Tag: President

How the President Shapes Federal Health Programs

This post, part two of a series, outlines the extensive role of the federal government in U.S. health policy, primarily through the Department of Health and Human Services (HHS). It discusses the executive branch’s involvement in health regulation, funding, and policy formation, emphasizing the significance of HHS programs and leadership roles.

This is the second post in a series helping us understand the federal government’s role in health policy in the United States. In short, its role is extensive and expensive. You can read the first post here.

The Constitution does not specifically say the government controls or provides healthcare. The Preamble hints with “promote the general welfare”.

Considering how basic and unorganized medical science was in the late 18th century, it’s not surprising they did not consider it in the plans for the new government.

I am publishing a series of posts based on

Congress and the Executive Branch and Health Policy

by Julie Jovner at KFF, an independent source for health policy research, polling, and news, an endowed national nonprofit organization.

Ms. Jovner’s article explains how the three branches of government work together, why the Department of Health and Human Services (and therefore its Secretary) is so important, and the budgeting and regulation processes.

This series is nonpartisan and objective. I made minimal edits to improve readability but retain meaning. I insert comments in parentheses to add clarity.

The photos are for illustration only and are not in the KFF article.

The Executive Branch

This post focuses on the executive branch of government, The White House including the President and his Cabinet, especially the Secretary of the Department of Health and Human Services.

The President

The executive branch carries out the laws made by Congress and operates the federal health programs, often filling in details Congress has left out through rules and regulations.

Federal workers in the health arena provide direct patient care, regulate how others provide care, set payment rates and policies, conduct medical or health systems research, regulate products sold by the private sector, and manage the billions of dollars the federal government spends on the health-industrial complex.   

Although most of the executive branch’s health policies are implemented by the Department of Health and Human Services (and to a smaller extent, the Departments of Labor and Justice), over the past several decades the White House itself (through the President) has taken on a more prominent role in policy formation.

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.

Department of Health and Human Services (HHS)

Most federal health policy is made through the Department of Health and Human Services except for several key areas.

Exceptions include the 

  • Veterans Health Administration, run by the Department of Veterans Affairs;
  •  TRICARE, the health insurance program for active-duty military members and dependents, run by the Defense Department; and the 
  • Federal Employees Health Benefits Program (FEHB), which provides health insurance for civilian federal workers and families and is run by the independent agency the Office of Personnel Management.   

The health-related agencies within HHS are roughly divided into the resource delivery, research, regulatory, and training agencies that comprise the U.S. Public Health Service and the health insurance programs run by the Centers for Medicare and Medicaid Services (CMS).  

The Surgeon General oversees the U.S. Public Health Service (USPHS) Commissioned Corps, an elite group of over 6,000 uniformed officers who are public health professionals. The USPHS mission is to protect, promote, and advance the health of our nation.

The U.S. Public Health Service

Ten of the 13 operating divisions of HHS are part of the U.S. Public Health Service, which also plays a role in U.S. global health programs. They are:  

  • The Administration for Strategic Preparedness and Response (ASPR)
  • The Advanced Research Projects Agency for Health  (ARPA-H)
  • The Agency for Healthcare Research and Quality (AHRQ)  
  • The Agency for Toxic Substances and Disease Registry (ATSDR)  
  • The Centers for Disease Control and Prevention (CDC)  
  • The Food and Drug Administration (FDA)  
  • The Health Resources and Services Administration (HRSA)  
  • The Indian Health Service (IHS)  
  • The National Institutes of Health (NIH)  
  • The Substance Abuse and Mental Health Services Administration (SAMHSA)  

CMS

The Centers for Medicare and Medicaid Services (CMS) is by far the largest operating division of HHS. It oversees not just the Medicare and Medicaid programs, but also the federal Children’s Health Insurance Program (CHIP) and the health insurance portions of the Affordable Care Act(ObamaCare).

Together, the programs under the auspices of CMS account for nearly a quarter of all federal spending in fiscal 2023, cost an estimated $1.5 Trillion in fiscal 2023, and served more than 170 million Americans – more than half the population.  

KFF’s website content is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license that allows for the sharing of our information with proper attribution and without alteration.

End of KFF article

The President’s Cabinet and other Agency Heads

As you can imagine, the leadership organization of HHS is large and complex. At the top is the Secretary, who is a member of the President’s Cabinet , approved by the Senate.

Other key leadership positions, all of which are appointed by the President include

  • U.S. Surgeon General
  • Director of the CDC
  • Commissioner of Food and Drugs (FDA)
  • Director of the NIH
  • Director of the National Library of Medicine
  • Administrator of CMS
James H. Shannon Building (Building One), NIH campus, Bethesda, MD
James H. Shannon Building (Building One), NIH campus, Bethesda, MD

Looking ahead-Congress

In the next post in this series, we will consider Congress’s role in overseeing these agencies and, most importantly, funding them.

“How Congress oversees the federal health care-industrial complex is almost as byzantine as the U.S. health system itself.

Jurisdiction and responsibility for various health agencies and policies is divided among more than two dozen committees in the House and Senate.”

KFF

Exploring the HEART of Health

I took the cover photo for this post at the Reagan Presidential Library in California. It is a replica of the Oval Office during his administration.

Thanks for getting through another post that’s maybe more informative than inspiring. I hope you learned something.

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Understanding the U.S. Government’s Role in Health Policy

In this post I explain how the U.S. federal government significantly influences health policy, controlling one-third of healthcare spending. Executive orders by recent presidents affect healthcare, prompting questions among professionals. Congress and the Executive Branch, particularly the Department of Health and Human Services, oversee critical health programs. State governments also play essential roles in healthcare regulation.

This information was current as of the date of publication and will be updated as changes occur.

Since taking office, President Trump has signed more executive orders than any other president in history in such a short time. Only President Biden and President Truman issued more than 40 executive orders in their first 100 days in office.

If you are wondering what effect these orders have on health care, you are not alone. Professionals in all facets of healthcare are wondering too. And at this point, none of them know for sure.

A place to start understanding what these changes mean is to understand the federal government’s role in healthcare. We all live under it, but may not understand how it works.

I am publishing a series of posts based on Congress and the Executive Branch and Health Policy by Julie Jovner at KFF, an independent source for health policy research, polling, and news, an endowed national nonprofit organization.

Ms. Jovner explains how the three branches of government work together, why the Department of Health and Human Services (and therefore its Secretary) is so important, and the budgeting and regulation processes.

This series is nonpartisan and objective. I made minimal edits to improve readability but retain meaning. I insert comments in parentheses to explain unfamiliar terms.

The photos are for illustration only and do not appear on the KFF article.

Congress and the Executive Branch and Health Policy

The federal government is not the only place health policy is made in the U.S., but it is by far the most influential. Of the $4.5 trillion the U.S. spent on health in 2022, the federal government was responsible for roughly a third of all health services.

The payment and coverage policies set for the Medicare program often serve as a model for the private sector. Many health programs at the state and local levels are also impacted by federal health policy, either through direct spending or rules and requirements.

Federal health policy is primarily guided by Congress, but carried out by the executive branch, predominantly by the Department of Health and Human Services, HHS. 

The Federal Role in Health Policy 

No one is “in charge” of the fragmented U.S. health system, but the federal government probably has the most influence, a role that has grown over the last 75 years. Today the federal government pays for care, provides it, regulates it, and sponsors biomedical research and medical training.   

The federal government pays for health coverage for well over 100 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), the Veterans’ Health Administration, the Indian Health Service, and the Affordable Care Act (ACA).  It also pays to help provide insurance coverage for tens of millions who are active-duty and retired military and for civilian federal workers. 

Federal taxpayers also underwrite billions of dollars in health research, mainly through the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).   

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

Federal public health policy is spearheaded by the Centers for Disease Control and Prevention. Its portfolio includes tracking not just infectious disease outbreaks in the U.S. and worldwide, but also conducting and sponsoring public health research and tracking national health statistics.  

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The Health Resources and Services Administration (HRSA) funds critical health programs for underserved Americans (including Community Health Centers) and runs workforce education programs to bring more health services to places without enough health care providers.  

Meanwhile, in addition to overseeing the nation’s largest health programs, the Centers for Medicare and Medicaid Services (CMS) also operates the federal insurance Marketplaces created by the ACA (Affordable Care Act, also called ObamaCare ) and enforces rules made by the law for private insurance policies.  

State and Local Government Roles

While the federal government exercises significant authority over medical care and its practice and distribution, state and local governments still have key roles to play.   

States oversee the licensing of health care professionals, distribution of health care resources, and regulation of health insurance plans that are not underwritten by employers themselves. State and local governments share responsibility for most public health activities and often operate safety-net facilities in areas with shortages of medical resources.  

The Three Branches of Government and How They Impact Health Policy 

All three branches of the federal government – Congress, the executive branch, and the judiciary – play important roles in health policy.  

3 BRANCHES OF U.S. GOVERNMENT-legislative, executive, judicial
3 BRANCHES OF U.S. GOVERNMENT, FROM usa.gov, public domain

Congress

Congress

  • makes laws that create new programs or modify existing ones. It also
  • conducts “oversight” of how the executive branch implements the laws Congress has passed.
  • sets the budget for “discretionary” and “mandatory” health programs and provides those dollar amounts. 

 Executive Branch

The executive branch carries out the laws made by Congress and operates the federal health programs, often filling in details Congress has left out through rules and regulations.

Federal workers in the health arena may

  • provide direct patient care,
  • regulate how others provide care,
  • set payment rates and policies,
  • conduct medical or health systems research,
  • regulate products sold by the private sector, and
  • manage the billions of dollars the federal government spends on the health-industrial complex.  

 The Judiciary

Historically, the judiciary has had the smallest role in health policy but has played a pivotal role in recent cases. It passes judgment on how or whether certain laws or policies can be carried out and settles disputes between the federal government, individuals, states, and private companies over how health care is regulated and delivered.  

Supreme Court Justice Ketanji Brown Jackson

Recent significant decisions from the Supreme Court have affected the legality and availability of abortion and other reproductive health services and the constitutionality of major portions of the ACA. 

Supreme Court Justice Amy Coney Barrett

The Executive Branch – The White House

 Although most of the executive branch’s health policies are implemented by the Department of Health and Human Services (and to a smaller extent, the Departments of Labor and Justice), over the past several decades the White House itself has taken on a more prominent role in policy formation.

THE WHITE HOUSE, PHOTO BY DR ALETHA

The White House Office of Management and Budget not only coordinates the annual funding requests for the entire executive branch, but it also reviews and approves proposed regulations, Congressional testimony, and policy recommendations from the various departments.

The White House also has its own policy support agencies – including the National Security Council, the National Economic Council, the Domestic Policy Council, and the Council of Economic Advisors, that augment what the President receives from other portions of the executive branch. 

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 4, 2025)

Coming next -HHS

In the next post, we will look closer at the role of the White House (the President) and the Department of HHS (the cabinet Secretary) as explained in the KFF article.

Exploring the HEART of Health

Thanks for your interest in learning more about our government and healthcare. It may not be the most exciting topic, but it is vitally important.

I’d love for you to follow this blog. I share information and inspiration to help you turn health challenges into health opportunities.

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