Only recently, however, has the largest government agency been on the average taxpayer’s radar due to a high-profile Congressional hearing to confirm Robert F. Kennedy Jr. as HHS secretary. HHS has touched nearly every American at some point and the scope of the agency might even surprise those who work in healthcare.
The mission of HHS is to “enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.”
Its name changed from Department of Health, Education, and Welfare in 1980 to the Department of Health and Human Services when the Department of Education formed and separated. But its duty to protect Americans’ health dates back to 1798 with the passage of an act for the relief of sick and disabled seamen, which established a federal network of hospitals to care for them. From there, it grew in size and in impact.
Other historical highlights:
- 1930: The National Institute (later Institutes) of Health was created out of the Public Health Service’s Hygienic Laboratory.
- 1946: The Communicable Disease Center was established, what is now the Centers for Disease Control and Prevention.
- 1953: The Cabinet-level Department of Health, Education, and Welfare (HEW) was created under President Dwight D. Eisenhower.
- 1980: HEW became the Department of Health and Human Services, with Patricia Roberts Harris as the first secretary of the renamed department.
- 1990: The Human Genome Project was established. The Nutrition Labeling and Education Act was passed, authorizing the food label. The Ryan White Comprehensive AIDS Resource Emergency (CARE) Act began providing support for people with HIV/AIDS.
- 2001: The Centers for Medicare & Medicaid was created, replacing the Health Care Financing Administration. HHS responds to the nation’s first bioterrorism attack — delivery of anthrax through the mail.
- 2010: The Affordable Care Act was signed into law, putting in place comprehensive U.S. health insurance reforms.
Here are eight other facts to know about HHS:
- Largest department: HHS is the largest government department, employing almost 80,000 people across its various agencies and offices.
- Budget: HHS has one of the largest budgets of any federal department, with an annual budget of nearly $2 trillion — accounting for almost one-quarter of the federal budget.
- Largest division: HHS’s largest division is CMS (with 6,000 employees), responsible for administering or overseeing health insurance coverage for Medicare, Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act’s Health Insurance Marketplaces.
- Agencies and offices: Under the umbrella of HHS, there are 13 operating divisions, including 10 agencies in the U.S. Public Health Service and three human services agencies, including the CDC, FDA, NIH and CMS.
- Head Start program: HHS administers the Head Start program, which provides early childhood education, health, nutrition, and parenting services to low-income families.
- Medical research funding: NIH, the largest funder of biomedical research in the world, is supported by HHS.
- Grant-making: HHS is the largest grant-making agency in the U.S. The grants support states, territories, tribes and educational and community organizations.
- Public health: HHS has addressed infectious disease outbreaks of COVID-19, H5N1 avian flu, mpox, and hepatitis A in just the past five years. Its role in vaccinations dates back to the 1950s polio vaccine and it continues to have a substantial role in influencing the country’s vaccine policy.
Here is a list and brief explanation of the wide-ranging duties of each division, agency and leaders under HHS:
Administration for Children and Families (ACF): The department promotes the economic and social well-being of families, children, individuals and communities through a range of educational and supportive programs in partnership with states, tribes, and community organizations.
Administration for Community Living (ACL): Provides support and resources for older Americans and people with disabilities.
Advanced Research Projects Agency for Health (ARPA-H): Supports the development of high-impact solutions to society’s most challenging health problems.
Administration for Strategic Preparedness and Response (ASPR): Leads the nation’s medical and public health preparedness for, response to, and recovery from disasters and public health emergencies.
Agency for Healthcare Research and Quality (AHRQ): Produces evidence to make healthcare safer, higher quality, more accessible, equitable, and affordable.
Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC): Ensures that HHS’ data and technology programs, policies and investments are coordinated and aligned.
Agency for Toxic Substances and Disease Registry (ATSDR): Determines public health effects of environmental exposures and protects people from these exposures, including unplanned releases and other environmental pollution.
Assistant Secretary for Administration (ASA): Provides leadership for HHS departmental management, including human resource policy and operations.
Assistant Secretary for Health (ASH): Advises on the nation’s public health and oversees HHS’ U.S. Public Service (PHS) for the secretary.
Assistant Secretary for Legislation (ASL): Provides advice on legislation and facilitates communication between the department and Congress.
Assistant Secretary for Planning and Evaluation (ASPE): Advises on policy development and contributes to policy coordination, legislation development, strategic planning, policy research, evaluation and economic analysis.
Assistant Secretary for Public Affairs (ASPA): Leads and guides HHS on public affairs and administers the Freedom of Information and Privacy Act.
Center for Faith-Based and Neighborhood Partnerships (CFBNP): Builds and supports partnerships with faith-based and neighborhood organizations.
Centers for Disease Control and Prevention (CDC): Protects the public health by leading prevention and control of diseases and other preventable conditions, and responding to public health emergencies.
Centers for Medicare & Medicaid Services (CMS): Provides oversight for Medicare and Medicaid Services and state Children’s Health Insurance Program, the Health Insurance Marketplace.
Departmental Appeals Board (DAB): Provides impartial review of disputed legal decisions involving HHS.
Food and Drug Administration (FDA): Ensures that food is safe; human and animal drugs, biological products, and medical devices are safe and effective; and electronic products that emit radiation are safe.
Health Resources and Services Administration (HRSA): Provides healthcare to people who are geographically isolated, economically or medically vulnerable.
Immediate Office of the Secretary (IOS): Oversees the secretary’s operations and coordinates the secretary’s work
Indian Health Service (IHS): Provides American Indians and Alaska Natives with comprehensive health services.
National Institutes of Health (NIH): Supports biomedical and behavioral research, conducts research in its own laboratories and clinics, trains researchers and collects and shares medical knowledge.
Office for Civil Rights (OCR): Ensures that individuals receiving services from HHS funded programs are not discriminated against and ensures their rights, religious freedom, and the privacy and security of their health information.
Office of Global Affairs (OGA): Provides global health diplomacy to contribute to a safer, healthier world.
Office of Inspector General (OIG): Protects the integrity of HHS programs as well as the health and welfare of the program participants.
Office of Intergovernmental and External Affairs (IEA): Represents the government and external perspective in federal policymaking.
Office of Medicare Hearings and Appeals (OMHA): Administers nationwide hearings for the Medicare program.
Office of the General Counsel (OGC): Provides quality representation and legal advice on a wide range of national issues.
Substance Abuse and Mental Health Services Administration (SAMHSA): Improves access and reduces barriers to high quality programs and services for those who suffer from addictive and mental disorders.
All of the above departments report to the secretary of HHS, who serves on the president’s Cabinet.
What the future holds for the HHS:
What HHS will focus on in the future is unclear. Among Mr. Kennedy’s stated plans for HHS, he has prioritized addressing chronic disease, end to direct-to-consumer advertising for prescription drugs and significant changes in Medicare and Medicaid. Among the changes being announced, HHS publicized a move to revoke a policy that requires public notice and comment on certain agency decisions could affect the NIH and Medicaid. Other recent moves include the resignation of Tom Corry, the assistant secretary of public affairs for HHS and the retirement of Francis Collins, MD, PhD, former director of the NIH after more than three decades with the department.
As part of the government’s downsizing, HHS is believed to have laid off around 2,000 employees in the past few weeks.