Ten thousand staffers at federal health agencies received pink slips on April 1 in a major overhaul to shrink the Department of Health and Human Services (HHS) headcount from 82,000 to 62,000.
“Our hearts go out to those who have lost their jobs,” posted HHS Secretary Robert F. Kennedy on X. “But the reality is clear: what we’ve been doing isn’t working. Despite spending $1.9 trillion in annual costs, Americans are getting sicker every year. In the past four years alone, the agency’s budget has grown by 38%—yet outcomes continue to decline. HHS needs to be recalibrated to emphasize prevention, not just sick care.”
The changes will not affect Medicare, Medicaid, or other essential health services, Kennedy wrote.
HHS is the seventh-largest department in the federal government, about one-tenth the size of the U.S. military. It includes the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention, and the National Institutes of Health (NIH).
‘Consolidating the Agency’
There is much fear mongering but plenty of room for cuts, says Kennedy.
“We’re not cutting front-line workers, we’re cutting administrators, and we’re consolidating the agency to make it more efficient,” Kennedy told NewsNation on March 27. “We have over 100 comms departments. You have 40 procurement departments. We have dozens of IT departments, dozens of HR departments. None of them talk to each other.”
The April 1 cuts arrived after voluntary resignations earlier in the year and included high-profile individuals such as Jeanne Marrazzo, who replaced Anthony Fauci as Director of the National Institute of Allergy and Infectious Diseases on August 3, 2023.
April 1 was the first day on the job for FDA Commissioner Marty Makary and NIH Director Jay Bhattacharya, Reuters reported.
Former FDA Commissioner Robert Califf, who stepped down in January, criticized the cuts.
“The FDA as we’ve known it is finished, with most of the leaders with institutional knowledge and a deep understanding of product development and safety no longer employed,” wrote Califf on LinkedIn. “I believe that history will see this a huge mistake. I will be glad if I’m proven wrong, but even then, there is no good reason to treat people this way.”
‘Wasteful Spending’
The federal government has plenty of bloat, fraud, and abuse, says Sally Pipes, president of the Pacific Research Institute.
“Recent federal statistics reveal an astounding level of wasteful spending in Medicare and Medicaid, but it’s important to be strategic about eliminating waste,” said Pipes. “Indiscriminate cuts are unwise.”
Wasteful spending is not necessarily a concern at the FDA, says Devon Herrick, a health care economist who posts on the Goodman Institute Health Care Blog.
“Most of [the FDA’s] budget is paid for by industry fees,” said Herrick on the Heartland Daily Podcast on March 26. “The trouble with the FDA is not what it is costing taxpayers; it is the bureaucracy. Nobody knows the bureaucracy quite like the people who worked there, and they are in high demand as consultants in the private sector.”
A Maze of Regulation
The agency’s regulations and guidance documents conflict with one another and cause confusion, says Herrick.
“What could probably improve quality is if the FDA could do a wholesale review of these regulations so that industry can understand what is required of them,” said Herrick.
Pipes says drug and device approvals are already too slow, and the administration should avoid making the situation worse.
“Patients depend on the FDA, for instance, to rapidly review and approve promising new therapies,” said Pipes. “But there’s concerning evidence that cuts at FDA are slowing review and approval of new drug applications even further. That’s the opposite of what this country needs. Instead, Trump officials should be modernizing the FDA and expediting the approval process.”
‘Deserve to Lose Their Jobs’
The COVID-19 pandemic was enough of an alarm bell to warrant a massive purge, even if it means letting supposedly good people go, wrote Jeff Childers at his Coffee and Covid Substack on April 2.
“All these ‘good’ CDC and NIH employees kept their mouths shut during covid,” wrote Childers. “They could have spoken up and mitigated the harm. But the ‘good ones’ stayed silent, kept their heads down, to save their jobs. … Silence in the face of institutional corruption is complicity.”
Michael Cannon, director of health care policy studies at the Cato Institute, says downsizing HHS is the right thing to do.
“Let’s be honest. Many HHS employees deserve to lose their jobs,” wrote Cannon in a blog post on Cato.org.
‘Misused Public Health Law’
The health agencies must undergo a major cultural shift if they are to become more responsive to the American public, says Linda Gorman, director of the Health Care Policy Center at the Independence Institute.
“For decades, HHS has devoted itself to remodeling U.S. health care to make it more like the dysfunctional British, Canadian, and European systems,” said Gorman. “It oversaw the corruption of health data during COVID. It misused public health law to impose an eviction moratorium during the COVID epidemic.”
HHS is a classic case of government overreach and mission creep, says Gorman.
“HHS defends and funds ineffective programs like Head Start, nurse home visiting programs, and Medicaid doulas,” said Gorman. “Its programs on the social determinants of health seek to expand its meddling into the food, housing, and labor markets even as many of its quality measures and guidelines have been shown to be of questionable value.”
AnneMarie Schieber ([email protected]) is the managing editor of Health Care News.
AnneMarie Schieber is a research fellow at The Heartland Institute and managing editor of Health Care News, Heartland’s monthly newspaper for health care reform.
