On Wednesday the Government Accountability Office ruled that the Department of Health and Human Services broke the Impoundment Control Act of 1974 when it let more than $78 million in health research money expire unspent on Sept. 30, 2025, after laying off the employees who awarded the grants.
The money belonged to the Agency for Healthcare Research and Quality, or AHRQ, a small HHS agency that pays for studies of how medical care is delivered, from hospital infections to diagnostic errors. Congress gave it a $369 million lump sum for fiscal 2025. When the year closed it had obligated about $290 million, according to the decision, which was signed by GAO’s general counsel, Edda Emmanuelli Perez. Jake Johnson reported the ruling for Common Dreams.
The finding settles the legal question and changes almost nothing about the money. GAO orders no remedy. Its only enforcement tool, a lawsuit brought by the comptroller general, has been used once in the law’s 52 years, in 1975, and that case was dropped within six months. Most of the $78 million lapsed a year ago. What can still be recovered is $70 million that a federal judge in Maryland ordered the agency to set aside, and that money depends on a private lawsuit that a Supreme Court order last year made harder to win.
That leaves Congress, and so far the record there runs the other way. The House Appropriations Committee’s spending bill for next year gives the agency nothing. In the fiscal year that ended last week, the White House moved on Sept. 25 to cancel $27.7 million more of AHRQ’s money through a so-called pocket rescission, and GAO called that unlawful four days later.
How the money ran out
GAO’s timeline starts on March 27, 2025, when HHS announced a reorganization that would fold the agency into the Office of the Assistant Secretary for Planning and Evaluation. Layoff notices went out on April 1. Soon after, AHRQ took down its listings for grant peer review sessions scheduled for May and June and posted no new ones for the rest of the fiscal year. More than 120 employees were separated on July 14. Grant obligations then stopped until Sept. 10.
The monthly numbers follow the layoffs. AHRQ obligated $191,795 in grants in April 2025 and $0 in May, against $10.1 million and $20.1 million in the same months of 2024. By Sept. 1, 2025, it had obligated $214 million, under 60 percent of its appropriation. A year earlier the figure was $328 million, about 89 percent. Its total for the year included $75 million for 185 grants.
The money was one-year money, in GAO’s words “set to expire September 30, 2025.” That detail is what made delay work as policy. Under the 1974 law, a president who wants to cancel appropriated funds sends Congress a special message proposing a rescission, and Congress has 45 days of session to agree. If nobody spends expiring money, the calendar cancels it with no message and no vote. HHS sent no message.
In an April 24 response to GAO, HHS called the slowdown a “programmatic delay,” the time it takes to follow the statutory and regulatory steps for awarding grants. GAO answered that the agency had taken those steps apart itself. “The elective decision to remove a substantial number of key grant administration personnel cannot then be offered as an unavoidable circumstance,” it wrote, and “AHRQ precluded itself from following statutory directives in order to obligate funds.” The lump sum gave HHS no cover either. An agency may choose among permitted uses, GAO said, but may not withhold money “simply because they were appropriated as part of a lump-sum appropriation.”
Most of the people who did that work are gone. Josh Caplan, director of advocacy at AcademyHealth, a professional society for health services researchers, wrote in a post on Wednesday that AHRQ has not issued a new research grant in more than 18 months. He listed who went out with the layoffs.
Those reductions include the entirety of the staff overseeing [AHRQ’s] extramural grant program that reviews, issues awards, and manages federal investments, as well as nearly all staff supporting the US Preventive Services Task Force, dissemination and communication efforts, and intragovernmental experts
Head counts vary by source. Jessie Hellmann of Roll Call reported in April that about 90 of a former 300 employees remained. Arthur Allen of KFF Health News counted 74 in July.
What a GAO finding does
The decision closes with a duty, not a remedy: “GAO has a statutory duty to report to Congress impoundments the President has not reported.” A GAO spokesperson told Ryan Quinn of Inside Higher Ed that “if an agency does not release improperly withheld budget authority for obligation, the Comptroller General may bring a civil action” to make it spend the money.
That power sits in Section 1016 of the act. The comptroller general files an explanatory statement with the speaker of the House and the president of the Senate, waits 25 calendar days of continuous session and may then sue in federal court in Washington. The act’s definitions leave out any day when either chamber is away for more than three days. The House left in late September and is not due back until after the Nov. 3 elections, Roll Call reported, so a statement filed this week might not start counting until November.
Gene Dodaro, comptroller general until his 15-year term ended in December, told the House Oversight Committee in February 2025 that GAO had to be thorough “because the next step for us is to go to court ourselves,” MeriTalk reported. By July of that year a GAO spokesperson was calling a lawsuit a “last resort.” In the same testimony, Mr. Dodaro described what a lawsuit would demand.
I need to be prepared and be careful because when I go there, I want to win
No suit came. Before he left, Mr. Dodaro named Orice Williams Brown acting comptroller general, as the law requires the outgoing officeholder to do, Citizens for Responsibility and Ethics in Washington noted. GAO’s Sept. 29 ruling on the pocket rescission was the administration’s 12th violation of the act since January 2025, Federal News Network reported. Wednesday brought two more, the AHRQ case and a finding against the Environmental Protection Agency over climate grants. No GAO lawsuit over any of them has been reported, part of a wider pattern of federal grant money that never arrived.
The findings are slow, too. Eloise Pasachoff, a Georgetown law professor, and two co-authors reviewed 126 GAO appropriations decisions for Brookings and found that they took 436 days on average. The AHRQ request, filed Sept. 22, 2025, took 380.
On Reddit’s r/sciences, one reader looked at the story and concluded that the system had stopped working.
The fact no one has done anything about this or can do anything about this proves how deeply infected our political system has become
The record supports half of that. Someone can act: the statute names the comptroller general, and two research societies are already in court in Maryland. What the record shows is that the one officer the law empowers to sue has not done so since 1975.
The 1975 precedent
The law was written with Richard Nixon in mind. By 1973 his administration was impounding $12 billion to $18 billion in appropriated money, according to the Committee for a Responsible Federal Budget. Nixon signed the act in July 1974, a month before he resigned. In February 1975 the Supreme Court ruled in Train v. City of New York that his Environmental Protection Agency had to allot the full water-cleanup sums Congress set, deciding the case on the statute’s words rather than on the Constitution, according to the Constitution Annotated.
The only comptroller general suit came that spring. In September 1974 President Gerald Ford proposed rescinding more than $264 million in contract authority for a federal housing program, Congress declined, and in April 1975 Comptroller General Elmer Staats sued. In October 1975 Housing Secretary Carla Hills released the money and both sides dropped the case, leaving open whether GAO could sue the executive at all, according to the Congressional Research Service.
President Trump campaigned on bringing the old power back. A 2023 video from his campaign laid out the plan.
AHRQ has nearly died before, at Congress’s hands rather than the White House’s. In December 1994 its predecessor, the Agency for Health Care Policy and Research, issued a guideline that found little evidence for surgery as a first treatment for acute low back pain. Spine surgeons lobbied against the agency, and the House Budget Committee under John Kasich put it on a list of programs to eliminate, The Washington Monthly recounted. It came out of the 1996 budget with $125 million, a 21 percent cut, and in 1999 Congress renamed it and gave it a new mandate. A 2003 Health Affairs analysis blamed the near-death partly on how few allies the agency had.
The case in Maryland
The Society of General Internal Medicine and the North American Primary Care Research Group sued on Aug. 21, 2025, in federal court in Maryland, represented by Public Citizen. They said the assault on AHRQ “eliminated” its “ability to process research grant applications, delayed decisions on pending applications, and withheld the use of funds that Congress specifically appropriated for healthcare research.” The case went to Judge Brendan A. Hurson.
On Sept. 19, 2025, the judge extended the agency’s deadline to obligate the money. The government asked him to vacate that order, and on Sept. 29 he replaced it with a narrower one: AHRQ had to set aside $70 million while the case is pending. GAO agreed that holding the money after that order was not an impoundment, but said the order “does not justify the agency’s withholding” before it.
That order is why $70 million is still within reach. Under federal law, the expiration of an appropriation does not affect pending lawsuits over money payable from it, and expired accounts are not closed and canceled until Sept. 30 of the fifth fiscal year after they lapse, under another provision. For this money that date is Sept. 30, 2030. GAO’s decision does not say what became of the rest.
The case has moved slowly. It was stayed during the government shutdown in October 2025, and the government moved to dismiss on Jan. 20. In May it told the court that AHRQ had given continuation money to 35 existing grants out of fiscal 2026 funds, according to Georgetown’s Health Care Litigation Tracker. In July the agency began telling grantees it would not continue their funding. Noam Ross of Grant Witness, which tracks federal grants, logged 150 of those letters and called them “merely terminations in a different set of clothes.” AcademyHealth asked researchers to report the notices as they arrived.
AcademyHealth is working to understand a significant new development affecting AHRQ-funded research. We are hearing from researchers who have received notices from AHRQ regarding changes to their grant funding.
If you received a notice, contact us: advocacy@academyhealth.org
The plaintiffs amended their complaint on Sept. 3 to add the denials, and the court then denied the first motion to dismiss as moot, according to Public Citizen. The government’s response to the new complaint was due Wednesday, the day GAO ruled. GAO’s decision describes the first motion as still pending as of Sept. 28, which conflicts with Public Citizen’s account of the docket.
The suit’s bigger obstacle is the Supreme Court. On Sept. 26, 2025, the court voted 6 to 3 in Department of State v. AIDS Vaccine Advocacy Coalition to let the administration keep $4 billion in foreign aid it had pocket-rescinded. The unsigned order said the government had “made a sufficient showing that the Impoundment Control Act precludes respondents’ suit, brought pursuant to the Administrative Procedure Act, to enforce the appropriations at issue here,” NPR reported, and that it “should not be read as a final determination on the merits.” The Maryland groups sued under the same Administrative Procedure Act. They argue that AHRQ’s own statute requires it to run a grant program.
The administration’s case
Russell Vought, director of the Office of Management and Budget, rejects GAO’s authority outright. OMB updated its budget circular in September 2025 to describe GAO’s opinions as non-binding on the executive branch, Federal News Network reported. At a House Budget Committee hearing on April 15, Mr. Vought called GAO’s rulings “typically wrong and very partisan” and said, “Of course I believe in impoundments,” according to Government Executive. Sarah Kaczmarek, GAO’s managing director of public affairs, called it “an independent, nonpartisan agency.”
After GAO’s Sept. 29 ruling on the pocket rescission, Mr. Vought answered on X.
Not a surprise. GAO has become hyper partisan and Congress recently attempted to cut their spending because of it. GAO changed its long-time opinion on this very issue from the 1970s when they specifically noted the tool was available to the president. They make their legal…
Part of that holds up. GAO did change its view. In a December 2018 decision it overruled 1975 opinions that had let a president hold expiring funds for the full 45 days, saying later Supreme Court rulings had removed their premise. That reversal came during Mr. Trump’s first term. The partisanship charge has less behind it. The Brookings review found no statistically significant difference in how often GAO found violations under Presidents Obama and Trump, and GAO’s first decision of this term, on electric vehicle chargers, also faulted the Biden administration’s Transportation Department. Neither point reaches the AHRQ ruling, which concerns money withheld with no special message at all.
HHS’s public explanations have been about direction, not delay. Andrew Nixon, an HHS spokesman, told Roll Call in April that “efforts have been focused on the reorientation toward Presidential and Secretarial priorities, and a return to AHRQ’s core statutory mission,” and blamed slow fiscal 2026 awards on the “Democratic-led shutdown along with the late passage of the minibus.” In July another spokeswoman, Emily Hilliard, told KFF Health News that grants were “not awarded continued funding” rather than terminated. HHS and AHRQ did not respond to Inside Higher Ed’s requests for comment on Wednesday.
In the same r/sciences thread, a reader made the policy case for the cuts.
And the flip side to this is the Trump Administration has stopped fraud and wasteful spending labeled as Health Research and Social Justice initiatives...
GAO’s decision takes no side on that, and the reader offers no evidence of fraud in AHRQ’s grants. The law does offer a lawful way to cut spending an administration considers wasteful: send the special message and let Congress vote. HHS never sent one. The stronger objection is to the enforcement machinery itself. Josh Blackman, a professor at South Texas College of Law Houston, wrote on the Volokh Conspiracy that if the comptroller general counts as an executive officer under the Supreme Court’s 1986 ruling in Bowsher v. Synar, a suit against the president would be an internal dispute that courts cannot hear. “This conflict should be resolved in the political process, rather than in the courts,” he wrote. He added that Mr. Vought appeared to be inviting a GAO suit in order to get the enforcement mechanism struck down.
Fiscal 2026
On Sept. 25 the White House sent Congress a special message proposing to cancel $810 million across 11 accounts, all due to expire at the end of the month. AHRQ’s share was $27.7 million of its $345 million appropriation, or 8.0 percent, according to the National Taxpayers Union. Sen. Patty Murray of Washington, the top Democrat on the Senate Appropriations Committee, said Wednesday that Mr. Trump “announced to the world just a few days ago that he was illegally cutting nearly $30 million more” and that HHS “has failed to detail to the committee exactly how it has spent down AHRQ funding for fiscal year 2026.” Her figure matches the $27.7 million in the pocket rescission package.
Sen. Susan Collins of Maine, the Republican who chairs the committee, objected the day the message arrived.
Without warning or consultation, Congress just received an $810 million package of pocket rescissions from the Administration. This is the most recent attempt by this Office of Management and Budget (OMB) to undermine Congress’s Constitutional power of the purse.
This move…
“This move shows that OMB intentionally withheld these funds for months to execute this unlawful cancellation of appropriations that were approved on a bipartisan basis and signed into law,” Ms. Collins said in her statement, ABC News reported. GAO answered four days later, in a decision signed by Ms. Emmanuelli Perez.
The President may not force the expiration of budget authority Congress has already enacted and did not rescind.
The agency’s grant spending fell again. Roll Call found in April that none of the $345 million had been spent. Grant Witness, which counts awards from all of AHRQ’s funding rather than just the annual appropriation GAO examined, recorded $41.3 million in grants for fiscal 2026, against $216 million in 2025 and $419 million in 2024, Inside Higher Ed reported. California and six other states sued over the pocket rescission on Sept. 30, KEYT reported. GAO has not ruled on whether the rest of AHRQ’s fiscal 2026 money was withheld, and AcademyHealth has urged it to.
What comes next
In Maryland, the government’s response to the amended complaint was due Wednesday under a Sept. 15 scheduling order. In Congress, a stopgap law signed Sept. 2 funds the government at fiscal 2026 rates through Dec. 11, according to the Congressional Research Service, which keeps AHRQ at its current level for now.
AHRQ’s future will be settled in the full-year bill. On June 9 the House Appropriations Committee voted 34 to 28 to approve a health spending bill that would eliminate AHRQ’s funding, $345 million below this year, according to the committee’s Democrats. The Senate committee has not written its version. Ms. Collins and Ms. Murray are drafting language for the lame-duck session to limit political interference in research grants, Roll Call reported. “The action is going to happen in the lame duck,” Sen. Tammy Baldwin, Democrat of Wisconsin, told Roll Call.
Reps. Diana DeGette, Doris Matsui and Don Beyer, the Democrats who asked for the GAO review in September 2025, said in a statement that the decision “confirms what we have known for over a year” and that “Republicans must join Democrats in demanding that the Constitution is upheld.” Dr. Aaron Carroll, AcademyHealth’s president and chief executive, said in the group’s post:
The law was not followed, and health research that Congress paid for did not happen.
The stopgap expires on Dec. 11. Until Judge Hurson decides the case, the $70 million stays set aside under his order.