The US Department of Health and Human Services (HHS) will lay off 10,000 workers and shut down entire agencies, including ones that oversee billions of dollars in funds for addiction services and community health centres across the United States.
HHS Secretary Robert F Kennedy Jr (RFK) criticised the department he oversees as an inefficient “sprawling bureaucracy” in a video announcing the restructuring on Thursday. He faulted the department’s 82,000 workers for a decline in Americans’ health.
“I want to promise you now that we’re going to do more with less,” Kennedy said in the video, posted to social media.
The restructuring plan caps weeks of tumult at the nation’s top health department, which has been embroiled in rumours of mass firings, the revocation of $11bn in public health funding for cities and counties, a tepid response to a measles outbreak, and controversial remarks about vaccines from its new leader.
Still, Kennedy said a “painful period” lies ahead for HHS, which is responsible for monitoring infectious diseases, inspecting foods and hospitals and overseeing health insurance programmes for nearly half the country.
‘Make Americans healthy again’
Overall, the department will downsize to 62,000 positions, losing nearly a quarter of its staff – 10,000 jobs through layoffs and another 10,000 through workers taking early retirement and voluntary separation offers encouraged by US President Donald Trump’s administration.
Public health experts, doctors, current and former HHS workers and congressional Democrats quickly panned Kennedy’s plans, warning they could have untold consequences for millions of people across the country.
“These staff cuts endanger public health and food safety,” said Brian Ronholm, director of food policy at Consumer Reports, in a statement. “They raise serious concerns that the administration’s pledge to make Americans healthy again could become nothing more than an empty promise.”
But Kennedy, in announcing the restructuring, blasted HHS for failing to improve Americans’ lifespans and not doing enough to drive down chronic disease and cancer rates.
“All of that money,” Kennedy said of the department’s $1.7 trillion yearly budget, “has failed to improve the health of Americans.”
Federal health workers – stationed across the country at agencies including the National Institutes of Health (NIH) and the Food and Drug Administration (FDA), both in Maryland – described shock, fear and anxiety rippling through their offices on Thursday. Workers were not given advance notice of the cuts, several told The Associated Press, and many remained uncertain about whether their jobs were on the chopping block.
“It’s incredibly difficult and frustrating and upsetting to not really know where we stand while we’re trying to keep doing the work,” said an FDA staffer who spoke on the condition of anonymity out of fear of retaliation. “We’re being villainised and handicapped and have this guillotine just hanging over our necks.”
‘Drastically scale back’
The planned FDA job cuts would not affect inspectors or reviewers of drugs, medical devices, or food, HHS said.
The terminations are likely to delay drug and medical device application reviews or cause missed deadlines, said Eva Temkin, a lawyer at Arnold & Porter who advises clients on drug and medical device applications. “There’s a real risk that this results in delayed patient access to treatments,” she said.
The Administration for Strategic Preparedness and Response, currently an independent HHS agency with 1,000 employees, will be folded into the Centers for Disease Control and Prevention (CDC).
The NIH will see staff reductions across its 27 institutes and centres.
“The only way to cut that high of a percentage of our staff, along with the 35 percent contracting cuts that are being directed, is to drastically scale back what NIH does across the board,” said Nate Brought, the recently departed director of NIH’s Executive Secretariat.
The Centers for Medicare and Medicaid Services was comparatively spared, with a reduction of only about 300 employees. It was not immediately clear from which HHS divisions or offices the remaining 2,600 cuts would come.
As part of the restructuring, the department’s 10 regional offices will be cut to five and its 28 divisions consolidated into 15, including a new Administration for a Healthy America, or AHA, which will combine offices that address addiction, toxic substances and occupational safety into one central office.
AHA will include the Office of the Assistant Secretary for Health, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Agency for Toxic Substances and Disease Registry, and the National Institute for Occupational Safety and Health.
It will be divided into divisions of primary care, maternal and child health, mental health, environmental health, HIV/AIDS, and workforce, the department said.
The changes centralise functions such as communications, human resources, IT, and policy planning that currently spread out across several health agencies, including the FDA, CDC, and NIH. Agencies report to the health secretary but have traditionally operated somewhat independently of HHS and the White House.
HHS said it would also combine the Office of the Assistant Secretary for Planning and Evaluation and the Agency for Healthcare Research and Quality into a new Office of Strategy that will conduct research that informs Kennedy’s policies.
There are no additional cuts currently planned, the department said.
‘Pretty devastated’
The cuts and consolidation go far deeper than anyone expected, an NIH employee said.
“We’re all pretty devastated,” said the staff member, who spoke on the condition of anonymity for fear of retaliation. “We don’t know what this means for public health.”
Union leaders for CDC workers in Atlanta said they received notice from HHS on Thursday morning that reductions will primarily focus on administrative positions including human resources, finance, procurement and information technology.
