Latest news with #AHRQ
Medscape
23-05-2025
- Health
- Medscape
Save the USPSTF
Hi, everyone. I'm Dr Kenny Lin. I am a family physician and associate director of the Lancaster General Hospital Family Medicine Residency, and I blog at Common Sense Family Doctor . Imagine arriving at the office at the start of a full day, only to discover that someone has taken away your stethoscope, you no longer have access to your electronic health record or online clinical references, your medical assistant was terminated overnight without your consent, and your patients can no longer hear you. Welcome to the real-life nightmare that the US Preventive Services Task Force (USPSTF) is facing. Earlier this year, the Trump administration fired about half of the employees at the Agency for Healthcare Research and Quality (AHRQ) and planned a restructuring of the Department of Health and Human Services (HHS) that would eliminate the agency and fold it into a new Office of Strategy. In April, 45 former Task Force chairs, members, and scientific directors sent an extraordinary letter to the Secretary of HHS, Robert F. Kennedy, Jr, warning that these actions would effectively bring the USPSTF's work to a halt. A few weeks later, former USPSTF chair Alex Krist, MD, MPH, and colleagues echoed this message in a JAMA viewpoint. Although primary care clinicians use the USPSTF's preventive care recommendations every day, most are unaware of the extensive supporting cast that makes the development of these recommendations possible. Since the 1990s, Congress has tasked AHRQ with convening the USPSTF, protecting its scientific independence, providing personnel and funding to maintain and update more than 140 recommendations on 90 clinical topics, and supporting its communications with medical organizations and the public. I can testify from personal experience that all these functions are essential to creating and disseminating evidence-based guidelines for primary care; as a young family physician working at the AHRQ, I staffed the USPSTF from 2006 to 2010. The uncertain future of AHRQ is not the only threat to the Task Force's continued existence. Many physicians do not realize that the Patient Protection and Affordable Care Act (ACA) provision that mandates no-cost coverage of the USPSTF's recommended services is currently at risk. On April 21, 2025, the Supreme Court heard arguments regarding the appeal of a 2022 lawsuit against the federal government by plaintiffs who objected, for religious reasons, to paying for medications for HIV preexposure prophylaxis. The plaintiffs asserted that the ACA's mandate requiring insurers to cover preventive services with A or B grades is unconstitutional because USPSTF members are not nominated by the President or confirmed by the Senate; traditionally, members have been selected by the AHRQ Director and approved by the HHS Secretary. The preventive services at risk of losing coverage include, but are not limited to, screenings for breast cancer, colorectal cancer, perinatal depression, cervical cancer, intimate partner violence, lung cancer, HIV, and hepatitis B and C. This ruling would also affect no-cost coverage for medications to reduce breast cancer risk and statin use to prevent cardiovascular disease. Although the legal issues are arcane and complex, a ruling against the government could dissolve the USPSTF and jeopardize care for millions of Americans. A recent study found that 1 in 3 persons and nearly half of women received no-cost preventive services between 2018 to 2022 as a result of the ACA mandate. Researchers also conducted a modeling study to simulate the potential impact of this court ruling, and they found that losing access to no-cost colorectal cancer screenings could increase colorectal cancer incidence by 5.1% and colorectal cancer mortality by 9.1%. Furthermore, decreased screening participation could also lead to increased long-term health care costs, given increased cancer incidence and more intensive care requirements due to delayed diagnoses. The USPSTF's judgments are not perfect. On occasion, I have disagreed with its assessments, and I suspect that most family physicians have questioned a new or updated recommendation now and then. But it is clear that if the AHRQ is eliminated and its functions are not replaced, or if the Supreme Court strikes down the ACA's mandate and Congress does not act to preserve the USPSTF, we cannot ensure that evidence-based preventive care will remain affordable for everyone. In sum, our patients will suffer. Many physicians and health care professionals have shied away from engaging in policy debates regarding the size and structure of government in general and health agencies in particular. But when is it time to speak up? Dr Steven Woolf, a family physician and former USPSTF member, recently argued, 'To condone policies that the [medical] profession knows will compromise health — or to remain silent and look away — is to be complicit in putting population health at risk,' and 'We must draw the line when the science is clear that a policy will increase the risk of disease, complications, or premature death.' This is that time. I encourage you to contact your Congressional representatives to express your support for this vital organization and check if your state has enacted legislation to adopt the ACA's preventive services mandate into their state insurance code. Your voice matters. By advocating for the USPSTF, you are helping to protect health recommendations that benefit all Americans. Together, we can ensure that the work of the USPSTF continues to thrive and serve the health needs of our patients and communities.
Yahoo
17-04-2025
- Health
- Yahoo
Trump HHS eliminates office that sets poverty levels tied to benefits for at least 80 million people
President Donald Trump's firings at the Department of Health and Human Services included the entire office that sets federal poverty guidelines, which determine whether tens of millions of Americans are eligible for health programs such as Medicaid, food assistance, child care, and other services, former staff said. The small team, with technical data expertise, worked out of HHS' Office of the Assistant Secretary for Planning and Evaluation, or ASPE. Their dismissal mirrored others across HHS, which came without warning and left officials puzzled as to why they were 'RIF'ed' — as in 'reduction in force,' the bureaucratic language used to describe the firings. 'I suspect they RIF'ed offices that had the word 'data' or 'statistics' in them,' said one of the laid-off employees, a social scientist whom KFF Health News agreed not to name because the person feared further recrimination. 'It was random, as far as we can tell.' Among those fired was Kendall Swenson, who had led development of the poverty guidelines for many years and was considered the repository of knowledge on the issue, according to the social scientist and two academics who have worked with the HHS team. The sacking of the office could lead to cuts in assistance to low-income families next year unless the Trump administration restores the positions or moves its duties elsewhere, said Robin Ghertner, the fired director of the Division of Data and Technical Analysis, which had overseen the guidelines. The poverty guidelines are 'needed by many people and programs,' said Timothy Smeeding, a professor emeritus of economics at the La Follette School of Public Affairs at the University of Wisconsin. 'If you're thinking of someone you fired who should be rehired, Swenson would be a no-brainer,' he added. Under a 1981 appropriations bill, HHS is required annually to take Census Bureau poverty-line figures, adjust them for inflation, and create guidelines that agencies and states use to determine who is eligible for various types of help. There's a special sauce for creating the guidelines that includes adjustments and calculations, Ghertner said. Swenson and three other staff members would independently prepare the numbers and quality-check them together before they were issued each January. Everyone in Ghertner's office was told, without warning, that they were being put on administrative leave until June 1, when their employment would officially end, he said. 'There's literally no one in the government who knows how to calculate the guidelines,' he said. 'And because we're all locked out of our computers, we can't teach anyone how to calculate them.' ASPE had about 140 staff members and now has about 40, according to a former staffer. The HHS shake-up merged the office with the Agency for Healthcare Research and Quality, or AHRQ, whose staff has shrunk from 275 to about 80, according to a former AHRQ official who spoke on the condition of anonymity. HHS has said it laid off about 10,000 employees and that, combined with other moves, including a program to encourage early retirements, its workforce has been reduced by about 20,000. But the agency has not detailed where it made the cuts or identified specific employees it fired. 'These workers were told they couldn't come into their offices so there's no transfer of knowledge,' said Wendell Primus, who worked at ASPE during the Bill Clinton administration. 'They had no time to train anyone, transfer data, etc.' HHS defended the firings. The department merged AHRQ and ASPE 'as part of Secretary Kennedy's vision to streamline HHS to better serve Americans,' spokesperson Emily Hilliard said. 'Critical programs within ASPE will continue in this new office' and 'HHS will continue to comply with statutory requirements,' she said in a written response to KFF Health News. After this article published, HHS spokesperson Andrew Nixon called KFF Health News to say others at HHS could do the work of the RIF'ed data analysis team, which had nine members. 'The idea that this will come to a halt is totally incorrect,' he said. 'Eighty million people will not be affected.' Secretary Robert F. Kennedy Jr. has so far declined to testify about the staff reductions before congressional committees that oversee much of his agency. On April 9, a delegation of 10 Democratic members of Congress waited fruitlessly for a meeting in the agency's lobby. The group was led by House Energy and Commerce health subcommittee ranking member Diana DeGette (D-Colo.), who told reporters afterward that Kennedy must appear before the committee 'and tell us what his plan is for keeping America healthy and for stopping these devastating cuts.' Matt VanHyfte, a spokesperson for the Republican committee leadership, said HHS officials would meet with bipartisan committee staff on April 11 to discuss the firings and other policy issues. ASPE serves as a think tank for the HHS secretary, said Primus, who later was Rep. Nancy Pelosi's senior health policy adviser for 18 years. In addition to the poverty guidelines, the office maps out how much Medicaid money goes to each state and reviews all regulations developed by HHS agencies. 'These HHS staffing cuts — 20,000 — obviously they are completely nuts,' Primus said. 'These were not decisions made by Kennedy or staff at HHS. They are being made at the White House. There's no rhyme or reasons to what they're doing.' HHS leaders may be unaware of their legal duty to issue the poverty guidelines, Ghertner said. If each state and federal government agency instead sets guidelines on its own, it could create inequities and lead to lawsuits, he said. And sticking with the 2025 standard next year could put benefits for hundreds of thousands of Americans at risk, Ghertner said. The current poverty level is $15,650 for a single person and $32,150 for a family of four. 'If you make $30,000 and have three kids, say, and next year you make $31,000 but prices have gone up 7%, suddenly your $31,000 doesn't buy you the same,' he said, 'but if the guidelines haven't increased, you might be no longer eligible for Medicaid.' The 2025 poverty level for a family of five is $37,650. As of October, about 79 million people were enrolled in Medicaid or the related Children's Health Insurance Program, both of which are means-tested and thus depend on the poverty guidelines to determine eligibility. Eligibility for premium subsidies for insurance plans sold in Affordable Care Act marketplaces is also tied to the official poverty level. One in eight Americans rely on the Supplemental Nutrition Assistance Program, or food stamps, and 40% of newborns and their mothers receive food through the Women, Infants, and Children program, both of which also use the federal poverty level to determine eligibility. Former employees in the office said they were not disloyal to the president. They knew their jobs required them to follow the administration's objectives. 'We were trying to support the MAHA agenda,' the social scientist said, referring to Kennedy's 'Make America Healthy Again' rubric. 'Even if it didn't align with our personal worldviews, we wanted to be useful.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
CNN
17-04-2025
- Health
- CNN
Trump HHS eliminates office that sets poverty levels tied to benefits for at least 80 million people
President Donald Trump's firings at the Department of Health and Human Services included the entire office that sets federal poverty guidelines, which determine whether tens of millions of Americans are eligible for health programs such as Medicaid, food assistance, child care, and other services, former staff said. The small team, with technical data expertise, worked out of HHS' Office of the Assistant Secretary for Planning and Evaluation, or ASPE. Their dismissal mirrored others across HHS, which came without warning and left officials puzzled as to why they were 'RIF'ed' — as in 'reduction in force,' the bureaucratic language used to describe the firings. 'I suspect they RIF'ed offices that had the word 'data' or 'statistics' in them,' said one of the laid-off employees, a social scientist whom KFF Health News agreed not to name because the person feared further recrimination. 'It was random, as far as we can tell.' Among those fired was Kendall Swenson, who had led development of the poverty guidelines for many years and was considered the repository of knowledge on the issue, according to the social scientist and two academics who have worked with the HHS team. The sacking of the office could lead to cuts in assistance to low-income families next year unless the Trump administration restores the positions or moves its duties elsewhere, said Robin Ghertner, the fired director of the Division of Data and Technical Analysis, which had overseen the guidelines. The poverty guidelines are 'needed by many people and programs,' said Timothy Smeeding, a professor emeritus of economics at the La Follette School of Public Affairs at the University of Wisconsin. 'If you're thinking of someone you fired who should be rehired, Swenson would be a no-brainer,' he added. Under a 1981 appropriations bill, HHS is required annually to take Census Bureau poverty-line figures, adjust them for inflation, and create guidelines that agencies and states use to determine who is eligible for various types of help. There's a special sauce for creating the guidelines that includes adjustments and calculations, Ghertner said. Swenson and three other staff members would independently prepare the numbers and quality-check them together before they were issued each January. Everyone in Ghertner's office was told, without warning, that they were being put on administrative leave until June 1, when their employment would officially end, he said. 'There's literally no one in the government who knows how to calculate the guidelines,' he said. 'And because we're all locked out of our computers, we can't teach anyone how to calculate them.' ASPE had about 140 staff members and now has about 40, according to a former staffer. The HHS shake-up merged the office with the Agency for Healthcare Research and Quality, or AHRQ, whose staff has shrunk from 275 to about 80, according to a former AHRQ official who spoke on the condition of anonymity. HHS has said it laid off about 10,000 employees and that, combined with other moves, including a program to encourage early retirements, its workforce has been reduced by about 20,000. But the agency has not detailed where it made the cuts or identified specific employees it fired. 'These workers were told they couldn't come into their offices so there's no transfer of knowledge,' said Wendell Primus, who worked at ASPE during the Bill Clinton administration. 'They had no time to train anyone, transfer data, etc.' HHS defended the firings. The department merged AHRQ and ASPE 'as part of Secretary Kennedy's vision to streamline HHS to better serve Americans,' spokesperson Emily Hilliard said. 'Critical programs within ASPE will continue in this new office' and 'HHS will continue to comply with statutory requirements,' she said in a written response to KFF Health News. After this article published, HHS spokesperson Andrew Nixon called KFF Health News to say others at HHS could do the work of the RIF'ed data analysis team, which had nine members. 'The idea that this will come to a halt is totally incorrect,' he said. 'Eighty million people will not be affected.' Secretary Robert F. Kennedy Jr. has so far declined to testify about the staff reductions before congressional committees that oversee much of his agency. On April 9, a delegation of 10 Democratic members of Congress waited fruitlessly for a meeting in the agency's lobby. The group was led by House Energy and Commerce health subcommittee ranking member Diana DeGette (D-Colo.), who told reporters afterward that Kennedy must appear before the committee 'and tell us what his plan is for keeping America healthy and for stopping these devastating cuts.' Matt VanHyfte, a spokesperson for the Republican committee leadership, said HHS officials would meet with bipartisan committee staff on April 11 to discuss the firings and other policy issues. ASPE serves as a think tank for the HHS secretary, said Primus, who later was Rep. Nancy Pelosi's senior health policy adviser for 18 years. In addition to the poverty guidelines, the office maps out how much Medicaid money goes to each state and reviews all regulations developed by HHS agencies. 'These HHS staffing cuts — 20,000 — obviously they are completely nuts,' Primus said. 'These were not decisions made by Kennedy or staff at HHS. They are being made at the White House. There's no rhyme or reasons to what they're doing.' HHS leaders may be unaware of their legal duty to issue the poverty guidelines, Ghertner said. If each state and federal government agency instead sets guidelines on its own, it could create inequities and lead to lawsuits, he said. And sticking with the 2025 standard next year could put benefits for hundreds of thousands of Americans at risk, Ghertner said. The current poverty level is $15,650 for a single person and $32,150 for a family of four. 'If you make $30,000 and have three kids, say, and next year you make $31,000 but prices have gone up 7%, suddenly your $31,000 doesn't buy you the same,' he said, 'but if the guidelines haven't increased, you might be no longer eligible for Medicaid.' The 2025 poverty level for a family of five is $37,650. Dr. Richard Besser joins The Lead As of October, about 79 million people were enrolled in Medicaid or the related Children's Health Insurance Program, both of which are means-tested and thus depend on the poverty guidelines to determine eligibility. Eligibility for premium subsidies for insurance plans sold in Affordable Care Act marketplaces is also tied to the official poverty level. One in eight Americans rely on the Supplemental Nutrition Assistance Program, or food stamps, and 40% of newborns and their mothers receive food through the Women, Infants, and Children program, both of which also use the federal poverty level to determine eligibility. Former employees in the office said they were not disloyal to the president. They knew their jobs required them to follow the administration's objectives. 'We were trying to support the MAHA agenda,' the social scientist said, referring to Kennedy's 'Make America Healthy Again' rubric. 'Even if it didn't align with our personal worldviews, we wanted to be useful.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
CNN
17-04-2025
- Health
- CNN
Trump HHS eliminates office that sets poverty levels tied to benefits for at least 80 million people
President Donald Trump's firings at the Department of Health and Human Services included the entire office that sets federal poverty guidelines, which determine whether tens of millions of Americans are eligible for health programs such as Medicaid, food assistance, child care, and other services, former staff said. The small team, with technical data expertise, worked out of HHS' Office of the Assistant Secretary for Planning and Evaluation, or ASPE. Their dismissal mirrored others across HHS, which came without warning and left officials puzzled as to why they were 'RIF'ed' — as in 'reduction in force,' the bureaucratic language used to describe the firings. 'I suspect they RIF'ed offices that had the word 'data' or 'statistics' in them,' said one of the laid-off employees, a social scientist whom KFF Health News agreed not to name because the person feared further recrimination. 'It was random, as far as we can tell.' Among those fired was Kendall Swenson, who had led development of the poverty guidelines for many years and was considered the repository of knowledge on the issue, according to the social scientist and two academics who have worked with the HHS team. The sacking of the office could lead to cuts in assistance to low-income families next year unless the Trump administration restores the positions or moves its duties elsewhere, said Robin Ghertner, the fired director of the Division of Data and Technical Analysis, which had overseen the guidelines. The poverty guidelines are 'needed by many people and programs,' said Timothy Smeeding, a professor emeritus of economics at the La Follette School of Public Affairs at the University of Wisconsin. 'If you're thinking of someone you fired who should be rehired, Swenson would be a no-brainer,' he added. Under a 1981 appropriations bill, HHS is required annually to take Census Bureau poverty-line figures, adjust them for inflation, and create guidelines that agencies and states use to determine who is eligible for various types of help. There's a special sauce for creating the guidelines that includes adjustments and calculations, Ghertner said. Swenson and three other staff members would independently prepare the numbers and quality-check them together before they were issued each January. Everyone in Ghertner's office was told, without warning, that they were being put on administrative leave until June 1, when their employment would officially end, he said. 'There's literally no one in the government who knows how to calculate the guidelines,' he said. 'And because we're all locked out of our computers, we can't teach anyone how to calculate them.' ASPE had about 140 staff members and now has about 40, according to a former staffer. The HHS shake-up merged the office with the Agency for Healthcare Research and Quality, or AHRQ, whose staff has shrunk from 275 to about 80, according to a former AHRQ official who spoke on the condition of anonymity. HHS has said it laid off about 10,000 employees and that, combined with other moves, including a program to encourage early retirements, its workforce has been reduced by about 20,000. But the agency has not detailed where it made the cuts or identified specific employees it fired. 'These workers were told they couldn't come into their offices so there's no transfer of knowledge,' said Wendell Primus, who worked at ASPE during the Bill Clinton administration. 'They had no time to train anyone, transfer data, etc.' HHS defended the firings. The department merged AHRQ and ASPE 'as part of Secretary Kennedy's vision to streamline HHS to better serve Americans,' spokesperson Emily Hilliard said. 'Critical programs within ASPE will continue in this new office' and 'HHS will continue to comply with statutory requirements,' she said in a written response to KFF Health News. After this article published, HHS spokesperson Andrew Nixon called KFF Health News to say others at HHS could do the work of the RIF'ed data analysis team, which had nine members. 'The idea that this will come to a halt is totally incorrect,' he said. 'Eighty million people will not be affected.' Secretary Robert F. Kennedy Jr. has so far declined to testify about the staff reductions before congressional committees that oversee much of his agency. On April 9, a delegation of 10 Democratic members of Congress waited fruitlessly for a meeting in the agency's lobby. The group was led by House Energy and Commerce health subcommittee ranking member Diana DeGette (D-Colo.), who told reporters afterward that Kennedy must appear before the committee 'and tell us what his plan is for keeping America healthy and for stopping these devastating cuts.' Matt VanHyfte, a spokesperson for the Republican committee leadership, said HHS officials would meet with bipartisan committee staff on April 11 to discuss the firings and other policy issues. ASPE serves as a think tank for the HHS secretary, said Primus, who later was Rep. Nancy Pelosi's senior health policy adviser for 18 years. In addition to the poverty guidelines, the office maps out how much Medicaid money goes to each state and reviews all regulations developed by HHS agencies. 'These HHS staffing cuts — 20,000 — obviously they are completely nuts,' Primus said. 'These were not decisions made by Kennedy or staff at HHS. They are being made at the White House. There's no rhyme or reasons to what they're doing.' HHS leaders may be unaware of their legal duty to issue the poverty guidelines, Ghertner said. If each state and federal government agency instead sets guidelines on its own, it could create inequities and lead to lawsuits, he said. And sticking with the 2025 standard next year could put benefits for hundreds of thousands of Americans at risk, Ghertner said. The current poverty level is $15,650 for a single person and $32,150 for a family of four. 'If you make $30,000 and have three kids, say, and next year you make $31,000 but prices have gone up 7%, suddenly your $31,000 doesn't buy you the same,' he said, 'but if the guidelines haven't increased, you might be no longer eligible for Medicaid.' The 2025 poverty level for a family of five is $37,650. Dr. Richard Besser joins The Lead As of October, about 79 million people were enrolled in Medicaid or the related Children's Health Insurance Program, both of which are means-tested and thus depend on the poverty guidelines to determine eligibility. Eligibility for premium subsidies for insurance plans sold in Affordable Care Act marketplaces is also tied to the official poverty level. One in eight Americans rely on the Supplemental Nutrition Assistance Program, or food stamps, and 40% of newborns and their mothers receive food through the Women, Infants, and Children program, both of which also use the federal poverty level to determine eligibility. Former employees in the office said they were not disloyal to the president. They knew their jobs required them to follow the administration's objectives. 'We were trying to support the MAHA agenda,' the social scientist said, referring to Kennedy's 'Make America Healthy Again' rubric. 'Even if it didn't align with our personal worldviews, we wanted to be useful.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
CBS News
11-04-2025
- Health
- CBS News
Trump HHS eliminates office that sets poverty levels tied to benefits for 80 million people
President Donald Trump's firings at the Department of Health and Human Services included the entire office that sets federal poverty guidelines, which determine whether tens of millions of Americans are eligible for health programs such as Medicaid , food assistance, child care, and other services, former staff said. The small team, with technical data expertise, worked out of HHS' Office of the Assistant Secretary for Planning and Evaluation, or ASPE. Their dismissal mirrored others across HHS , which came without warning and left officials puzzled as to why they were "RIF'ed" — as in "reduction in force," the bureaucratic language used to describe the firings. "I suspect they RIF'ed offices that had the word 'data' or 'statistics' in them," said one of the laid-off employees, a social scientist whom KFF Health News agreed not to name because the person feared further recrimination. "It was random, as far as we can tell." Among those fired was Kendall Swenson, who had led development of the poverty guidelines for many years and was considered the repository of knowledge on the issue, according to the social scientist and two academics who have worked with the HHS team. The sacking of the office could lead to cuts in assistance to low-income families next year unless the Trump administration restores the positions or moves its duties elsewhere, said Robin Ghertner, the fired director of the Division of Data and Technical Analysis, which had overseen the guidelines. The poverty guidelines are "needed by many people and programs," said Timothy Smeeding, a professor emeritus of economics at the La Follette School of Public Affairs at the University of Wisconsin. "If you're thinking of someone you fired who should be rehired, Swenson would be a no-brainer," he added. Under a 1981 appropriations bill, HHS is required annually to take Census Bureau poverty-line figures, adjust them for inflation, and create guidelines that agencies and states use to determine who is eligible for various types of help. There's a special sauce for creating the guidelines that includes adjustments and calculations, Ghertner said. Swenson and three other staff members would independently prepare the numbers and quality-check them together before they were issued each January. Everyone in Ghertner's office was told last week, without warning, that they were being put on administrative leave until June 1, when their employment would officially end, he said. "There's literally no one in the government who knows how to calculate the guidelines," he said. "And because we're all locked out of our computers, we can't teach anyone how to calculate them." ASPE had about 140 staff members and now has about 40, according to a former staffer. The HHS shake-up merged the office with the Agency for Healthcare Research and Quality, or AHRQ, whose staff has shrunk from 275 to about 80, according to a former AHRQ official who spoke on the condition of anonymity. HHS has said it laid off about 10,000 employees and that, combined with other moves, including a program to encourage early retirements, its workforce has been reduced by about 20,000. But the agency has not detailed where it made the cuts or identified specific employees it fired. "These workers were told they couldn't come into their offices so there's no transfer of knowledge," said Wendell Primus, who worked at ASPE during the Bill Clinton administration. "They had no time to train anyone, transfer data, etc." HHS did not respond to a request for comment. Secretary Robert F. Kennedy Jr. has so far declined to testify about the staff reductions before congressional committees that oversee much of his agency. On April 9, a delegation of 10 Democratic members of Congress waited fruitlessly for a meeting in the agency's lobby. The group was led by House Energy and Commerce health subcommittee ranking member Diana DeGette (D-Colo.), who told reporters afterward that Kennedy must appear before the committee "and tell us what his plan is for keeping America healthy and for stopping these devastating cuts." Matt VanHyfte, a spokesperson for the Republican committee leadership, said HHS officials would meet with bipartisan committee staff on April 11 to discuss the firings and other policy issues. ASPE serves as a think tank for the HHS secretary, said Primus, who later was Rep. Nancy Pelosi's senior health policy adviser for 18 years. In addition to the poverty guidelines, the office maps out how much Medicaid money goes to each state and reviews all regulations developed by HHS agencies. "These HHS staffing cuts — 20,000 — obviously they are completely nuts," Primus said. "These were not decisions made by Kennedy or staff at HHS. They are being made at the White House. There's no rhyme or reasons to what they're doing." HHS leaders may be unaware of their legal duty to issue the poverty guidelines, Ghertner said. If each state and federal government agency instead sets guidelines on its own, it could create inequities and lead to lawsuits, he said. And sticking with the 2025 standard next year could put benefits for hundreds of thousands of Americans at risk, Ghertner said. The current poverty level is $15,650 for a single person and $32,150 for a family of four. "If you make $30,000 and have three kids, say, and next year you make $31,000 but prices have gone up 7%, suddenly your $31,000 doesn't buy you the same," he said, "but if the guidelines haven't increased, you might be no longer eligible for Medicaid." The 2025 poverty level for a family of five is $37,650. As of October, about 79 million people were enrolled in Medicaid or the related Children's Health Insurance Program, both of which are means-tested and thus depend on the poverty guidelines to determine eligibility. Eligibility for premium subsidies for insurance plans sold in Affordable Care Act marketplaces is also tied to the official poverty level. One in eight Americans rely on the Supplemental Nutrition Assistance Program, or food stamps, and 40% of newborns and their mothers receive food through the Women, Infants, and Children program, both of which also use the federal poverty level to determine eligibility. Former employees in the office said they were not disloyal to the president. They knew their jobs required them to follow the administration's objectives. "We were trying to support the MAHA agenda ," the social scientist said, referring to Kennedy's "Make America Healthy Again" rubric. "Even if it didn't align with our personal worldviews, we wanted to be useful." KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
