Clinical, Consumer Groups Alarmed by HHS Reorganization, Downsizing

Clinical associations, philanthropies, and patient and family organizations all responded with alarm to the sweeping restructuring and downsizing at the U.S. Department of Health and Human Services announced on March 27. 


So far, HHS has not announced any changes to the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT, although there have been rumors that it could be moved under a different office or department. 

In the area of research and evaluation, HHS announced it would merge the Assistant Secretary for Planning and Evaluation (ASPE) with the Agency for Healthcare Research and Quality (AHRQ) to create the Office of Strategy.

AcademyHealth put out a statement saying it strongly opposes both the substance and the process by which HHS announced a sweeping reorganization. “We are deeply concerned about the potential effective elimination of the Agency for Healthcare Research and Quality (AHRQ), a critical supporter of vital research and evidence-based healthcare practices. The ambiguity surrounding this reorganization deprives researchers and patients of the clarity needed to make informed plans, posing a reckless threat to ongoing and future initiatives.”

AcademyHealth said that reform must be developed with Congressional and stakeholder input. “This reorganization was crafted without transparency or opportunity for input, leaving many health leaders in Congress and out blindsided.”

“Just last month, the Friends of AHRQ just last month sent a letter to Congress advocating for AHRQ’s preservation and full funding. This letter was signed by 194 organizations representing researchers, patients, doctors, nurses, health systems, hospitals, insurers, universities, think tanks, and more, clearly highlights how AHRQ is a non-controversial and nonpartisan cornerstone of creating better health outcomes across all health care access points. 

Stakeholders also expressed concern about the creation of the Administration for a Healthy America (AHA), which will combine multiple agencies — the Office of the Assistant Secretary for Health (OASH), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute for Occupational Safety and Health (NIOSH).

Brian Hurley, M.D., M.B.A., president of the American Society of Addiction Medicine (ASAM), issued a statement saying that “ASAM is deeply concerned about the possible domino effects of SAMHSA’s restructuring and its potential to deprioritize addiction care services nationwide. Any weakening of centralized substance use disorder (SUD) expertise within HHS would be cause for alarm, especially amidst the ongoing deadly addiction and overdose crisis.  

The CEO Alliance for Mental Health, a coalition of CEOs from the nation’s leading organizations dedicated to improving the lives of people living with mental health and substance use conditions, put out a statement expressing deep concern about “potential cuts to SAMHSA that would interrupt services for people with mental health conditions and substance use disorders – cuts that have the potential to cause widespread harm to our communities. We strongly urge the Administration to protect SAMHSA and other federal programs that address the mental illness and substance use epidemic, and that help to prevent suicide – crises deeply affecting American families.”

Stakeholders also expressed concern about the potential impact of the elimination of the Administration for Community Living (ACL) on older Americans and people with disabilities. 

 “The announcement of workforce cuts at the Department of Health and Human Services could have serious consequences at this time of unprecedented growth in America’s aging population,” said Terry Fulmer, Ph.D., R.N., president of the John A. Hartford Foundation, in a statement. “The proposed reorganization of the Administration for Community Living and its integration into other agencies requires careful consideration …..ACL administers programs that older adults depend on in their daily lives, such as meal delivery, transportation to medical appointments and chronic disease management. It also coordinates the federal government’s vital support for family caregivers, a lifeline for families nationwide. Absorbing this wide range of functions, with far fewer staff, would take planning and time. The societal promise to care for America’s older adults requires a cautious approach.”

LeadingAge, a community of nonprofit aging services providers, noted that “decreasing overall staff by almost 25% is a massive downsizing that should be undertaken with the utmost care and sensitivity to impact — particularly on the millions of older adults who rely on HHS programs and services. We are concerned that carrying out staff reductions at a dramatic scale such as this on a tight timeline does not allow for a thorough consideration of short- and long-term impacts to our country’s older adults and those who care for them.”
 
The National Consumers League (NCL) said the impact of the job cuts and restructuring is particularly concerning for agencies like the Health Resources and Services Administration (HRSA) and the National Institute for Occupational Safety and Health (NIOSH). NCL said these agencies are crucial to the functioning of vital public health and safety programs, including the 340B Drug Pricing Program, which allows hospitals, community health centers, and other providers to purchase prescription medications at discounted prices. This ensures that low-income and underserved communities can afford the medications they need.    

“In the wake of a nationwide measles outbreak, this is a reckless decision by the Trump administration,” said Samatha Sears, NCL health policy associate, in a statement. “HHS leadership should be prioritized on bolstering public health and delving into medical research for vaccines and medications, not firing thousands of staff and jeopardizing agencies like HRSA and NIOSH. Downsizing this department under our current circumstances is irresponsible and dangerous to the American people.”