Robert F. Kennedy Jr. Would Have Wide Purview as H.H.S. Secretary

 

Robert F. Kennedy Jr. Would Have Wide Purview as H.H.S. Secretary

 

President-elect Donald Trump’s nominee would oversee agencies that regulate food, vaccines and medicine and were instrumental during the pandemic.

 

Hank Sanders Sara Ruberg Christina Jewett

By Hank SandersSara Ruberg and Christina Jewett

Nov. 14, 2024

https://www.nytimes.com/2024/11/14/us/rfk-jr-hhs-agencies.html

 

When President-elect Donald J. Trump announced on Thursday that he would nominate Robert F. Kennedy Jr. to lead the Department of Health and Human Services, questions immediately arose about how the department would change if it were to be led by someone who has expressed skepticism toward vaccines and a resistance to public health measures.

 

If confirmed, Mr. Kennedy, who ended his presidential campaign in August and endorsed Mr. Trump, would run a department whose divisions manage billions of dollars and regulate the nation’s food, medications, vaccines and medical treatments.

 

The H.H.S. oversees 13 divisions that administer services and conduct research through various agencies and offices, including:

 

Centers for Disease Control and Prevention

The C.D.C. helps track food-borne illnesses, makes recommendations on vaccines and tracks outbreaks of infectious diseases such as the flu and measles. For instance, the agency recently coordinated with states to track illnesses and coordinate the response to a listeria outbreak related to Boar’s Head meat, and to an E. coli outbreak related to McDonald’s Quarter Pounders.

 

The agency also inspects public health labs and oversees safety protocols meant to safeguard the public from lab leaks of infectious diseases.

 

The C.D.C. oversees 10 centers and institutes, including the National Institute for Occupational Safety and Health. NIOSH helps guide the government on regulations meant to prevent work-related injuries and illnesses through research and recommendations. NIOSH was established alongside the Department of Labor’s Occupational Safety and Health Administration to collaborate on work safety issues.

 

National Institutes of Health

The N.I.H. wields billions of dollars in funding for studies on the treatment of diseases such as cancer and Alzheimer’s. The agency also supports studies at universities and basic science that can form the backbone of new treatments and technologies.

 

The agency has drawn scrutiny in recent years over funding studies on the care of transgender adolescents and in the past over research involving embryonic stem cells.

 

Mr. Kennedy has cited a ProPublica story that found numerous conflicts of interest among researchers and has said he will sharply limit funding in such cases.

 

The N.I.H. includes 27 institutes and centers, including:

 

The National Cancer Institute, which focuses on cancer research and funds industry efforts to study cancer. The agency is the “largest funder of cancer research in the world,” according to the N.I.H.

 

The National Institute on Drug Abuse, which supports scientific research into addiction and drug use. The agency has focused on substance abuse treatment and prevention, as well as on other public health issues involving drug use, like the spread of H.I.V. through syringes.

 

The National Institute of Mental Health, a federal research arm that studies mental illnesses and treatments. It has been around for over 75 years.

 

Food and Drug Administration

The F.D.A. approves or denies authorization to market drugs and oversees dietary supplements, food and medical devices. The agency inspects thousands of facilities overseas and in the United States, ensuring the safety of food, medications and medical devices. During shortages of cancer drugs and IV fluids, an increasingly acute problem, the agency coordinates with drugmakers to try to boost backup production.

 

Dr. Robert Califf, the F.D.A. commissioner, noted in a speech on Tuesday that it would be possible for Mr. Trump or Mr. Kennedy to alter agency decisions.

 

“It’s totally within the law for the president or the H.H.S. secretary to overrule the entire F.D.A.,” Dr. Califf said.

 

The agency also reviews applications for new tobacco products with an eye toward ensuring that new cigarettes are not too enticing and that e-cigarettes help smokers transition to a less harmful product. The agency has recently begun work with the Justice Department to seize illicit e-cigarettes that come in flavors that appeal to adolescents.

 

Mr. Kennedy has emerged as a critic of agency funding, nearly half of which is paid by the drug, tobacco and medical device industries that the agency oversees.

 

Centers that the F.D.A. oversees include the Center for Tobacco Products and the Center for Drug Evaluation and Research.

 

Centers for Medicare and Medicaid Services

This agency operates Medicare and Medicaid, overseeing the enrollment of millions of people in the programs and paying the bills for their health care. The agency also plays a role in deciding which products to pay for, at times declining to cover drugs, diagnostic tests or medical devices that don’t benefit Medicare or Medicaid patients.

 

The agency also oversees thousands of inspections each year by state officials and accreditation agencies to ensure that hospitals, surgery centers and nursing homes uphold high standards of safety and sanitation. In some cases of repeat violations, officials refuse to pay some providers.

 

Indian Health Service

The I.H.S. provides government medical care to about 2.2 million of the nation’s 3.7 million Native Americans and Alaska Natives and is the primary advocate for the health needs of Indigenous communities. The program runs 24 hospitals nationwide. Widespread problems have led some tribes to seize control so that they can run the facilities themselves.

 

Administration for Children and Families

Programs such as foster care and the Head Start program, which provides child care assistance to low-income families, are funded through the A.C.F., which focuses on children.

 

Administration for Community Living

The A.C.L., which was created under the Obama administration, provides services to adults with disabilities through employment initiatives and networks to find accessible housing.

 

Advanced Research Projects Agency for Health

This agency, known as ARPA-H, was founded under the Biden administration in 2022 to support biomedical research and technology that solves health problems. Some Republicans have argued that the agency duplicates the N.I.H.’s efforts.

 

Administration for Strategic Preparedness and Response

The ASPR was elevated by the Biden administration during the Covid pandemic to become a division, so it could better coordinate the nation’s response to health emergencies. ASPR is responsible for crucial health logistics, including oversight of the Strategic National Stockpile, the nation’s emergency medical reserve, and contracts for and distributes vaccines in an emergency.

 

Agency for Healthcare Research and Quality

Through research and analysis, the AHRQ tries to improve the quality of health care by making it safer, more timely or more accessible. In 2017, the Trump administration proposed folding the agency into the National Institutes of Health, an idea that Congress rejected. The agency oversees the National Guideline Clearinghouse, a federal database intended to help doctors answer almost any medical question. Created in the 1990s as part of a wider movement to better link the practice of medicine to sound scientific research, the database has been targeted by some Republicans who argue that it is redundant.

 

Agency for Toxic Substances and Disease Registry

This agency works to determine and prevent the human health effects of exposure to hazardous substances. When changes to the water supply in the city of Flint, Mich., caused significant health problems in the community, A.T.S.D.R. worked to reduce problems and help those affected.

 

Health Resources and Services Administration

Programs supported by HRSA deliver care to people who live in rural areas, to low-income families, to patients with H.I.V. and to pregnant women. The agency also oversees the organ transplant system and programs that offer discounts on prescription drugs and critical care. During the pandemic, the agency accepted claims for testing and treatment from uninsured patients and reimbursed providers for vaccinating uninsured people.

 

Substance Abuse and Mental Health Services Administration

S.A.M.H.S.A. works to promote mental health and prevent substance abuse by providing grant funding, analysis of behavioral health data and public education. The agency recently launched the 988 hotline, a revamped National Suicide Prevention Lifeline billed as the 9-1-1 of mental health.

 

Hank Sanders is a Times reporter and a member of the 2024-25 Times Fellowship class, a program for journalists early in their careers. More about Hank Sanders

 

Sara Ruberg covers breaking news and is a member of the 2024-25 class of Times Fellows, a program for journalists early in their careers. More about Sara Ruberg

 

Christina Jewett covers the Food and Drug Administration, which means keeping a close eye on drugs, medical devices, food safety and tobacco policy. More about Christina Jewett