On March 27, 2025, Department of Health and Human Services Secretary Robert F. Kennedy, Jr. announced plans to dramatically transform the department. HHS is the umbrella agency responsible for pandemic preparedness, biomedical research, food safety and many other health-related activities.
In a video posted that afternoon,
Kennedy said the cuts and reorganization to HHS aim to “streamline our agency”
and “radically improve our quality of service” by eliminating rampant waste and
inefficiency. “No
American is going to be left behind,” the health secretary told the nation.
As a scholar of U.S. health and public health policy, I have written about administrative burdens that prevent many Americans from accessing benefits to which they are entitled, including those provided by HHS, like Medicaid. Few experts would deny that the federal bureaucracy can be inefficient and siloed. This includes HHS, and calls to restructure the agency are nothing new
Combined with previous reductions,
these cuts may achieve some limited short-term savings. However, the proposed
changes dramatically alter U.S. health policy and research, and they may
endanger important benefits and protections for many Americans. They may also
have severe consequences for scientific progress. And as some policy experts
have suggested, the poorly targeted cuts may
increase inefficiencies and waste down the line.
Health and science in a
big-budget agency
HHS is tasked with providing
a variety of public health and social
services as well as fostering scientific advancement.
Originally established as the
Department of Health, Education, and Welfare in 1953, HHS has seen substantial
growth and transformation over time. Today, HHS is home to 28
divisions. Some of these are well known to many Americans, such as
the National Institutes of Health,
the Food and Drug Administration and
the Centers for Disease Control and
Prevention. Others, such as the Center
for Faith-Based and Neighborhood Partnerships and the Administration for Community Living, may fly under
the radar for most people.
With an annual budget of roughly US$1.8
trillion, HHS is one of the largest federal spenders, accounting
for more than 1 in 5 dollars of the federal budget. Under the Biden
administration, HHS’s budget increased by
almost 40%, with a 17% increase in staffing. However, 85% of that money is
spent on 79
million Medicaid and 68
million Medicare beneficiaries. Put differently, most of HHS’ spending
goes directly to many Americans in the form of health benefits.
A new direction for Health and
Human Services
From a policy perspective, the
changes initiated at HHS by the second-term Trump administration are
far-reaching. They involve both staffing cuts and substantial reorganization. Prior
to the March 27 announcement, the administration had already cut thousands of
positions from HHS by letting
go probationary employees and offering
buyouts for employees to voluntarily leave.
Now, HHS is slated to lose another
10,000 workers. The latest cuts focus
most heavily on a handful of agencies. The FDA will lose an additional
3,500 employees, and the NIH will lose 1,200. The CDC, where cuts are steepest,
will lose 2,400 positions.
In all, the moves will reduce the
HHS workforce by about 25%, from
more than 82,000 to 62,000. These changes will provide savings of
about $1.8
billion, or 0.1% of the HHS budget.
Along with these cuts comes a major
reorganization that will eliminate 13 out of 28 offices and agencies,
close five of the 10 regional offices, reshuffle existing divisions and
establish a new division called the
Administration for a Healthy America.
In his latest message, Kennedy
noted that this HHS transformation would return the agency to its core mission:
to “enhance the health and
well-being of all Americans”. He also announced his intention to refocus
HHS on his Make
America Healthy Again priorities, which involve reducing
chronic illness “by focusing on safe, wholesome food, clean water and
the elimination of environmental toxins.”
How HHS’ new reality will affect
Americans
Kennedy has said the HHS
overhaul will not
affect services to Americans. Given the magnitude of the cuts, this seems
unlikely. HHS
reaches into the lives of all Americans. Many have family members on
Medicaid or Medicare, or know individuals with disabilities or those dealing
with substance use disorder. Disasters may strike anywhere. Bird flu and measles
outbreaks are unfolding in many
parts of the country. Everyone relies on access to safe foods, drugs and
vaccines.
In his announcement, the health
secretary highlighted
cuts to HHS support functions, such as information technology and human
resources, as a way to reduce redundancies and inefficiencies. But scaling down
and reorganizing these capacities will inevitably
have implications for how well HHS employees will be able to fulfill
their duties – at least temporarily. Kennedy acknowledged this as a “painful
period” for HHS.
However, large-scale reductions and
reorganizations inevitably lead to more systemic disruptions, delays and
denials. It seems implausible that Americans seeking access to health care,
help with HIV prevention or early education benefits such as Head Start, which
are also administered by HHS, will not be affected. This is particularly the
case when conceived rapidly
and without transparent long-term planning.
These new cuts are also further
exacerbated by the administration’s previous slashes to public
health funding for state and local governments. Given the crucial functions
of HHS – from health coverage for vulnerable populations to pandemic
preparedness and response – the American Public Health Association predicts the
cuts will result in a
rise in rates of disease and death.
Already, previous cuts at the FDA –
the agency responsible for safe foods and drugs – have led to delays
in product reviews. Overall, the likelihood of increasing
access challenges for people seeking services or support as well
as fewer
protections and longer wait times seems high.
A fundamental reshaping of
American public health
The HHS restructuring should be
viewed in a broader context. Since coming to office, the Trump administration
has aggressively sought to reshape the U.S. public health agenda. This has
included vast cuts to
research funding as well as funding for state
and local governments. The most recent cuts at HHS fit into the mold of
rolling back protections and reshaping science.
The Trump administration has
already announced plans to curtail
the Affordable Care Act and roll back regulations that address everything
from clean water to safe vaccines. State programs focused on health
disparities have
also been targeted.
HHS-funded research has also
been scaled back
dramatically, with a long list of projects
terminated in research areas touching on health
disparities, women’s and LGBTQ-related health issues, COVID-19
and long COVID, vaccine
hesitancy and more.
The HHS reorganization also revamps
two bodies within HHS, the Office of the
Assistant Secretary for Planning and Evaluation and the Agency for Healthcare Research and Quality,
that are instrumental in improving U.S. health care and providing policy
research. This change further diminishes the likelihood that health policy will
be based on scientific evidence and raises the risk for more politicized
decision-making about health.
More cuts are likely still to come.
Medicaid, the program providing health coverage for low-income
Americans, will be a particular target. The House of Representatives passed
a budget resolution on Feb. 25 that allows up to $880 billion in cuts to the
program.
All told, plans already announced
and those expected to emerge in the future dramatically alter U.S. health
policy and roll back substantial protections for Americans.
A vision for deregulation
Regulation has emerged as the most
prolific source of policymaking
over the last five decades, particularly for health policy. Given its
vast responsibilities, HHS is one of the federal government’s most prolific
regulators. Vast cuts to the HHS workforce will likely curtail this
capability, resulting in fewer regulatory protections for Americans.
At the same time, with fewer
experienced administrators on staff, industry influence over
regulatory decisions will likely only grow stronger. HHS will simply
lack the substance and procedural expertise to act independently. More industry
influence and fewer independent regulators to counter it will also further
reduce attention to disparities
and underserved populations.
Ultimately, the Trump
administration’s efforts may lead to a vastly different federal health policy –
with fewer benefits, services and protections – than what Americans have become
accustomed to in modern times.
Dr. Simon F. Haeder has
previously received funding from the Centers for Medicare and Medicaid Services
(CMS) of the U.S. Department of Health and Human Services (HHS) .