Hobbling Health & Human Services

March 29, 2025

HHS Announces Transformation to Make America Healthy Again
U. S. Department of Health and Human Services
March 27, 2025

Today, the U.S. Department of Health and Human Services (HHS) announced a dramatic restructuring in accordance with President Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.”

Fact Sheet

1. The plan combines personnel cuts, centralization of functions, and consolidation of HHS divisions, including:

1. • The current 82,000 full-time employees will be reduced to 62,000
   • 28 divisions will be consolidated to 15
   • 10 regional offices will become 5
   • Human Resources, Information Technology, Procurement, External Affairs, and Policy will be centralized.

2. Regarding FDA, CDC, NIH, and CMS:

1. • FDA [Food & Drug Administration] will decrease its workforce by approximately 3,500 full-time employees, with a focus on streamlining operations and centralizing administrative functions. This reduction will not affect drug, medical device, or food reviewers, nor will it impact inspectors.
   • The CDC [Centers for Disease Control & Prevention] will decrease its workforce by approximately 2,400 employees, with a focus on returning to its core mission of preparing for and responding to epidemics and outbreaks. …
   • The NIH [National Institutes of Health] will decrease its workforce by approximately 1,200 employees by centralizing procurement, human resources, and communications across its 27 institutes and centers.
   • CMS [Center for Medicare & Medicaid Services] will decrease its workforce by approximately 300 employees, with a focus on reducing minor duplication across the agency. This reorganization will not impact Medicare and Medicaid services. 

3. The consolidation and cuts are designed not only to save money, but to make the organization more efficient and more responsive to Americans’ needs, and to implement the Make America Healthy Again goal of ending the chronic disease epidemic.

4. No additional cuts are currently planned, but the Department will continue to look for further ways to streamline its operations and agencies. 

5. A new Administration for a Healthy America (AHA) will consolidate the OASH, HRSA, SAMHSA, ATSDR, and NIOSH [in brief: access, workforce, equity; substance use & mental health; environmental toxins; occupational health], so as to more efficiently coordinate chronic care and disease prevention programs and harmonize health resources to low-income Americans. Divisions of AHA include Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce, with support of the U.S. Surgeon General and Policy team.

6.  HHS will have a new Assistant Secretary for Enforcement to provide oversight of the Departmental Appeals Board (DAB), Office of Medicare Hearings and Appeal (OMHA), and the Office for Civil Rights (OCR) to combat waste, fraud, and abuse.

7.  HHS will combine the Assistant Secretary for Planning and Evaluation (ASPE) and Agency for Healthcare Research and Quality (AHRQ) into the Office of Strategy to conduct research that informs the Secretary’s policies and evaluates the effectiveness of the Department’s programs for a healthier America.

8.   The critical programs within the Administration for Community Living (ACL) that support older adults and people of all ages with disabilities will be split across the Administration for Children and Families (ACF), Assistant Secretary for Planning and Evaluation (ASPE), and Centers for Medicare and Medicaid Services (CMS).

HHS Announces Transformation to Make America Healthy Again
YouTube
By HHS Secretary Robert F. Kennedy Jr. (6 minute video)

 

Comment by: Don McCanne & Jim Kahn

Be afraid. Be very afraid.

These changes may appear innocuous, just bureaucratic streamlining. However, name changes matter, reflecting major policy shifts. For example, “Substance Abuse” (in SAMHSA) and “Toxic” (in ATSDR) are gone from the new agency names and thus focus. Also, you can be sure that “equity” (an explicit HRSA mandate) is expunged from the new health agency mix.

It has not been revealed exactly who proposed the structural changes in “Transformation to Make America Healthy Again.” From prior media reports we suspect Elon Musk, senior advisor to the president and de facto head of the Department of Government Efficiency (which still lacks official status as a governmental agency) plus his unqualified employees, all tacking to the preferences of Secretary Robert Kennedy Jr. and President Donald Trump. Remarkably absent are qualified health care professionals and economists who place patients first. Soon on the scene as head of CMS will be Dr. Mehmet Oz who wishes to privatize Medicare with Medicare Advantage. (He has proposed “Medicare Advantage for All” but that won’t happen – and if it did would pale in comparison even to current Medicare Advantage.) We have no idea how the new agencies hope to reduce waste, fraud, and abuse … and the DOGE current track record bodes poorly.

Considerable damage will be inflicted on important existing programs. The planned cuts in personnel (and presumably resources) for the FDA, CDC, and NIH will reduce their essential services and harm us: riskier drugs, weaker public health, and diminished discovery research. RFK Jr states that he will establish a new “Administration for a Healthy America” (“Ah Ha”, he says) … but we have zero confidence that this carefully crafted phrase actually portends improved government organization to strengthen US health care services.

Not to mention our need for a universal, comprehensive, equitably funded, affordable health care system that we can all be proud of. In contrast to what RFK Jr claims, our over-spending and poor longevity have nothing to do with DHHS functioning. As we’ve discussed in HJM, the excess mortality is due to higher risk factors (including obesity, opioids, poverty, guns, and traffic accidents) and … worse health insurance! Recent surges in mortality reflect poor COVID response and lack of insurance. Our higher costs are due to massive administrative waste as well as high prices for drugs and procedures.

The new HHS will shift health care dollars from public health and patient care to tax cuts for billionaires.

As we said, be afraid, be very afraid!