Tag: federal budget

Can Kennedy’s HHS Restructuring End Chronic Disease?

In this post I look at Secretary of Health Robert Kennedy Jr’s plans to cut 10,000 jobs and close five regional offices in the Department of Health and Human Services (HHS) to tackle the “chronic disease epidemic”. The restructuring intends to reduce HHS’s budget by $1.8 billion while facing significant criticism from Democrats about the potential public health impact.

Secretary of Health Robert Kennedy Jr. and President Trump have established a goal of eliminating the “chronic disease epidemic.” To do so, the Secretary has ordered a massive reduction in the budget and workforce of HHS, the Department of Health and Human Services.

What is Chronic Disease?

Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.

Centers for Disease Control and Prevention

What is an Epidemic?

In the 21st century, epidemics of infectious diseases have threatened humans. Severe acute respiratory syndrome (SARS), avian influenza, and HIV/AIDS have supported the reality of this threat. 

Measles is highly contagious and spreads through the air when an infected person coughs or sneezes.

Late in the 20th century, epidemic was applied to noninfectious diseases, such as cancer epidemics or epidemics of obesity. Using epidemic for noninfectious causes refers to a disease that affects many people, with a recent and substantial increase in cases.

For nonmedical events, journalists use the term epidemic for anything that adversely affects large numbers of persons or objects and propagates like a disease, such as crack cocaine, computer viruses, or severe weather.

Reference: Martin P, Martin-Granel E. 2,500-year Evolution of the Term Epidemic. Emerging Infectious Diseases. 2006;12(6):976-980. doi:10.3201/eid1206.051263.

Here is the Secretary’s plan for HHS to address the “epidemic” he believes exists.

U.S. Department of Health and Human Services to slash 10,000 jobs, close 5 regional offices

By Jennifer Shutt, States Newsroom, March 27, 2025 | 12:26 pm ET

WASHINGTON — The Trump administration announced a sweeping plan Thursday to restructure the Department of Health and Human Services by cutting an additional 10,000 workers and closing down half of its 10 regional offices.

The overhaul will affect many of the agencies that make up HHS, including the Food and Drug Administration, Centers for Disease Control and Prevention, National Institutes of Health, and the Centers for Medicare and Medicaid Services.

HHS overall will be downsized from a full-time workforce of 82,000 to 62,000, including those who took early retirement or a buyout offer.

HHS Secretary Robert F. Kennedy, Jr. released a written statement along with the announcement, saying the changes would benefit Americans.

“We aren’t just reducing bureaucratic sprawl.

We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy said. “This Department will do more — a lot more — at a lower cost to the taxpayer.”  

The U.S. Senate voted to confirm Kennedy as the nation’s top public health official in mid-February.

James H. Shannon Building (Building One), NIH campus, Bethesda, MD
James H. Shannon Building (Building One), NIH campus, Bethesda, MD

Congressional reaction

Democrats immediately reacted with deep concern.

Senate Appropriations Committee ranking member Patty Murray, D-Wash., said that she was “stunned at the lack of thought about what they are doing to the American public and their health.”

Murray said the committee, which controls about one-third of all federal spending, “absolutely” has an oversight role to play in tracking HHS actions.

Wisconsin Sen. Tammy Baldwin, the top Democrat on the Appropriations subcommittee that funds HHS, said she believes HHS has overstepped its authority and expects the panel will look into its actions.

“These individuals who are going to be terminated under this plan play vital roles in the health of Wisconsinites and people nationally,” Baldwin said. “And I believe that they do not have the authority, the Trump administration does not have the authority to do this wholesale reorganization without working with Congress.”

Maryland Democratic Sen. Angela Alsobrooks, whose constituents in suburban Washington likely hold many of the jobs in question, wrote in a statement the HHS’ restructuring plans are “dangerous and deadly.”

“I warned America that confirming RFK Jr. would be a mistake,” Alsobrooks wrote. “His blatant distrust of science and disregard for research and advancement makes him completely unqualified.”

Cuts across department

The announcement says reorganizing HHS will cut its $1.7 trillion annual budget by about $1.8 billion, in part, by lowering overall staff levels.

Staffing cuts will be spread out over HHS and several of the agencies it oversees. The restructuring plans to eliminate

  • 3,500 full-time workers at the FDA,
  • 2,400 employees at the CDC,
  • 1,200 staff at the NIH and
  • 300 workers at the Centers for Medicare and Medicaid Services.
President Donald Trump visited NIH on March 3, 2020 and toured the National Institute of Allergy and Infectious Diseases’ Vaccine Research Center (VRC) to learn about research on a vaccine for the novel coronavirus SARS-CoV-2. public domain photo from flickr

“The consolidation and cuts are designed not only to save money, but to make the organization more efficient and more responsive to Americans’ needs, and to implement the Make America Healthy Again goal of ending the chronic disease epidemic,” according to a fact sheet.

Senate Health, Education, Labor and Pensions, or HELP, Committee Chairman Bill Cassidy, R-La., wrote in a statement that he looks “forward to hearing how this reorganization furthers these goals.”

“I am interested in HHS working better, such as lifesaving drug approval more rapidly, and Medicare service improved,” Cassidy wrote.

Regional offices, divisions affected

HHS did not immediately respond to a request from States Newsroom about which five of its 10 regional offices would shutter or when those closures would take effect.

Its website shows the offices are located in Boston; New York City; Philadelphia; Atlanta; Chicago; Dallas; Kansas City, Missouri; Denver; San Francisco; and Seattle.

HHS plans to reduce its divisions from 28 to 15 while also establishing the Administration for a Healthy America, or AHA.

That new entity will combine the Office of the Assistant Secretary for Health, Health Resources and Services Administration, Substance Abuse and Mental Health Services Administration, Agency for Toxic Substances and Disease Registry and National Institute for Occupational Safety and Health.

That change will “improve coordination of health resources for low-income Americans and will focus on areas including, Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce development.

Transferring SAMHSA to AHA will increase operational efficiency and assure programs are carried out because it will break down artificial divisions between similar programs,” according to the announcement.

HHS will roll the Administration for Strategic Preparedness and Response into the CDC.

The department plans to create a new assistant secretary for enforcement, who will be responsible for work within the Departmental Appeals Board, Office of Medicare Hearings and Appeals and Office for Civil Rights.

House speaker says HHS is ‘bloated’

U.S. House Speaker Mike Johnson, R-La., posted on social media that he fully backed the changes in store for HHS.

​​”HHS is one of the most bureaucratic and bloated government agencies,” Johnson wrote. “@SecKennedy is bringing new, much-needed ideas to the department by returning HHS to its core mission while maintaining the critical programs it provides Americans.”

Advocates shared Democrats’ concern about the staff cutbacks.

Stella Dantas, president of the American College of Obstetricians and Gynecologists, released a statement saying the organization was “alarmed by the sudden termination of thousands of dedicated HHS employees, whose absence compounds the loss of thousands of fellow employees who have already been forced to leave U.S. health agencies.”

“Thanks to collaboration with HHS, ACOG has been able to contribute to advances in the provision of maternal health care, broadened coverage of critical preventive care, increased adoption of vaccines, raised awareness of fetal alcohol syndrome, strengthened STI prevention efforts, and more,” Dantas wrote. “This attack on public health—and HHS’ ability to advance it—will hurt people across the United States every single day.”

Originally Published on News From The States

All States Newsroom content is free to republish, as per our policy. 

https://www.newsfromthestates.com/article/us-department-health-and-human-services-slash-10000-jobs-close-5-regional-offices

Is there an “epidemic of chronic disease”?

When I practiced medicine, I and other professionals treated “chronic disease” daily. The number of people who live with a specific chronic disease varies, but the number and percentage of the population who have a chronic disease doesn’t seem to change much.

While we will always work to eliminate chronic disease, that will likely be impossible, at least soon. But improved treatments and lifestyle changes do help people with chronic diseases live longer, and healthier.

Key prevention points from the CDC

  • Most chronic diseases are caused by a short list of risk factors: tobacco use, poor nutrition, physical inactivity, and excessive alcohol use.
    • By avoiding these risks and getting good preventive care, you can improve your chance of staying well, feeling good, and living longer.
examples of ways to reduce the risk of a chronic disease, breast cancer.
Cover Image

The cover image is from the CDC website. It represents hypertension, high blood pressure, one of the most prevalent chronic medical conditions.

Exploring the HEART of Health

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Dr. Aletha

How the Federal Budget is Created: A Step-by-Step Guide

To help us understand what goes on in Washington, this post outlines the federal government budget creation. It explains processes involving the Congressional Budget Office, budget resolutions by House and Senate, appropriations bills, and the concept of reconciliation, highlighting deadlines and potential government shutdowns if not adhered to.

In this post we’re learning how the federal government budget is created with the help of Julie Rovner at KFF.

I have gently edited the text for length and readability, added headings, and added notes in parentheses to clarify terms.

The cover image for this post was generated by JetpackAI, available on WordPress. (affiliate link)

The Federal Budget Process

Under Article 1 of the U.S. Constitution, Congress is granted the exclusive power to

“lay and collect Taxes, Duties, Imposts (tax or duty) and Excises,
and to pay the Debts and provide for the common Defense and General Welfare of the United States.”  

the U.S. Constitution
Magnus, Charles, Publisher. Civil War envelope showing Columbia with shield and American flag and White House
. United States, 1862. N.Y.: C. Magnus, 12 Frankfort St. Photograph. https://www.loc.gov/item/2010648441/.

The 1974 Budget Act

In 1974, lawmakers passed the Congressional Budget and Impoundment Control Act to

  • standardize the annual process for deciding tax and spending policy for each federal fiscal year (October 1 to September 30) and
  • to prevent the executive branch from making spending policy reserved for Congress.

It created the House and Senate Budget Committees and set timetables for each step of the budget process.  

CBO-Congressional Budget Office

The 1974 Budget Act also created the Congressional Budget Office (CBO). This non-partisan agency has plays a pivotal role in both the budget and the lawmaking processes.

The CBO issues economic forecasts, policy options, and other analytical reports, but most significantly estimates how much individual legislation would cost or save the federal government. Those estimates can and do often determine if legislation passes or fails.

President’s Proposed Budget

The annual budget process is supposed to begin the first Monday in February, when the President presents his proposed budget for the fiscal year beginning the following Oct. 1. This is one of the few deadlines in the Budget Act that is usually met. 

Little Red School House
. [New Orleans, Louisiana:publisher not transcribed] Photograph. Retrieved from the Library of Congress, <www.loc.gov/item/2018756464/>.

Congress’ Spending Blueprint

The House and Senate Budget Committees each write their own “Budget Resolution,” a spending blueprint for the year that includes annual totals for mandatory and discretionary spending.

(Mandatory spending , required by law is also known as entitlement spending. Examples are Social Security, Medicare, veterans benefits, and interest on debt.)

Mandatory spending (roughly two-thirds of the budget) is automatic unless changed by Congress.

The budget resolution may also include “reconciliation instructions” to the authorizing committees overseeing those programs to make changes to lower the cost of the mandatory programs in line with the terms of the budget resolution.

(Discretionary spending is approved by Congress each year.)

The discretionary total will eventually be divided by the House and Senate Appropriations Committees between the 12 subcommittees, each responsible for a single annual spending (appropriations) bill.

Refer to this previous post for lists of the Congressional Committees and what they oversee.

Most of those bills cover multiple agencies – the appropriations bill for the Department of Health and Human Services, for example, also includes funding for the Departments of Labor and Education.  

After the budget resolution is approved by each chamber’s Budget Committee, it goes to the House and Senate floors for debate.

Assuming the resolutions are approved, a “conference committee” comprised of members from each chamber is tasked with working out the differences between the respective versions. A final compromise budget resolution is supposed to be approved by both chambers by April 15 but rarely happens.

Because the final product is a resolution rather than a bill, the budget does not go to the President to sign or veto.  

The Appropriations Process

The annual appropriations process kicks off May 15, when the House starts considering the 12 annual spending bills for the fiscal year that begins Oct. 1. By tradition, spending bills originate in the House, although if the House is delayed, the Senate will take up its version of an appropriation first.

The House completes action on all 12 spending bills by June 30, to provide enough time for the Senate to act, and for a conference committee to negotiate a final version that each chamber can approve by October 1, the only deadline with consequences if it is not met.

Avoiding a government shut-down

Unless an appropriations bill for each federal agency is passed by Congress and signed by the President by the start of the fiscal year, that agency must shut down all “non-essential” activities funded by discretionary spending until funding is approved. (The so-called government “shut-down” that we hear about.)

A CR (Continuing Resolution) can last the full fiscal year and may cover all of the federal government or just the departments for the unfinished bills.

Congress may pass multiple CRs while it works to complete the appropriations process. 

  

An Omnibus Measure

While each appropriations bill is usually considered individually, to save time (and sometimes to win needed votes), a few, several, or all the bills may be packaged into a single “omnibus” measure. Bills that package only a handful of appropriations bills are cheekily known as “minibuses.”  

Reconciliation

Meanwhile, if the budget resolution includes reconciliation instructions, that process proceeds separately. The committees in charge of the programs requiring alterations vote on and report their proposals to the respective budget committees, which assemble all changes into a single bill. (which the budget committees may not change.)  

  • Reconciliation legislation is frequently the vehicle for significant health policy changes.
  • Reconciliation bills are subject to special rules, especially in the Senate including debate time limitations (no filibusters) and restrictions on amendments.
  • Reconciliation bills may not contain provisions that do not pertain directly to taxing or spending. 

Unlike the appropriations bills, nothing happens if Congress does not meet the Budget Act’s deadline to finish the reconciliation process, June 15. In fact, in more than a few cases, Congress has not completed work on reconciliation bills until the calendar year AFTER they were begun.   

Rovner, J., Congress, the Executive Branch, and Health Policy. In Altman, Drew (Editor), Health Policy 101, (KFF, January 2025) https://www.kff.org/health-policy-101-congress-and-the-executive-branch-and-health-policy/ (February 14, 2025).

Zimmerman, Edw. M., Lyricist, and Anna Howard Shaw. Votes for Women: Suffrage Rallying Song
. comp by Zimmerman, Marie, Active 1915 [Philadelphia, Pa.: E.M. Zimmerman, ©, 1915] Notated Music. Retrieved from the Library of Congress, <www.loc.gov/item/2017562229/>.

Exploring the HEART of Health

If you made it this far, congratulations! This is not easy to absorb so I thank you for choosing to inform yourself about what happens after we vote.

The illustrations on this post are from the Library of Congress, Free to Use and Reuse site, believed to be in the public domain.

I’d love for you to follow this blog. I share information and inspiration to help you transform challenges into opportunities for learning and growth.

Add your name to the subscribe box to be notified of new posts by email. Click the link to read the post and browse other content. It’s that simple. No spam.

I enjoy seeing who is new to Watercress Words. When you subscribe, I will visit your blog or website. Thanks and see you next time.

Dr. Aletha