Source: AAFP CEO Shawn Martin
Department of Health and Human Services (HHS) Secretary Robert Kennedy, Jr., announced a major restructuring to HHS by consolidating 28 agencies and units into 15. Additionally, Secretary Kennedy announced a major reduction in force for the department that would result in an estimated 10,000 jobs being eliminated. This staff reduction is in addition to the 10,000 employees who either accepted an early departure agreement, retired early, or were terminated due to their temporary/probationary status. The reorganization also calls for the reduction in HHS regional offices from 10 to five.
The reduction in force is spread across HHS with the bulk of the positions being eliminated coming from the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) and smaller reductions at the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), and other agencies. For the time being, it appears that the Agency for Healthcare Research and Quality (AHRQ) has survived, albeit slimmed down. The Office of Minority Health in both HHS and CMS has been eliminated, along with offices focused on HIV and sexually transmitted infections. The American Academy of Family Physicians (AAFP) is still working to determine the scope of these actions, but some are very concerning.
- The FDA 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 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. This includes moving the Administration for Strategic Preparedness and Response (ASPR) under the CDC to enhance coordination of response efforts.
- The NIH will decrease its workforce by approximately 1,200 employees by centralizing procurement, human resources, and communications across its 27 institutes and centers.
- CMS 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.
- The consolidation and cuts are designed not only to save money, but also 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. No additional cuts are currently planned, but the Department will continue to look for further ways to streamline its operations and agencies.
- A new Administration for a Healthy America (AHA) will consolidate the Office of the Assistant Secretary of Health (OASH), the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Agency for Toxic Substances and Disease Registry (ATSDR), and the National Institute for Occupational Safety and Health (NIOSH), to more efficiently coordinate chronic care and disease prevention programs. Divisions of the 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.
- HHS will have a new Assistant Secretary for Enforcement to provide oversight of the Departmental Appeals Board (DAB), the Office of Medicare Hearings and Appeals (OMHA), and the Office for Civil Rights (OCR) to combat waste, fraud, and abuse.
- HHS will combine the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and AHRQ into the Office of Strategy to conduct research that informs the Secretary’s policies and evaluates the effectiveness of HHS programs for a healthier America.
- 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), the ASPE, and CMS.
The AAFP has already communicated with the four committees of jurisdiction in the House and Senate regarding these actions and their impacts on patients, family physicians, and our healthcare system.