HHS announces major job cuts and restructuring

The main point: The Department of Health and Human Services (HHS) is starting to slash 10,000 jobs and restructure to consolidate several agencies under a newly created sub-agency, Administration for a Healthy America (AHA).

The stats:

• HHS claimed that laying off 10,000 workers, including 3,500 Food and Drug Administration (FDA) employees, 1,200 National Institutes of Health (NIH) employees, and 2,400 Centers for Disease Control and Prevention (CDC) employees, would save $1.8 billion.
• Combined with other early retirement and buyout offers, roughly 20,000 people will leave the department, which will go from 82,000 to 62,000 workers — a nearly 25% cut. The last time HHS had that many employees was 2002.
• HHS would go from 28 to 15 divisions.
• Regional offices will be reduced from 10 to 5.

Administration for a Healthy America (AHA):

• Combines agencies: AHA will combine the Office of the Secretary for Health, Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Toxic Substances and Disease Registry, and National Institute for Occupational Safety and Health.
• Focus/divisions: Divisions of AHA will 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. Notably, substance use/addiction is not listed as a division.
• What HHS is saying: HHS says the consolidation is “to more efficiently coordinate chronic care and disease prevention programs and harmonize health resources to low-income Americans, and that “transferring SAMHSA to AHA will increase operational efficiency and assure programs are carried out because it will break down artificial divisions between similar programs.”

Other changes:

• CDC: CDC will “focus on returning to its core mission of preparing for and responding to epidemics and outbreaks.”
• Enforcement: HHS will create a new Assistant Secretary for Enforcement to combat waste, fraud, and abuse in federal health programs.
• Research and Evaluation: HHS will merge the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Agency for Healthcare Research and Quality (AHRQ) to create the Office of Strategy “to enhance research that informs the Secretary’s policies and improves the effectiveness of federal health programs.”
• Administration for Community Living (ACL): ACL will be reorganized, with programs that support older adults and people with disabilities integrated into other HHS agencies.

The response:

• While many Republican lawmakers applauded the move, Democratic lawmakers in both the House and Senate quickly condemned the announcement, calling it a “catastrophe” and “devastating.” Former Biden officials and experts also spoke out against the cuts.
• Many current health staffers were blindsided by the cuts, with many learning details from news reports. The cuts sent shockwaves through the HHS workforce, prompting a scramble among senior agency officials to figure out which employees and policy priorities would be affected.

Why it’s important: The move endangers progress on addressing the mental health and addiction crises on several fronts. For example…

• • SAMHSA: The move could cripple SAMHSA, the agency responsible for mental health and addiction funding, resources, regulation, etc. SAMHSA’s more than 700 staffers would co-exist with employees from other agencies, diluting the focus and weakening the agency and possibly eliminating it. But SAMHSA was created by Congress, so closing it is illegal without congressional action.
  • CDC: CDC’s Injury Center includes the Division of Overdose Prevention, and the CDC also has programs/divisions focused on tobacco prevention and reducing risk factors for and consequences of substance use (e.g., adverse childhood experiences, HIV). Restructuring CDC to focus only on infectious diseases means much of this work, which includes funding, research, and resources, is in danger.
  • Research: Cuts to NIH staff and combining ASPE and AHRQ could significantly curtail scientific and policy research on addiction, including effective treatment and implementation.