Huge HHS cuts getting 'close to the bone' of already strained US health care system
Key takeaways:
- HHS announced a massive restructuring to comply with an executive order about government efficiency.
- The agency said this will save taxpayers money and not impact critical services, but experts disagree.
HHS announced a massive restructuring today to comply with an executive order to implement the controversial Department of Government Efficiency’s initiative for workforce optimization.
There are several key elements to the restructuring, according to an HHS press release: massive layoffs, halving the number of regional offices (there will now be five), consolidating “redundant units” across the HHS’ 28 divisions (there will now be 15 new divisions) and reflecting HHS’ current priorities (ending the chronic illness epidemic through safer food and water as well as reduced environmental toxins).
Details
The agency is laying off approximately 10,000 more full-time employees — dropping from 82,000 to 62,000 when including HHS’ other recent downsizing efforts — to save taxpayers $1.8 billion per year, according to the release.
The new cuts include about 3,500 fewer FDA employees, which HHS said “will not affect drug, medical device or food reviewers, nor will it impact inspectors.” In addition, there will be approximately 2,400 fewer CDC employees (“with a focus on returning to its core mission of preparing for and responding to epidemics and outbreaks”); around 1,200 fewer NIH employees (human resources, communications and procurement will be centralized); and about 300 fewer CMS employees (“with a focus on reducing minor duplication across the agency”).
The overall restructuring will not impact critical services but instead “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,” according to the release.
“Over time, bureaucracies like HHS become wasteful and inefficient even when most of their staff are dedicated and competent civil servants,” HHS Secretary Robert F. Kennedy Jr. said in the release. “This overhaul will be a win-win for taxpayers and those that HHS serves. That’s the entire American public, because our goal is to Make America Healthy Again.”
So far, few specific details of the restructuring plan have been announced. They include:
- The newly minted Administration for a Healthy America will absorb several agencies: Agency for Toxic Substances and Disease Registry (ATSDR), Health Resources and Services Administration (HRSA), National Institute for Occupational Safety and Health (NIOSH), Office of the Assistant Secretary for Health (OASH) and Substance Abuse and Mental Health Services Administration (SAMHSA). Under the new restructuring, they will become “a new unified entity” that “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,” HHS said.
- Reorganizing the Administration for Community Living (ACL). According to the release, the crucial programs supporting people with disabilities and older adults will integrate into other HHS agencies.
- Merging the Agency for Healthcare Research and Quality (AHRQ) with the Assistant Secretary for Planning and Evaluation (ASPE) to create the new Office of Strategy, which will “enhance research that informs the Secretary’s policies.”
- A new Assistant Secretary for Enforcement position will be created to oversee the Office for Civil Rights, the Office of Medicare Hearings and Appeals, and the Departmental Appeals Board. The goal will be to “combat waste, fraud and abuse in federal health programs.”
- Transferring the Administration for Strategic Preparedness and Response — which responds to national disaster and public health emergencies — to the CDC.
The prognosis
Arthur L. Caplan, PhD, a professor and founding head of the Division of Medical Ethics at NYU Grossman School of Medicine, told Healio that the cuts “are dangerous and little to do with efficiency,” but rather “rapidly comply with directives to save money.”
“They're cutting important services like vaccines for children, funding, important services like administrative support for FDA food inspections and factory inspections overseas, where they make a lot of our drugs,” Caplan said. “You had already trimmed the agency; you're starting to get pretty close to the bone.”
Although the cuts will be detrimental to the agencies, this is “ultimately a drop in the bucket” of a massive federal budget, he said. In other words, this disinvestment will likely offer very little return.
“These savings, to me, are not major relative to the federal budget. They're tiny,” Caplan said. “So, you're giving up a lot of safety surveillance and public health protections for minuscule return. I mean, when you think about what they're going to save relative to what these agencies do, particularly FDA, it's nothing.
“It sounds like a big number, but relative to what the federal government says it needs to achieve its savings, it's a rounding error,” he continued.
Former CDC director and current president and CEO of Resolve to Save Lives Tom Frieden, MD, MPH, told Healio that, for generations, “CDC has been the flagship of public health” as it pursues its core mission of protecting people from all kinds of health threats and saving lives.
“No other part of the federal government has the depth and breadth tracking, understanding and supporting communities and providers to stop our leading killers,” Frieden continued. “Breaking up the agency by sending the experts in noncommunicable diseases to another new agency isn’t efficient, it just creates new bureaucracy. Infectious diseases do not occur in a vacuum, and factors including pre-existing chronic diseases play critical roles in understanding and controlling infectious diseases.”
According to an HHS’ fact sheet, no additional cuts are currently on the table but remain possible as HHS looks to further streamline its agencies and operations.
“It is impossible to savagely cut public health funding and staffing without endangering Americans,” he said.
Transparency has been a major point in several of the hearings for nominees to lead the U.S.’s health organizations in the past few months. In fact, Bill Cassidy, MD, a Republican from Louisiana and chairman of the United States Senate Committee on Health, Education, Labor and Pensions, called it the key to restoring the public’s trust in the country’s health care.
Gostin said that the cuts “were not made transparently,” as “there was no consultation with public health professionals and organizations.”
“Put simply, this is just a cost cutting exercise and will make Americans less healthy and safe,” he said. “The president has strong powers to reorganize federal agencies. But it cannot fail to spend funds that Congress has already allocated. The administration often forgets that Congress holds the power of the purse under the Constitution.”
Caplan stressed that this move is not only about cost, but also controlling oversight and public communications.
“These cuts give RFK Jr. more control of the agencies reporting to him. That means more bias in terms of his views, in terms of communications to the public,” he said. “He's tightening up the reporting lines and the control over what all HHS affiliated agencies say to the public.”
Caplan said he does not think this is a good thing “because I don't trust his views on most matters.” Considering the devastating impacts of bird flu, “this isn't the time to let down pandemic vigilance.” Although he then admitted that “there's probably never a time,” he stressed that this move at this moment in time “puts us all at risk unnecessarily.”
In terms of legal pushback, Caplan said it is possible but unlikely.
“There may be some employees who fight their downsizing — that always happens — but that usually results in a buyout,” he said. “It also means that many people will just walk away because they don't think they're getting any job security in the longer run, or that they're going to basically be ignored.
“I fear that the damage will be severe, and the pushback will not lead to avoiding that damage,” Caplan concluded.
HHS has not responded to Healio’s request for comment at the time of publication.
References:
- Fact Sheet: HHS’ transformation to make America healthy again. https://www.hhs.gov/about/news/hhs-restructuring-doge-fact-sheet.html. Published March 27, 2025. Accessed March 27, 2025.
- HHS announces transformation to make America healthy again. https://www.hhs.gov/about/news/hhs-restructuring-doge.html. Published March 27, 2025. Accessed March 27, 2025.
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