Robert F. Kennedy Jr.’s restructuring of the Department of Health and Human Services (HHS) has led to significant reductions in several divisions dedicated to enhancing the health of minority and underserved populations across the United States, according to sources familiar with the changes who spoke on condition of anonymity.
The divisions impacted include the HHS Office of Minority Health and the National Institute on Minority Health and Health Disparities (NIMHD). Further cuts affect similar offices at the Food and Drug Administration, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration.
Health policy experts have warned that such extensive cuts could exacerbate existing health disparities in the U.S., reversing years of progress made in this area. They stress that this could lead to deteriorating health outcomes for already marginalized groups, threaten public health, strain the healthcare infrastructure, and escalate costs.
Dr. Stephanie Ettinger De Cuba, a research professor at Boston University, expressed concern about the broader implications of the cuts. “These changes will negatively affect not only the targeted racial and ethnic minorities but ultimately impact us all,” she stated. “The loss of these offices will have a detrimental effect on community health.”
The Trump administration, while unable to fully eliminate these critical offices due to legal protections established under the Affordable Care Act over a decade ago, seems intent on “narrowing the scope” of the NIMHD and related agencies, diminishing their authority and resources.
These budget cuts occur amidst ongoing challenges related to health disparities in the U.S., which not only affect communities of color but also impact rural residents, low-income populations, and individuals with disabilities. Marginalized communities often experience poorer health outcomes, including lower life expectancy and higher rates of chronic diseases and infant mortality, while having limited access to healthcare and resources.
The COVID-19 pandemic notably intensified these disparities, revealing how systemic issues like poverty and racial inequity have long contributed to unequal health outcomes in America.
Experts argue that addressing these disparities is paramount to fostering broader public health improvements, as healthier communities benefit the entire population. A 2023 study funded by NIMHD estimated that racial and ethnic health disparities cost the U.S. economy around $451 billion in 2018.
Kennedy’s plan proposes to consolidate divisions within HHS and eliminate 10,000 jobs within the $1.7 trillion agency, which oversees vaccines, medical research, public health initiatives, and healthcare services for millions of Americans reliant on Medicare, Medicaid, and Affordable Care Act markets.
A new agency called the Administration for a Healthy America is slated to be established, merging several existing offices, such as HRSA, SAMHSA, the Office of the Assistant Secretary for Health, and others. Reports suggest that the HHS Office of Minority Health would be incorporated under this agency, although this plan, which aims to cut the HHS budget by a third or about $40 billion, requires congressional approval.
HHS has yet to respond to requests for comments regarding these significant changes.
Structural Changes at Minority Health Agencies
The scale of the cuts varies across HHS agencies, significantly reducing the size of minority health divisions. In total, all 40 employees at the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health were laid off, and while a new director is anticipated, current Director Martin Mendoza remains in his position for the time being.
This office collaborates with local and federal partners to eliminate disparities in health coverage and ensure accessibility for minority and underserved populations regarding Medicare, Medicaid, and Affordable Care Act plans. It is also engaged in research aimed at lowering costs and the prevalence of chronic conditions in the U.S.
Similar drastic reductions have occurred within the CDC’s Office of Minority Health, which is reportedly facing near-total staff losses. In adherence to legal requirements, the Trump administration may consider restructuring this unit alongside the Office of Women’s Health to ensure each has at least a minimum staffing level, such as one director.
This CDC office promotes research into health disparities and develops programs to enhance the health of racial and ethnic minority populations.
At the FDA’s Office of Minority Health and Health Equity, all staff have reportedly been dismissed, casting uncertainty on the future of this unit. This office emphasizes clinical trial diversity and aims to ensure that medical products effectively address various populations.
The Office of Health Equity at HRSA has also experienced complete staff layoffs, as well as other retirements and reassignments, leaving its future uncertain aside from plans for its consolidation under the newly proposed agency. Similar circumstances prevail at SAMHSA’s Office of Behavioral Health Equity, where only a newly appointed director remains, following widespread staff reductions.
At NIMHD, around a third of its workforce has been let go, which includes layoffs and departures from early retirements. Additionally, some employees were placed on leave just prior to the onset of these cuts. NIMHD strives to reduce health disparities through research funding and program development.
While the HHS Office of Minority Health has faced cuts, the exact number of affected staff remains unclear. This office leads the national initiative to enhance health outcomes for racial and ethnic minority groups, focusing on policy development and funding programs.
Potential Long-term Consequences
Experts predict that the repercussions of staff reductions at NIMHD and other offices may not surface immediately, possibly taking months or even a year to become evident. However, these cuts could hinder the collection of vital data essential for tackling health disparities, according to Samantha Artiga from KFF, a health policy research organization.
Artiga emphasizes that data and research are critical for identifying disparities, understanding their causes, developing viable solutions, and monitoring progress. Without focused research, significant disparities could go undetected, creating future blind spots in public health efforts.
“A lack of targeted data and research can lead to unrecognized disparities, necessitating the rebuilding of knowledge in the future,” Artiga cautioned.
The implications for various grants provided by NIMHD and other offices remain uncertain. Recently awarded grants from the HHS Office of Minority Health, amounting to $11.6 million, aimed at boosting preventive health service utilization in communities may also be at risk if funding is curtailed or ceased entirely.
Such funding is crucial for community organizations in delivering culturally tailored care and could lead to program reductions or closures if financial resources dwindle. The cessation of grants may stall necessary research, innovation, and public health initiatives led by universities, healthcare systems, and social services.
Boston University’s Dr. Ettinger De Cuba remarked on the importance of government funding in these areas, stating, “Philanthropy cannot maintain this level of support in the long run. Government intervention is essential.”
Nathan Boucher, a research professor at Duke University, highlighted that these cuts undermine the accountability of government agencies charged with protecting vulnerable populations. While Kennedy has framed the cuts as a move toward an efficient HHS, Boucher contended that minority health offices are vital for efficiently pinpointing key challenges and utilizing taxpayer dollars effectively.
