A leaked Office of Management and Budget (OMB) document has unveiled extensive plans for the Department of Health and Human Services (HHS) reorganization, detailing significant budget cuts and structural changes that would fundamentally transform the agency. The unauthorized disclosure provides an unprecedented glimpse into the administration’s vision for dramatically reshaping one of the federal government’s largest departments.
Massive Budget Reduction Proposed
According to the leaked 64-page document first reported by Inside Medicine and later authenticated by The Washington Post, the HHS would face an approximate $40 billion reduction, bringing its overall budget to slightly over $80 billion. This figure doesn’t include funding from additional sources. The preliminary budget document, labeled “Not For Distribution, 04/10/2025” with a “Pre-decisional” header, outlines the department’s fiscal year 2026 president’s budget proposal.
The document acknowledges the severity of the changes, stating: “Many difficult decisions were necessary to reach the funding level in this passback.” Among the most dramatic cuts, the National Institutes of Health (NIH) would see its budget slashed by approximately 40%, dropping from $47 billion to $27 billion.
New Agency Structure Emerges
A key component of the reorganization is the creation of the Administration for a Healthy America (AHA), which would receive approximately $14 billion in funding. This newly established agency would absorb components from several eliminated entities, including:
- Health Resources Services Administration (HRSA)
- Administration for Community Living (ACL)
- Substance Abuse and Mental Health Services Administration
- Agency for Healthcare Research and Quality
- Administration for Strategic Preparedness and Response
The AHA’s structure would include the surgeon general, a primary care department composed of former HRSA offices, elements from the CDC’s National Center for Injury Prevention and Control, and an Office of Minority Health. It would also house departments focusing on policy and research, maternal and child health, mental health, environmental health, HIV/AIDS, and workforce development.
Healthcare Access Implications
The budget document makes significant assumptions about healthcare access, noting that Centers for Medicare & Medicaid Services (CMS) funding “assumes a decline in Federal Exchange enrollment due to the expiration of the enhanced premium tax credits.” These Affordable Care Act subsidies have been consistently targeted by Republicans for elimination.
A recent Commonwealth Fund report warned that allowing these subsidies to expire would result in states losing $34 billion in gross domestic product and $2 billion in tax revenue. States that haven’t expanded Medicaid would experience the most severe economic consequences over time. Healthcare providers, particularly those in rural areas, would face substantial revenue declines. Estimates suggest approximately 4 million Americans could lose their health insurance coverage, while the Congressional Budget Office projects a 4.3% increase in premiums.
Program Eliminations and Consolidations
The reorganization would eliminate numerous programs and offices throughout HHS. Within HRSA, casualties include State Offices of Rural Health, Title V Block grants, certain Ryan White HIV program services, public health workforce development initiatives, geriatric programs, primary care training and enhancement, nursing workforce diversity, medical school education, training in oral health, and behavioral health programs.
At the CDC, eliminated programs would include youth violence prevention, traumatic brain injury research, elderly falls prevention, climate and health initiatives, asthma programs, childhood lead poisoning prevention, mining research, and personal protective technology development. The CDC would also lose its Global Health Center, HIV and AIDS programs, Office of Readiness and Response, and nearly all of the Prevention & Public Health Fund.
Other significant eliminations include:
- Head Start program
- Low Income Home Energy Assistance Program
- National Institute on Minority Health at NIH
- “Health Equity” initiatives at CMS
- Discretionary Inflation Reduction Act implementation funding
- Office of Population Affairs
- Food as medicine programs
- Stillbirth taskforce
- Teen pregnancy prevention
- “Embryo Adoptive Awareness Campaign” (listed twice in the document)
Structural Transformation of Key Institutions
The NIH would undergo a dramatic restructuring into an eight-institute model, significantly condensing its current organization. Meanwhile, CMS would absorb numerous ACL offices focused on aging services. The Food and Drug Administration would no longer maintain a “direct role in routine inspections of food facilities,” though the budget claims the department would still meet user fee requirements outlined in federal law.
Funding for the National Institute for Occupational Safety and Health would be discontinued, with exceptions for the Firefighter Cancer Registry, National Mesothelioma Registry & Tissue Bank, World Trade Center Health, and Energy Employees Occupational Illness Compensation Act programs.
Additional Budget Impacts
The proposed budget includes several other significant changes:
- Implementation of a pay freeze for HHS employees
- Elimination of funding for the HIV Epidemic Initiative
- Discontinuation of CDC funding for two monthly peer-reviewed journals: Emerging Infectious Diseases and Preventing Chronic Disease
- Cuts to programs focused on Lyme disease and Prion diseases
- Establishment of a “new biodetection system that can rapidly detect novel pathogens with 24-hour turnaround times” in collaboration with the Department of Defense
The document also indicates plans to “scrub” grants and contracts at the Administration for Children and Families that allegedly “promote abortions and high-risk sexual behavior, inflict radical gender ideology on already vulnerable children, and facilitate discriminatory practices in service delivery.”
If approved, the budget would also require the Advanced Research Projects Agency for Health to “update all contracts to include a clause for the agency to recoup profits for invested products.” These recouped funds would be directed to a newly created U.S. Sovereign Wealth Fund, as announced in a recent executive order.
As of publication, HHS has neither authenticated the document nor responded to requests for comment. The proposed changes would require congressional approval before implementation.
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