Kennedy’s Health Cuts Seen as Taking Toll on Services, Oversight

Secretary Robert F. Kennedy Jr.'s overhaul of the Department of Health and Human Services is alarming public health experts who say the moves are too blunt to deliver on the promise of efficiency and will come at the expense of key services.

A reduction of 10,000 full time employees, half of the department’s regional offices, and the folding of 28 divisions into 15 are among the massive changes announced Thursday. The department provided a broad outline of the consolidations and cuts, but didn’t give full details on the overhaul.

The changes come amid public health issues such as a measles outbreak and fear of spreading bird flu, with the HHS making cuts to agencies that would have a hand in responding such as the Centers for Disease Control and Prevention and Food and Drug Administration.

“Cutting 10,000 people from a workforce that many believe is already too lean, because it is responsible for the health of hundreds of millions of people is inherently a mistaken approach,” said Nicole Huberfeld, law professor at Boston University.

Kennedy framed the move as both an effort to reduce “bureaucratic sprawl” and better implement his “Make America Healthy Again” agenda, describing it as “realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic.”

While recognizing the concept of government inefficiency and bloat, public health observers were largely skeptical of the reorganization, describing the cuts as excessive, orchestrated by an agency leader driven by misguided goals and with little understanding of how the department functions.

“It is very unlikely that it will somehow improve the health of Americans, because a lot of what he’s cutting is the actual research work of HHS,” Huberfeld said. “You can’t improve the research while firing people who do the research.”

Fraud and Abuse

Reorganizations aren’t new in the federal government, observers say, and sometimes they can be beneficial.

The HHS said its restructuring would save $1.8 billion and Kennedy promised the department could do “a lot more” for taxpayers “at a lower cost.”

But cuts to the workforce “will ultimately affect government services,” said Larry Levitt, executive vice president for health policy at KFF. “People and health-care providers may find themselves waiting longer to get help and get their questions answered.”

“Much of what HHS employees do is behind the scenes oversight, working to prevent fraud and abuse and ensure health-care programs provide the services they promise. With fewer people watching the store at HHS, problems will start to pop up,” Levitt said.

Under the reorganization, the HHS will bring on a new assistant secretary for enforcement to oversee a consolidation of HHS agencies for combating “waste, fraud, and abuse.”

Among those HHS agencies being moved is the Office for Civil Rights, which “really is not focused on waste, fraud and abuse,” said Brook Baker, professor of law emeritus at Northeastern University. “It’s about discrimination. It’s about people not getting equal health services.”

Impact of Change

Still, some echo Kennedy’s view that the reorganization is a moment of opportunity to better align the agency’s priorities.

“Our health-care professionals are called to safeguard their patients’ health, safety, and well-being,” Matt Bowman, senior counsel at the conservative legal group Alliance Defending Freedom, said in a statement.

“As the Trump administration reorganizes HHS to advance the health of our citizens, we hope they will continue to appoint people who protect the sanctity of life, conscience, and biological reality in the new positions responsible for civil rights, Title X, and other grant programs,” Bowman said.

Robert Moffit, a deputy assistant secretary at the HHS in the Reagan administration, said the department “was huge then. It’s even bigger now.”

Under Reagan, the HHS “was a bureaucratic empire, with many, many powerful kingdoms,” said Moffit, now a Heritage Foundation fellow.

“What Kennedy brought up is the fact that a lot of these institutions have been siloed, in effect, for so many years,” Moffit said, noting the NIH and CDC as examples.

“One of the things that we found during the pandemic is, on occasion, it was a public relations problem to some extent, but was also a managerial problem. People were saying, well, who’s really in charge?”

“This is really very much long overdue,” Moffit said.

Others, however, are alarmed by which HHS agencies are facing cuts.

Kennedy is “dramatically cutting into CDC and FDA, two agencies that need more people, not less, and are directly at the frontline of overseeing pharmaceutical companies and responding to public health,” said Dorit Reiss, who teaches law at UC Law San Francisco. “That’s going to hurt us.”

The FDA will slash 3,500 full-time employees under the plan, though the HHS noted the cuts won’t impact food, drug, or medical device reviewers.

That’s a significant reduction for the FDA, said Rachel Rebouché, Kean Family Dean of Temple University Beasley School of Law.

“Sure, maybe it won’t affect drug, device and food reviews, but who’s going to do them? These aren’t offices that are particularly known for their expediency. So what’s the plan?” Rebouché said.

FDA acting Commissioner Sara Brenner told staff in an email obtained by Bloomberg Law that workers will “restore trust in public health institutions like ours with integrity and radical transparency,” and “endeavor to Make America Healthy Again.”

Brenner added that the changes “may be challenging for some employees, who we value as both colleagues and friends.”

“As we chart our course into the future, I ask for your patience, grace and sanguinity with both the process and with each other,” Brenner said.

The CDC, meanwhile, will drop about 2,400 employees and focus on epidemic and outbreak preparation and response.

“Imagine what our Covid response would have been without the CDC being able to move quickly,” Rebouché said. “Now, having kind of an emaciated version of that, if there’s a big public health crisis, who knows. Then I think we might see the effects of this much more clearly.”