On March 27, the U.S. Department of Health and Human Services announced sweeping changes to staffing and organization inside the agency, through a restructuring that will cost 20,000 jobs. The announcement was posted as a press release to the agency’s website.
The announcement began thus: “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.’ The restructuring will address this and serve multiple goals without impacting critical services. First, it will save taxpayers $1.8 billion per year through a reduction in workforce of about 10,000 full-time employees who are part of this most recent transformation. When combined with HHS’ other efforts, including early retirement and Fork in the Road, the restructuring results in a total downsizing from 82,000 to 62,000 full-time employees.”
The press release continued, “Secondly, it will streamline the functions of the Department. Currently, the 28 divisions of the HHS contain many redundant units. The restructuring plan will consolidate them into 15 new divisions, including a new Administration for a Healthy America, or AHA, and will centralize core functions such as Human Resources, Information Technology, Procurement, External Affairs, and Policy. Regional offices will be reduced from 10 to 5. Third, the overhaul will implement the new HHS priority of ending America’s epidemic of chronic illness by focusing on safe, wholesome food, clean water, and the elimination of environmental toxins. These priorities will be reflected in the reorganization of HHS. Finally, the restructuring will improve Americans’ experience with HHS by making the agency more responsive and efficient, while ensuring that Medicare, Medicaid, and other essential health services remain intact.”
The announcement including a statement from HHS Secretary Robert F. Kennedy, Jr., who said, “We aren't just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic. This Department will do more – a lot more – at a lower cost to the taxpayer.”
The press release went on to add the following details: “The specific contents of the restructuring plan that have been announced so far are as follows:
Creation of the Administration for a Healthy America (AHA), which will combine multiple agencies — the Office of the Assistant Secretary for Health (OASH), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute for Occupational Safety and Health (NIOSH) — into a new, unified entity. This centralization will improve coordination of health resources for low-income Americans and will focus on areas including, Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce development. Transferring SAMHSA to AHA will increase operational efficiency and assure programs are carried out because it will break down artificial divisions between similar programs.
Strengthening the Centers for Disease Control and Prevention (CDC): the Administration for Strategic Preparedness and Response (ASPR), responsible for national disaster and public health emergency response, will transfer to the CDC, reinforcing its core mission to protect Americans from health threats.
New Assistant Secretary for Enforcement: HHS will create a new Assistant Secretary for Enforcement to oversee the Departmental Appeals Board (DAB), Office of Medicare Hearings and Appeals (OMHA), and Office for Civil Rights (OCR) to combat waste, fraud, and abuse in federal health programs.
Research and Evaluation for Health Policy: HHS will merge the Assistant Secretary for Planning and Evaluation (ASPE) with the Agency for Healthcare Research and Quality (AHRQ) to create the Office of Strategy to enhance research that informs the Secretary’s policies and improves the effectiveness of federal health programs.
Reorganization of the Administration for Community Living (ACL): Critical programs that support older adults and people with disabilities will be integrated into other HHS agencies, including the Administration for Children and Families (ACF), ASPE, and the Centers for Medicare and Medicaid Services (CMS). This reorganization will not impact Medicare and Medicaid services.”
And the press release concluded with an additional quote from Secretary Kennedy: “Over time, bureaucracies like HHS become wasteful and inefficient even when most of their staff are dedicated and competent civil servants,” he said. “This overhaul will be a win-win for taxpayers and for those that HHS serves. That’s the entire American public, because our goal is to Make America Healthy Again.”
Per the massive cuts to funding and staffing, the New York Times’s Sheryl Gay Stolberg and Christina Jewett wrote on Thursday morning that “The layoffs are a drastic reduction in personnel for the sprawling health department, which now employs about 82,000 people and touches the lives of every American through its oversight of medical care, food and drugs. Together with previous layoffs and departures, the move will bring the department down to about 62,000 employees, the agency said.”
Further, Stolberg and Jewett wrote, “The 28 divisions of the health agency will be consolidated into 15 new divisions, according to a statement issued by the department. Mr. Kennedy announced the changes in a YouTube video. The staff cuts, reported earlier by The Wall Street Journal, are being made in line with President Trump’s order to implement the Department of Government Efficiency’s shrinking of the federal work force. Mr. Kennedy said rates of chronic disease rose under the Biden administration even as the government grew. He pitched the changes as a way to refocus the agency on Americans’ health, but did not outline any specifics on how he would mediate rates of diabetes, heart disease or any other condition.”
And, they noted, “The reorganization will cut 3,500 jobs from the Food and Drug Administration, which approves and oversees the safety of a vast swath of the medications and consumer products people eat and rely on for well-being, according to an H.H.S. fact sheet. The cuts are said to be administrative, but some of the roles support research and monitoring of the safety and purity of food and drugs, as well as travel planning for inspectors who investigate overseas food and drug facilities. The Centers for Disease Control and Prevention will also have its work force cut by about 2,400 employees, and will narrow its focus to “preparing for and responding to epidemics and outbreaks,” the fact sheet said. The C.D.C. also does work on H.I.V./AIDS, tobacco control, maternal health and the distribution of vaccines for children. The National Institutes of Health will lose 1,200 staff members, and the agency that administers Medicare and Medicaid is expected to lose 300,” they added in their report.
The Associated Press’s Amanda Seitz wrote on Thursday that “The cuts and consolidation go far deeper than anyone expected, an NIH employee said. ‘We’re all pretty devastated,’ said the staff member, who spoke on the condition of anonymity for fear of retaliation. ‘We don’t know what this means for public health.’ Union leaders for CDC workers in Atlanta said they received notice from HHS on Thursday morning that reductions will primarily focus on administrative positions including human resources, finance, procurement and information technology,” Seitz wrote. “At CMS, where cuts focus on workers who troubleshoot problems that arise for Medicare beneficiaries and Affordable Care Act enrollees, the result will be the ‘lowest customer service standards’ for thousands of cases, said Jeffrey Grant, a former deputy director at the agency who resigned last month.”
The first industry reactions were negative. NBC News’s Berkeley Lovelace Jr. spoke with Larry Levitt, executive vice president of health policy at the Kaiser Family Foundation (KFF), who said, "This is not just a reorganization of HHS. It's also a slashing of the federal workforce, which will ultimately affect government services. People and health care providers may find themselves waiting longer to get help and get their questions answered, and that will cause frustration and delays in services."
And, Lovelace reported, “An FDA employee who received notice of the agency's planned cuts Thursday morning worried that reviews of medical products including drugs and devices could be delayed, despite the administration's assurances. ‘The cuts to FDA will still adversely affect our mission, it doesn't matter if they're not directly cutting reviewers,’ said the employee, who asked not to be identified for fear of repercussions. ‘We're only able to review because of a lot of back end support.’”
Meanwhile, Reuters’ Ahmed Aboulenein and Sriparna Roy, noting that “The NIH will see staff reductions across its 27 institutes and centers,” spoke with Nate Brought, the recently departed director of NIH’s Executive Secretariat, who told them that "The only way to cut that high of a percentage of our staff, along with the 35-percent contracting cuts that are being directed, is to drastically scale back what NIH does across the board.”
One of the first members of Congress to come out publicly against the restructuring was Angela Alsobrooks (D-Md.). NPR’s Selena Simmons-Duffin and Diane Webber wrote on Thursday that “Senator Angela Alsobrooks, D-Md., wrote in a statement that the plan to cut 20,000 jobs from HHS was ‘dangerous and deadly.’ Many health agencies are headquartered in Maryland, including the Food and Drug Administration, the Centers for Medicare and Medicaid Services, and the National Institutes of Health. Alsobrooks also confronted Kennedy during his confirmation hearing about comments he'd made asserting that the childhood vaccine schedule should be adjusted depending on a child's race. ‘These mass layoffs at Health and Human Services will cost human lives,’ Alsobrooks said. ‘I will do all I can to fight this.’”
This is a developing story. Healthcare Innovation will update readers as new developments emerge.
