DOGE Envisions A Future Without Critical Public Health Services

After a week of rumors that the Trump administration was planning to implement severe cuts to the Department of Health and Human Services (HHS), it happened—though the White House reportedly denied that it would. This past Friday, senior officials were informed that 5200 relatively recent hires would be fired across multiple agencies at HHS, with 1300 at the CDC specifically. 

Why do these cuts matter? 

This latest spree of firings—in the wake of  Executive Order 14210, outlining DOGE’s “Workforce Optimization Initiative”—will have dire consequences for access to healthcare and life-saving treatments, and the US response to public health emergencies.  

What is HHS? 

The Department of Health and Human Services consists of 13 sub-agencies, with the National Institutes of Health (NIH), the Food and Drug Administration (FDA), the Indian Health Service (IHS), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMMS) being the five largest and best-known. As US News recently reported, before February 14th, the HHS had approximately 91,000 employees, and a $1.8 trillion dollar budget as of 2023, with the majority of that funding the critical Medicare and Medicaid programs. 

Chart 1. HHS Sub-agency Headcounts from US News & World Report.

Each of these sub-agencies has a vital role in ensuring access to healthcare and public health resources. 

• NIH: Funds and conducts research into serious and fatal diseases including Alzheimer’s, HIV, and cancer. 
• FDA: Regulates and approves pharmaceutical drugs, medical devices, and tobacco. Regulates the safety of many types of food (including dairy and produce). 
• IHS: Responsible for “ensur[ing] that comprehensive, culturally acceptable personal and public health services are available and accessible to all American Indian and Alaska Native people.”
• CDC: Manages the US response to public health emergencies, tracking data, publishing research, and responding more directly to disease outbreaks and other health threats. 
• CMMS: Administers Medicare, Medicaid, and the Affordable Care Act. 

Timeline: What has the Trump Administration done to HHS (so far)? 

January 24: The HHS Inspector General was fired, along with IGs at 16 other agencies.

February 6: Though the White House denied them, rumors swirled that there would be large layoffs at HHS, in response to senior management being direct to rank their employees who were in probationary periods (read: newer hires, who are easier to fire). As the Washington Post reported: 

“The anxieties [about firings] have been heightened at the Centers for Disease Control and Prevention, where officials were told to rank 10 percent of their probationary staff as mission-critical, 50 percent as important and 40 percent as not mission-critical, according to the people, who spoke on the condition of anonymity because of fear of reprisal. The CDC rankings of its probationary staff — those in a period that can last one or two years into their federal service — were due Thursday [Feb. 6].”

February 13: RFK Jr. was confirmed as Health Secretary, and made comments previewing plans to systematically fire at least 600 employees at NIH and an unspecified number at FDA.

February 14: 5200 firings—almost 6% of the Department’s workforce—are announced to HHS leadership, with directions that fired employees would lose access to work systems by the end of the day. 

February 15: The Trump administration laid off more employees at CMMS, CDC and the FDA. According to Bloomberg: “around 1,000 termination notices went out to employees at the NIH over the weekend […] Cuts were also made at HHS’s Administration for Children and Families, which funds child care and Head Start programs.”

Who would be affected

• All of us. Particularly in an era of corporate-driven climate change-induced epidemics and pandemics, cuts to the CDC are incredibly dangerous, interrupting the US government’s ability to respond to public health emergencies. From sharing public health information allowing communities to protect themselves, to supporting on-the-ground response efforts, CDC plays a key role in addressing wide-reaching and lethal health issues.
  
  • Elderly, immunocompromised, and racially and economically marginalized people are at elevated risk from contagious diseases. Undercutting vaccine access and other CDC services would have a disproportionate impact on those more likely to die or face serious health consequences from widespread contagious diseases, from pandemics to smaller outbreaks.
    
  • All food consumers. The cuts targeted FDA employees who were focused on the significant task of keeping dangerous chemicals out of our food. Now with their removal and subsequent resignations of top agency officials, necessary expertise to ensure safety of our food has been lost.
    
• People who access healthcare through Medicare, Medicaid, and the Affordable Care Act (ACA). Tens of millions of people—nearly 40% of Americans—receive Medicare and Medicaid, and the ACA currently dictates how millions of others access insurance that allows them to receive care. Medicare and Medicaid in particular are popular across party lines (with 71% of Americans expressing support for the program continuing as it is now), and Trump has publicly stated that he would not cut those programs, outside of addressing “waste”—but given Trump’s frequent dishonesty and the fact that DOGE personnel have already having accessed data systems at CMMS, there is ample cause for concern.

• Native American communities with IHS Programs. In cities and in rural communities, IHS programs are a crucial health resource for Native communities. While specific cuts to IHS have not been highlighted or previewed (to this author’s knowledge), cuts to staffing and funding at HHS could certainly affect its third-largest sub-agency.
  
• People with Alzheimer’s, HIV, and cancer who are reliant on ongoing research and innovation to improve treatments. The NIH funds and conducts a huge amount of research into serious and often fatal medical conditions affecting millions of people.

Who would benefit? 

Some of the most classic cartoon villains in corporate America stand to benefit from cuts to HHS. 

• Big Pharma.  Without regulators at the FDA overseeing the production of medical products, the corporate villains who extort money from Americans to access care stand to continue to grow their fortunes at even faster rates, with even fewer consumer protections in place. Further, cuts could make the FDA more lenient in approving new drugs, meaning even less oversight of medications and therapies entering the market.
  
  It’s also possible that the cuts will lead to a delay in Medicare drug price negotiations, a Biden provision to lower prescription drug costs that Big Pharma has heavily lobbied against. 

• Big Tobacco. The FDA also regulates tobacco products. With reduced FDA capacity, the same companies already raking in billions stand to see even less regulation and fewer lawsuits blocking their efforts to make a killing selling lethal products. Vaping companies have also been in a protracted legal battle with the FDA, challenging FDA denials of a small share of the millions of applications they have received to approve flavored e-cigarette products, as Bloomberg has reported. Industry group representatives claim that Trump is favorable to vaping companies’ interests, which this round of FDA cuts does nothing to disprove.  

• Insurance companies. Alongside Big Pharma and Big Tobacco, insurance companies do a huge share of the lobbying against HHS policies and initiatives, seeking to extract more and more money from people attempting to access necessary preventative and life-saving health care. They stand to increase their profit margins as most Americans get sicker and further from access to care, with cuts to HHS. 

Attacks on the Department of Health and Human Services stand to affect all of us, with the impacts being felt first and worst by the most economically and racially oppressed communities in the US. Trump, Musk, and RFK Jr. are widely dishonest, and there’s no reason to believe they’re actually seeking to increase “efficiency” in cutting staff at HHS—they all have billionaire friends who stand to benefit financially from these decisions. We’ll continue tracking the impacts of HHS attacks in the coming weeks; stay tuned. 

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