Scoop: Leaked PDF outlines major HHS restructuring proposal (authenticity now confirmed). "The safety nets are being blown up right and left."
Floated cuts include some programs mandated by Congress.
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UPDATE: The authenticity of this (and the entire document that accompanies it) has now been confirmed for us by The Washington Post. The full document can be found in a follow-up Inside Medicine just posted.
Current and former HHS employees widely shared a grainy screenshot of a PDF today amongst themselves, apparently taken from a document that appears to be a “pre-decisional” draft of the Trump administration’s plan to vastly overhaul the nation’s public health infrastructure. The document was shared with Inside Medicine by two separate sources, on the condition of anonymity.
While not yet authenticated, I’m posting it here because it seems unlikely to have been faked for any particularly nefarious reason. At a minimum, it warrants further analysis and discussion. It’s now authenticated.
UPDATE:
I am publishing the entire 64-page proposal.
One HHS employee familiar with some the discussions around the administration’s planned reorganization of HHS told me that the document looked similar to what has been floated in backrooms in recent weeks and was both credible and worrisome.
For example, the first item on the list of eliminated agencies—ASPR, the Administration for Strategic Preparedness and Response, a standalone division within HHS—has been mentioned as a target in previously published Trump administration documents. Still, the source was taken aback upon seeing the move on paper. “Are they eliminating an Assistant Secretary? That’s not a small thing,” the source told Inside Medicine. Indeed, ASPR is led by an Assistant Secretary, which, by federal law, is a Senate-confirmed position.
Asked whether the document looked real, a former CDC employee told me, “Yes, considering 92% of NIOSH was RIF’d. That aligns with the document.”
Meanwhile, a current CDC employee who had also seen the document was concerned but not surprised by its content. “It's still unclear whether all the eliminated offices mean more cuts or not.” This is an important point. While it’s concerning to see mission-critical federal public health assets on the chopping block, what’s unknown is the extent to which the cut programs will be redistributed into other agencies. In other words, the document does not indicate whether “eliminated” programs, resources, and services would cease to exist, or simply be shuffled into a new and possibly less baroque organization chart. This would get around legal requirements, as many of the programs on the kill list were statutorily mandated by Congress. However, given the Trump administration’s appetite for cutting life-saving programs that Congress has legislated (like PEPFAR), it’s reasonable to worry that this plan, if implemented, would deliver a dangerous blow to our national health security.
As the HHS employee I spoke to scrutinized the document more closely during our call, a philosophical tone emerged, one marked by deep worry for our nation’s safety. “The stuff the American public has lost already—and they didn’t even know they had it—is impossible for most people to understand. The safety nets are being blown up right and left,” the source said. “They’ve disappeared.”
I’m inviting experts to review the document (albeit, its low resolution may make it difficult to read everything) and chime in. I’m interested in expert assessments of what this plan might mean for the nation’s health and biothreat preparedness, if it were to be enacted. I’m also interested in legal opinions—what can the executive branch do unilaterally, and what will require Congressional acquiescence? Therefore, I’m opening the Comments to everyone on this one. For those who wish to provide information to me in private, I can be reached on Signal at Insidemedicine.88.
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So… Re NIH: Behavioral Health is not part of Brain Research but Dental and Craniofacial is??? Last I checked the brain drove behavior and teeth were not part of the brain.
The information about my very small corner of the department coincides with what I’ve heard internally. That’s all I’ll say publicly.