HHS Plans a Major Downsize, Restructuring of Federal Health Agencies

This is the first in a series looking at the reduction and restructuring of federal health services and how that will affect public health and infectious disease clinical care.

The Health and Human Services (HHS) department announced yesterday it is planning on a major shakeup, reshuffling of the agencies and laying off thousands of workers.

According to a statement by HHS, the restructuring will save taxpayers $1.8 billion per year. Its plan is to reduce 10,000 full-time employees, and when combined with HHS’ other efforts, including early retirement and Fork in the Road, the restructuring results in a total downsizing from 82,000 to 62,000 full-time employees.

“We aren't just reducing bureaucratic sprawl,” HHS Secretary Robert F. Kennedy, Jr. said in a statement. “We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic. This Department will do more —a lot more—at a lower cost to the taxpayer.”

The specific contents of the restructuring plan that have been announced so far are as follows:

• 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) — into a new, unified entity. This centralization 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.
• Strengthening the Centers for Disease Control and Prevention (CDC): the Administration for Strategic Preparedness and Response (ASPR), responsible for national disaster and public health emergency response, will transfer to the CDC, reinforcing its core mission to protect Americans from health threats.
• New Assistant Secretary for Enforcement: HHS will create a new Assistant Secretary for Enforcement to oversee the Departmental Appeals Board (DAB), Office of Medicare Hearings and Appeals (OMHA), and Office for Civil Rights (OCR) to combat waste, fraud, and abuse in federal health programs.
• Research and Evaluation for Health Policy: HHS will merge the Assistant Secretary for Planning and Evaluation (ASPE) with the Agency for Healthcare Research and Quality (AHRQ) to create the Office of Strategy to enhance research that informs the Secretary’s policies and improves the effectiveness of federal health programs.
• Reorganization of the Administration for Community Living (ACL): Critical programs that support older adults and people with disabilities will be integrated into other HHS agencies, including the Administration for Children and Families (ACF), ASPE, and the Centers for Medicare and Medicaid Services (CMS). This reorganization will not impact Medicare and Medicaid services.

In recent weeks, the Trump Administration has stopped vaccine funding to GAVI, has discussed the possibility of doing away with HIV prevention programs, and has previously cancelled 2 vaccine meetings.

Reference
HHS Announces Transformation to Make America Healthy Again. HHS press release. March 27, 2025. Accessed March 28, 2025.
https://www.hhs.gov/about/news/hhs-restructuring-doge.html