Massive layoffs hit HHS agencies

The main point: Last week, thousands of Department of Health and Human Services (HHS) workers began losing their jobs as part of the reduction in force that HHS Secretary Kennedy had announced would cut 10,000 of the department’s workers. The cuts were chaotic and hit staff across HHS agencies, with several offices eliminated entirely.

Here’s a look at some of the cuts…

Substance Abuse and Mental Health Services Administration (SAMHSA):

• In total: SAMHSA lost about half of its nearly 900 employees.
• Senior staff: Senior SAMHSA staff working to merge the agency into the new Administration for a Healthy America (AHA) were among the staff laid off.
• Offices closed: All of the agency’s 10 regional offices were closed, along with its external management team, the Office of Minority Health, the Office of Behavioral Health Equity, the internal policy lab, etc.
• NSDUH: The entire team working on the National Survey on Drug Use and Health (NSDUH) was cut. NSDUH is the primary source of data on mental health and substance use disorder in the U.S. and is critical for developing responses to the crises. HHS is required by law to collect the data, but it is unclear how the agency will do that going forward.

Food and Drug Administration (FDA):

• Tobacco: Brian King, the director of FDA’s Center for Tobacco Products (CTP), the office that reviews companies’ applications to market vaping and other tobacco products, was placed on administrative leave. Dozens of other employees in FDA’s tobacco center were also dismissed, including two entire offices responsible for drafting new tobacco regulations and setting policy. King told staff that their office drove adult smoking rates down to 75-year lows and youth tobacco use to 25-year lows, including a 70% decline in youth e-cigarette use over the past five years.
• Regulation and research: The offices responsible for ensuring regulatory decisions are not compromised by conflicts of interest (a priority of Kennedy’s) were hit hard. FDA’s entire library staff was also targeted, making employees fearful they will lose access to medical journals as the administration cancels subscriptions to cut costs. FDA staff regularly consult academic papers to support regulatory decisions and research.

Centers for Disease Control and Prevention (CDC):

• Infectious disease: The bulk of cuts hit agency units focused beyond the administration’s new vision for CDC that focuses only on infectious diseases. But some infectious disease divisions were also impacted, with the biggest cuts for the Division of HIV Prevention and eliminating CDC’s hepatitis labs.
• Tobacco: The CDC’s Office on Smoking and Health was gutted, with all scientists and public health experts at the office cut. The office has been instrumental in driving down smoking rates, protecting millions of children from addiction, and helping states run effective prevention programs. Former CDC director Tom Frieden called it “a gift to Big Tobacco.” It is unclear what will happen to the national network of quit lines for smokers, as the people who oversaw contracts with states and ran quit lines in various languages were fired.
• Overdose: CDC’s National Center for Injury Prevention and Control lost about a third of its staff. It will retain the Overdose Prevention Division and suicide prevention branch, and some surveillance activities will continue, like monitoring adverse childhood experiences.
• Data: All 40 employees at the Web-Based Injury and Statistics Query and Reporting System (WISQARS), a team within the Injury Center responsible for processing data around injuries and leading causes of injury-related deaths (including overdoses), were cut. That team had been working on machine learning initiatives for opioid overdose and suicide data. The entire staff for the Pregnancy Risk Assessment Monitoring System (PRAMS) survey on infant and maternal health was also placed on administrative leave. The dataset offers insights on the U.S.’s high maternal mortality rates, of which mental health and substance use disorders are primary drivers.

National Institutes of Health (NIH): The cuts at NIH mostly targeted communications, procurement, and human resources offices, but scientists were also among those dismissed. Whole offices at the National Institute of Child Health and Human Development were eliminated. Directors of five NIH institutes and at least two other members of senior leadership are out.

Centers for Medicare and Medicaid Services (CMS): Several divisions at CMS were eliminated, including its Office of Equal Opportunity and Civil Rights, as well as five divisions within its Office of Acquisition and Grants Management, which helps the agency contract Medicare and Medicaid operations to outside parties.

Health Resources and Services Administration (HRSA):

• Community health services: As many as 500-600 people were let go at HRSA, which is charged with improving care for uninsured, rural, and low-income communities. It funds community health centers, the Ryan White HIV/AIDS program, the National Health Service Corps, programs promoting maternal and child health, etc.
• Maternal mental health: Multiple teams within the Maternal and Child Health Bureau were cut, including workers who oversaw the Maternal Mental Health Hotline. The future of the hotline is uncertain.

Agency for Health Research and Quality (AHRQ) & Office of the Assistant Secretary for Planning and Evaluation (ASPE):

• By the numbers: More than half of employees ASPE and AHRQ have been laid off. The two agencies operated on less than $600 million combined, about 0.04% of federal government spending on health care.
• ASPE: The biggest cuts in ASPE came within its Office of Human Policy, Office of Science and Data Policy, and Office of Human Services Policy, including teams that research public health services, health care coverage and financing, and statisticians and analysts that help determine when people are eligible for health benefits.
• AHRQ: The biggest cuts to AHRQ were to a division that translates research into real-world tools to help doctors care for patients, including reviewing evidence and consolidating information for the U.S. Preventive Services Task Force, which makes recommendations that determine whether health insurers must cover certain preventive services at no charge. The agency also cut a division that funds research and the division where health disparities work is concentrated.
• Reminder: Kennedy’s reorganization plan includes combining ASPE and AHRQ into the “Office of Strategy.” But dismantling ASPE and AHRQ could eliminate vital health care research, undercut efforts to improve health care delivery, and introduce political interference into data-driven organizations.