Having reorganized both nonprofit and public sector organizations, these are a few reflections on Secretary Robert F. Kennedy Jr.’s restructuring of the Department of Health and Human Services (HHS). I know the department pretty well and worked there early in my career.

First, HHS is no stranger to reorganization. HHS itself was born from a reorganization when education was split off from the Department of Health, Education, and Welfare, and became a separate cabinet agency. CMS too was a product of a significant reorganization bringing together previously separate agencies and putting Medicare and Medicaid under one roof, later to be joined by the Affordable Care Act (ACA). (Medicare had been run by the Social Security Administration and Medicaid by something called the Social and Rehabilitation Service).  All that happened under Secretary Joe Califano, who was later fired by President Jimmy Carter as part of a wider cabinet purge for taking on tobacco companies too aggressively. Califano was possibly the last HHS Secretary with as independent an agenda as Secretary Kennedy has today, albeit a very different one.

Prior reorganizations at HHS were mostly dedicated to building new capabilities and the federal role in health. The exception was the Bush era name change from Health Care Financing Administration to CMS partly intended to signal a less aggressive purchasing and regulatory role. Secretary Kennedy’s reorganization breaks sharply with the past. It represents an effort to cut back the size and role of the department as part of broader administration-wide efforts to reduce the role of the federal government in health. read more