RFK Jr.'s emerging vision for HHS: More centralized power
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Health and Human Services Secretary Robert F. Kennedy Jr. says sweeping layoffs and restructuring in the department will bring order to a bureaucracy he claims is in "pandemonium." But experts say the overhaul also likely gives him far greater control over dozens of federal health agencies.
Why it matters: HHS has long functioned like a decentralized behemoth, with key decisions on hiring, grant funding, and public health priorities often in the hands of career staff and scientists.
The big picture: Along with cutting more than 10,000 jobs, HHS last week unveiled a plan centralize all human resources, IT, procurement and policy decisions, moving administrative control away from individual divisions.
- Central to this restructuring is the creation of the Administration for a Healthy America (AHA), a new entity that aims to centralize functions related to public health, addiction services and environmental health under a single umbrella.
- This move is seen by some as an attempt to exert greater political control over public health initiatives, potentially compromising the independence of operating agencies with specialized missions.
- Experts warn that folding an agency like the Substance Abuse and Mental Health Services Administration into a larger entity could dilute its focus and undermine efforts to combat the nation's ongoing addiction and mental health crises.
"What you see is an attempt by HHS to exert more control over most aspects of functioning of the department from communications to policy, to service delivery," Peter Lurie, president of the Center for Science in the Public Interest and a former associate Food and Drug Administration commissioner, told Axios.
It's notable that a fact sheet from the administration on the restructuring specifically says it will centralize "policy," Lurie said.
- He pointed to the FDA, which is absorbing the most job cuts and makes key decisions about drug and device reviews, vaccine schedules and the dispensing of abortion pills.
- Almost without exception, mid-level career staff have driven decision-making in new drug reviews, so that those with the most expertise can weigh risks and benefits without politics coming into play.
- "My concern is that there'll be a desire to meddle in the small workings of the department from the way that advisory committees are constructed, whether or not they meet, what it is that the people in FDA are allowed to say, and perhaps even, ultimately, over the way that drugs are approved or labeled," Lurie said.
HHS did not respond to a request for comment.
As for the Centers for Disease Control and Prevention, the agency is decreasing its workforce by almost a fifth while "returning to its core mission of preparing for and responding to epidemics and outbreaks."
- The CDC has grown over time to address the greatest threats to human health beyond infectious disease, which include chronic conditions, something Kennedy has said he wants to focus on, said Richard Besser, CEO of the Robert Wood Johnson Foundation and former acting director of the CDC.
- "You don't address that by taking the agency within your federal government that has the greatest expertise in chronic diseases and saying they're no longer going to work on that," Besser said.
- "I worry that this brief fact sheet is hiding some major changes to how the organization functions," Besser said.
Kennedy says the moves will save taxpayers $1.8 billion and straighten out a department that's been racked with mismanagement and duplicative functions.
- "HHS is a sprawling bureaucracy that encompasses literally hundreds of committees, departments and other offices," Kennedy said.
- "We're going to eliminate an entire alphabet soup of departments and agencies while preserving their core functions by merging them into a new organization."
Career scientists are increasingly dubious. Concerns about political interference in public health activities were highlighted by the departure of Peter Marks, the FDA's top vaccine official who stood up Operation Warp Speed, on Friday night.
- "It has become clear that truth and transparency are not desired by the secretary, but rather he wishes subservient confirmation of his misinformation and lies," Marks wrote in his resignation letter.
- One National Institutes of Health employee who spoke to Axios on the condition of anonymity said they initially wanted to give the new leadership the benefit of the doubt.
- "The vibe shifted. It is now centralize this, centralize that, centralize this. The political appointees clearly want more influence," the employee said.
The other side: Supporters of the reorganization contend that these changes will lead to a more efficient and responsive HHS, better equipped to tackle the nation's health challenges. They argue that reducing redundancy and streamlining operations will ultimately benefit public health outcomes.
Alison Snyder contributed to this report.
