bill — especially given the Congressional Budget Office projection that 24 million fewer Americans will have coverage if the bill takes effect.

TRUMP: I WOULD RATHER HAVE DONE TAX REFORM BEFORE HEALTH CARE — Speaking at a rally in Tennessee, the president repeatedly said that he’d rather have prioritized tax reform, if it had been possible. "I would’ve loved to have put it first,” Trump said.

He reiterated the point later, talking about ACA repeal. "It’s gonna be great. It’s gonna be great,” Trump said. "And then we get on to tax reductions, which I like."

Trump said he was confident that with deal-making, the GOP health care package would succeed. "We’re going to arbitrate, we’re going to all get together, we’re going to get something done," the president said. "We welcome this health care debate and its negotiation and we’re going to carry it out and have been carrying it out in the full light of day unlike the way Obamacare was passed."

… Appearing on Fox News after the rally, the president seemingly acknowledged that the bill's tax cuts for the rich are inconsistent with his campaign rhetoric. "A lot of things aren’t consistent," Trump told Fox News’s Tucker Carlson. "But these are going to be negotiated … We will take care of our people or I’m not signing it."

They're still committed to the embattled bill, however. "We want to get it pushed through as soon as possible," press secretary Sean Spicer told reporters.

THIS IS THURSDAY PULSE — Where it's been more than a week, but a (relatively influential!) battle isn't settled: What's the slang label for AHCA, anyway? Ryancare? Trumpcare? Obamacare-less?

Of course, there may not be a consensus name until we know the ultimate fate of the bill. In the meantime, send tips to ddiamond@politico.com or @ddiamond on Twitter.

With help from Adam Cancryn (@AdamCancryn) and Sarah Karlin-Smith (@SarahKarlin).

PRICE DEFENDS HEALTH PLAN IN TOWN HALL — In an hour-long session with CNN, the HHS secretary took a series of questions on Republicans’ health bill, the Affordable Care Act and public health. Among the key exchanges:

1) Price said GOP would cut Medicaid to make it better. Several questioners pushed Price on why the GOP is planning roll back Medicaid expansion and what would happen as a result.

“My life really depends on access to my doctors and medical care,” said Brian Kline, a cancer survivor and Medicaid enrollee who makes $11.66 per hour. “Why do you want to take away my Medicaid expansion?”

Price mostly framed his answer around an argument that Medicaid wasn’t working to deliver care and that too many doctors refuse to participate in the program. Watch 2-minute video and the contentious 75-second follow-up exchange.

“Folks don’t want to hear this, but the fact of the matter is, one out of every three physicians in this nation aren’t seeing Medicaid patients,” Price said. “If we want to be honest, we have to ask ourselves … why, and fix those challenges that exist in the program.”

2) Price endorsed the AHCA’s continuous coverage provisions. Price also supported the AHCA’s planned surcharge of up to 30 percent for Americans who don’t stay continually covered, arguing that it would help ensure the success of AHCA after the individual mandate is repealed. Some conservatives have been pushing to strike that provision from the bill, and Price later acknowledged that it’s still being “discussed.”

3) Price said ‘paying attention to the American people’ will ensure bill’s passage. CNN’s Dana Bash asked Price how Republicans plan to get the embattled bill through Congress, given Freedom Caucus Chairman Mark Meadows’s warning that dozens of Republicans may defect from AHCA.

“The way we’re going to get this through is by paying attention to the American people and what their concerns are,” Price responded.

4) Price punted to the states on immunizations. The secretary didn’t give a full-throated endorsement of vaccines when asked by CNN’s Wolf Blitzer, instead suggesting that state leaders needed to determine when they were necessary.

"It’s a perfectly appropriate role for the government — this happens by and large at the state government level … to determine whether or not immunizations are required for a community population,” Price said. See the 32-second clip.

** A message from PhRMA: More than a third of the initial list price of brand medicines is rebated back to insurance companies, PBMs and the government, or retained by the supply chain. And the gap between list and net prices is growing every year. New report: http://www.phrma.org/press-release/new-first-of-its-kind-study-shows-growing-share-of-medicine-list-prices-going-to-rebates-and-supply-chain **

IN CONGRESS

Paul Ryan can't say if AHCA would pass today. Appearing on CNN, the House Speaker refused to say whether Republicans had the votes to get through the embattled bill through the House, instead arguing with the terms of the question.

"It's not coming up this afternoon," Ryan told CNN's Jake Tapper. "It's going through the legislative process. That legislative process has not been finalized. That's, no offense, that's kind of a goofy question or faulty premise because this goes through four committees. We've gone through two so far."

The GOP vote count: Probably more than 40 nos, 20 undecideds. That's according to Freedom Caucus Chairman Mark Meadows, who shared his estimate with reporters on Wednesday afternoon after House leaders started whipping the bill during votes. Republicans can afford to lose about 20 votes.

The race to save Obamacare repeal. Ryan and his allies spent Wednesday floating the potential modifications — at the request of the White House — to members. They’re trying to gauge if the amendments could win over skeptical conservatives without repelling moderates, who are wary of political blowback if the bill moves too far to the right.

The goal remains: Pass the bill next week. But winning over unhappy conservatives without writing a bill that's dead-on-arrival in the Senate will be difficult, even as party strategists warn that the GOP could lose seats in the coming midterms if they fail to fulfill their campaign promises to enact a repeal, POLITICO's Rachael Bade, Kyle Cheney and Jennifer Haberkorn report. More.

War of the PowerPoints. Sen. Chris Murphy will roll up his shirt sleeves — figuratively, at least — and give a PowerPoint presentation on the American Health Care Act this morning intended to rebut House Speaker Paul Ryan's own health care walkthrough last week. The 9:30 a.m. presentation will be in the Lyndon B. Johnson Room in the U.S. Capitol. Watch livestream.

Lawmakers question 'unusual circumstances' of FDA approval for Emflaza. In a letter to the FDA, Sen. Bernie Sanders (I-Vt.) and Rep. Elijah Cummings (D-Md.), the Oversight ranking member, requested details about how the FDA approved Marathon's Emflaza — priced at $89,000 per year — while giving it priority review and orphan drug designation. The drug is 20 years old and has been available overseas. More for Pros.

PULSE CHECK

Joe Kennedy on fighting for the ACA — even if it takes all night. The Massachusetts congressman was arguably Democrats' breakout star of last week's 27-hour House Energy & Commerce Committee markup, with his late-night attacks on Republicans' health bill going viral and being watched by tens of millions of people.

"If someone had told me that what was going to go viral was the details of Medicaid policy, or essential health benefits, at 2 in the morning or 4 in the morning, I would’ve laughed and said you’re out of your mind," Kennedy told POLITICO's "Pulse Check" podcast. But "if I’d known that some of those moments would’ve gotten the viewership … I would’ve done it a long time ago."

Kennedy also defended Democrats' resistance in committees as more than a stunt.

"We can't stop this bill," he allowed. "Democrats alone don't have the votes for it. [But] we can help stop this bill by ensuring that, to the best extent we can, the American public understands the consequences of what this bill will mean for them and their families." Listen to the podcast.

OBAMACARE

An easy fix for Obamacare? Kick millennials off their parents' insurance. The wildly popular provision to allow Americans under age 26 to stay on their parents' coverage has backfired in one key way, Pro's Paul Demko and Adam Cancryn write. Not enough young, healthy people have signed up for coverage in the law's insurance marketplaces, or exchanges.

And while changing the rules would help fix the ACA's troubled insurance marketplaces, the idea also is politically toxic to both Democrats and Republicans because it would antagonize millions of middle-class voters. More for Pros.

AROUND THE NATION

Tom Steyer joins California lawmakers in battling drug prices. The billionaire activist waded into the drug-pricing wars Wednesday, joining two California lawmakers in introducing the details of a new state bill designed to promote transparency in pharmaceutical costs.

Speaking at the State Capitol, Steyer — rumored to be considering a run for California governor — said now is the time for the state to take the lead on the drug-pricing issue, especially given the national uncertainty around the future of health coverage.

"We have consistently gone into fights where the citizens of California are being put at a disadvantage by concentrated and organized economic interests,” Steyer told POLITICO's Victoria Colliver. “This is a situation where California citizens and California taxpayers are at a dramatic disadvantage compared to the pharmaceutical companies.” He declined to clarify his political aspirations. More for Pros.

WHAT WE'RE READING by Paul Demko

The prestigious Mayo Clinic is prioritizing care for patients with private insurance over those on government programs, according to a transcript of a speech by CEO John Noseworthy obtained by the Star Tribune.

Rural Americans pay more for insurance and have fewer options. The GOP’s repeal plan could exacerbate that problem, explains Roll Call’s Erin Mershon.

Republicans are making a mistake by focusing on the number of people covered under their repeal plan. Instead they should be focused on reducing health care costs, argues conservative radio host Erick Erickson in The New York Times.

Counties exposed to higher volumes of advertisements during Obamacare’s first open-enrollment period saw larger reductions in their uninsurance rates than other counties, according to a new paper in Health Affairs.

There are problems with the ACA that need to be addressed, but the GOP’s repeal plan moves in the wrong direction, argue Ascension executives Anthony Tersigni and Robert Henkel in Modern Healthcare.

** A message from PhRMA: Share of gross (based on list price) medicine spending kept by brand biopharmaceutical companies is falling. After accounting for discounts and rebates, brand biopharmaceutical companies retained just 63 percent of total list price spending on brand medicines. The rest was rebated back to PBMs, health plans and the government, or retained by other stakeholders in the biopharmaceutical supply chain. Read the first-of-its-kind study here: http://www.phrma.org/press-release/new-first-of-its-kind-study-shows-growing-share-of-medicine-list-prices-going-to-rebates-and-supply-chain **