Regardless of whether the U.S. Senate confirms Robert F. Kennedy Jr. as Secretary of Health and Human Services, his name And the opinions of others suggest that the federal government's role in health policy could change dramatically in a second Trump administration. Many members of Congress, including members of Congress, are asking important questions right now. How might changes at the Department of Health and Human Services affect public health?
Just for context, we've worked with federal, state, and local health agencies. The answer to this question is more complicated than you might think. Unlike some countries, the United States does not have a single, coherent public health system. In fact, under the Constitution, central responsibility for health rests with the states, not the federal government. As the nation has experienced during the COVID-19 pandemic, the federal government has no control over local decision-making on many important public health issues.
But the relative independence of state and local public health authorities cannot compensate for failures at the federal level. The Department and its core institutions perform four important roles that are difficult (or impossible) for others to take over.
First, the Department of Health and Human Services is a regulatory authority. Only the U.S. Food and Drug Administration, an agency within the Department of Health and Human Services, approves products such as drugs, medical devices, and vaccines. This means that if the federal government does not approve a vaccine for pandemic H5N1 influenza, it will not be available anywhere in the country, even in the event of a major outbreak. If the administration undermines the drug review process, there is no state or local process that can replace it.
There is also a role for regulators that is less appreciated within the sector. For example, the Office of the State Adjuster sets standards for access to medical records, and the Office of Civil Rights oversees health data privacy protection. The Centers for Disease Control and Prevention, through its advisory committees, sets standards for providing free vaccines to America's children through the Childhood Vaccine Program and to all Americans under the Affordable Care Act.
There are limits to the ability of political appointees to substantially influence regulation. Agencies need to understand what criteria they must consider, how evidence must be used, how allocated funds are used, and in some cases, who makes regulatory decisions. You must comply with the law that specifies your specific responsibilities. However, many of these laws leave significant discretion to agency and department leaders. Even small changes in regulatory policy can impact the health of thousands or even millions of Americans.
Second, Health and Human Services is the payer of medical services. The budget of the Centers for Medicare and Medicaid Services, another agency of the Department of Health and Human Services, is $1.5 trillionand this agency sets leading standards for hospitals, nursing homes, and other health care providers. These program changes will have a significant impact on healthcare delivery. 150 million Americans depend on it. These programs are aimed at coverage and quality standards.
Third, the Department of Health and Human Services is the funder. For example, the National Institutes of Health's budget is $48 billion Every year, most of it goes to universities across the country for research into diseases and treatments. Other federal agencies are distributing billions more across the country. Congress sets the amounts and priorities, but officials at the Department of Health and Human Services have significant say in where the money goes and how it is used. States and local governments generally lack the funding to fill gaps in core public health programs such as biomedical research and vaccinations.
Fourth, and finally, Health and Human Services is a communicator. The U.S. Surgeon General is providing focused guidance to Americans on how to protect their health, including quitting smoking, using naloxone, and getting recommended vaccinations. The Centers for Disease Control and Prevention provides guidance on the evolving outbreak, and the FDA strives to provide doctors and patients with new information about the safety and effectiveness of medical products, including vaccines.
To be sure, the Department of Health and Human Services is not the only source of information on public health topics. State and local public health leaders, academic experts, and thousands of clinicians and community leaders are trusted messengers on health topics. However, messages work best when they are clear and consistent. Confusion can ensue if federal officials say different things than local officials, as has often happened during the coronavirus pandemic. When it comes to vaccines, lies from government leaders could confuse parents about whether to vaccinate their children, leaving children and their communities vulnerable to outbreaks of deadly diseases. There is.
One of us worked for RFK's uncle, the late Sen. Edward Kennedy (D-Mass.). Healthcare Champion for Decades In the Senate. Even when he criticized agencies like the National Institutes of Health and the FDA, he always deeply respected the scientific expertise of these agencies and their critical role in protecting and promoting the health of Americans. was. The health and human services sector is far from perfect, and the new administration will have many opportunities for productive reform. Federal leadership in adopting new, evidence-based solutions could accelerate progress in reducing cardiovascular disease and overdoses and increase life expectancy in the United States.
In choosing a secretary, the president can launch initiatives to improve public health or roll back such initiatives nationally. Rather than thinking that one person cannot have too much influence, the Senate is relying on the performance of Robert F. Kennedy Jr. and other candidates as if the health of the American people depended on it. should be closely scrutinized.
David Blumenthal served as the National Coordinator for Health Information Technology at HHS from 2009 to 2011 and previously served on the staff of Sen. Edward Kennedy (D-Mass.).
Josh Sharfstein is the former principal deputy commissioner of the U.S. Food and Drug Administration from 2009 to 2011.
