With sweeping changes that include reorganizing the Centers for Medicare & Medicaid Services (CMS), the U.S. Department of Health & Human Services (HHS) has begun the “transformation” mandated by an executive order from President Donald Trump.
On March 27, HHS announced that changes — which will involve the Centers for Disease Control (CDC) and the U.S. Food & Drug Administration (FDA) in addition to CMS — would be part of Trump’s “Department of Government Efficiency workforce optimization initiative.”
HHS: Changes won’t hurt Medicare, Medicaid services
HHS said in its announcement that the restructuring won’t negatively affect the people it’s serving and supporting.
“The restructuring will … serve multiple goals without impacting critical services,” the announcement said. “First, it will save taxpayers $1.8 billion per year through a reduction in workforce of about 10,000 full-time employees who are part of this most recent transformation. When combined with HHS’s other efforts, including early retirement and Fork in the Road [deferred resignation], the restructuring results in a total downsizing from 82,000 to 62,000 full-time employees.”
The restructuring will also “streamline functions of the department [of HHS],” the announcement said, noting that many of the current 28 HHS divisions are “redundant.”
“The restructuring plan will consolidate them into 15 new divisions, including a new Administration for a Healthy America, or AHA, and will centralize core functions such as human resources, information technology, procurement, external affairs, and policy. Regional offices will be reduced from 10 to five.”
Going forward, HHS’s priority will be “ending America’s epidemic of chronic illness by focusing on safe, wholesome food, clean water, and the elimination of environmental toxins. These priorities will be reflected in the reorganization of HHS.”
CMS to be integrated into another agency
Current “critical programs” supporting older adults and people with disabilities “will be integrated into other HHS agencies,” the department said. That includes the Centers for Medicare & Medicaid Services (CMS), but the announcement added, “This reorganization will not impact Medicare and Medicaid services.”
An accompanying HHS fact sheet said CMS will reduce its staffing by approximately 300 employees, “with a focus on reducing minor duplication across the agency.”
On April 3, the Senate confirmed Mehmet Oz as the new CMS administrator, the Associated Press reported.
A new HHS assistant secretary for enforcement will “provide oversight of the Departmental Appeals Board, Office of Medicare Hearings and Appeal, and the Office for Civil Rights to combat waste, fraud, and abuse.”
“The critical programs within the Administration for Community Living that support older adults and people of all ages with disabilities will be split across the Administration for Children and Families, Assistant Secretary for Planning and Evaluation, and Centers for Medicare & Medicaid Services,” the fact sheet added.
Stakeholders react to layoffs
As HHS began mass layoffs this week, stakeholders voiced concerns over how the changes would impact patients.
“The recent mass layoffs at HHS affecting employees at the CDC, FDA, and other federal health agencies are dangerous, irresponsible and unacceptable,” the American Federation of Government Employees said in an April 1 social media statement. “Cutting 10,000 critical public health jobs puts every American at risk — weakening our defenses against disease outbreaks, unsafe medications, and contaminated food.”
“This is a nonsensical rearrangement of the agencies under their charge and an excuse to devastate the workforce for financial reasons,” said Georges C. Benjamin, M.D., executive director of the American Public Health Association, in a March 27 statement. “It will increase the morbidity and mortality of our population, increase health costs and undermine our economy. This proposal will break federal structures. It comes just days after destroying the state and local infrastructure and workforce with $11 billion in cuts, weakening the mission to make us all healthier. We actually know how to increase longevity and improve health. This will not accomplish it.”
“The Center for Medicare Advocacy is deeply concerned about plans to drastically cut and restructure the Department of Health & Human Services (HHS),” the organization said in an April 3 announcement. “This restructuring includes cutting and dividing the critical work of the Administration for Community Living, which was formed to better coordinate services for older adults and individuals with disabilities. We are also concerned about announced plans to consolidate oversight of independent agencies that administer Medicare appeals, and what it could mean for Medicare beneficiaries in need of meaningful and fair appeals. Given what we have already seen with cuts and restructuring of the Social Security Administration, HHS’s claim that they are engaging in ‘dramatic restructuring … without impacting critical services’ rings hollow. These proposed changes must not proceed.”
In a March LinkedIn post, former CMS Administrator Chiquita Brooks-LaSure and other former HHS agency heads said, “The Trump Administration now has begun arbitrarily removing HHS staff from their positions, leaving no doubt that the health and well-being of families and communities across the country will suffer as a result. The work of the members of the HHS team is not just important to the health of this country, it is also vital to the economic security of our nation.”
The National Medical Association said in an April 1 statement that the HHS layoffs were raising physician concerns: “Layoffs in the Department of Health and Human Services began this week as part of the Trump administration’s plan to cut 10,000 jobs. The job cuts will affect programs focused on disease and injury prevention, mental health services, environmental health, and other key initiatives that address important health issues.
“The cuts to these programs will slow the progress of necessary public health research and communications, with a potentially devastating effect on minority populations and every race who is disproportionately impacted by many of the diseases and ailments these programs address. The layoffs will also hamper efforts to limit the spread of infectious diseases while the country faces a measles outbreak in a growing number of states.”
