Department of Health and Human Services Restructuring

On Thursday, March 27, the Trump Administration announced a major restructuring of the Department of Health and Human Services (HHS). The plan would reduce the total HHS workforce by 20,000 people. The restructuring would also reduce the number of divisions of HHS from 28 to 15. Additionally, regional offices will be reduced from 10 to 5.

Some specific cuts include

• FDA will decrease its workforce by about 3,500 full-time employees. The reduction will not affect drug, medical device, food reviewers, nor inspectors.
• CDC will decrease its workforce by about 2,400 employees. This includes moving ASPR under CDC.
• NIH will decrease its workforce by about 1,200 employees.
• CMS will decrease its workforce by about 300 employees. According to the fact sheet, the reorganization will not impact Medicare and Medicaid services.

The restructuring would also create a new Administration for a Healthy America (AHA). AHA’s goal is to “more efficiently coordinate chronic care and disease prevention programs.” In efforts to do this, AHA will consolidate OASH, HRSA, SAMHSA, ATSDR, and NIOSH. The new divisions of AHA will include Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce. The work will be supported by the US Surgeon General and Policy team.

Additional changes include

• Create a new Assistant Secretary for Enforcement that will oversee the Departmental Appeals Board (DAB), Office of Medicare Hearing and Appeal (OMHA), and the Office for Civil Rights (OCR).
• Combine the Assistant Secretary for Planning and Evaluation (ASPE) and Agency for Healthcare Research and Quality (AHRQ) into the Office of Strategy.
• Split critical programs that support older adults and people of all ages with disabilities from the Administration for Community Living (ACL) across the Administration for Children and Families (ACF), Assistant Secretary for Planning and Evaluation (ASPE), and Centers for Medicare and Medicaid Services (CMS).

The overall impact of the restructuring is unclear, but public health experts warn that there could be negative impacts to the people served by HHS. Alison Barkoff, law professor at George Washington University’s Milken Institute of Public Health stated, “There’s no way to have these reductions in force (RIFs) and not impact the programs and the people who rely on them.