Fact BoxUnited States Department of Health and Human Services  Preceding departments- United States Department of Health, Education, and Welfare Headquarters- Hubert H. Humphrey Building, Washington, D.C. Secretary of Health and Human Services -- Sylvia Burwell Employees (2004) 67,000 Annual budget (2015) $1.020 trillion (of which $906.8 billion is for Medicare and Medicaid) Website- hhs.gov One of the largest civilian departments in the federal government, the Department of Health and Human Services (HHS) oversees the implementation of numerous health and welfare-related programs. HHS’ budget accounts for almost one out of every four federal dollars, and it administers more grant dollars than all other federal agencies combined. HHS’ Medicare program is the nation’s largest health insurer, handling more than 1 billion claims per year. Medicare and Medicaid together provide health care insurance for 25% of Americans. Many HHS-funded services are provided at the local level by state or county agencies or through private sector grantees. With its large size also has come a large number of troubles and controversies involving birth control, prescription drugs, food safety and more. History Before the federal government established a cabinet-level department to address health issues, lawmakers took a number of steps to create programs and agencies that focused on health-related research and regulation. The earliest effort came in 1798 with the passage of an act to help sick and disabled seamen. This led to the establishment of a federal network of hospitals for the care of merchant seamen, forerunner of today’s Public Health Service. During the administration of President Abraham Lincoln, the Bureau of Chemistry was created within the Department of Agriculture. This move represented the earliest attempt to address food-related issues, and it helped lead to the founding of the Food and Drug Administration several decades later. The post-Civil War era would see the appointment of the first Supervising Surgeon (later called Surgeon General) in 1871 for the Marine Hospital Service; the opening of a one-room laboratory on Staten Island for research on disease (the forerunner to the National Institutes of Health); and passage in 1891 of legislation that made the Marine Hospital Service responsible for medical examination of arriving immigrants. Shortly after the turn of the 20th Century, the Public Health Service was officially established in 1902, and four years later, Congress passed the Pure Food and Drugs Act authorizing the government to monitor the purity of foods and the safety of medicines (another key step that led to the founding of the FDA). The era following World War I witnessed the creation of two important offices that would later become part of the health and human services department: the Bureau of Indian Affairs Health Division in 1921 (later to become the Indian Health Service); and the National Institute (later Institutes) of Health in 1930. In response to the economic downturn of the Great Depression, President Franklin Roosevelt’s New Deal brought about several important policy decisions that had long-term impacts on government health programs. The first was the passage of the Social Security Act in 1935, without which future programs like Medicare and Medicaid would not have been possible. In 1938, Roosevelt and Congress adopted the Federal Food, Drug and Cosmetic Act of 1938, which led to the establishment of the FDA. And in 1939, Roosevelt pushed for the formation of the Federal Security Agency, which brought together federal activities in the fields of health, education and social insurance under a single cabinet-level authority. Although the Federal Security Agency did not last, its founding demonstrated a need to make health matters a top priority for federal policymakers. Subsequently, the Eisenhower administration established a successor - the Department of Health, Education and Welfare in 1953. The 1950s and 1960s would constitute a time of important health policy decisions by federal officials. In 1955, the polio vaccine created by Jonas Salk was licensed, helping lead to the elimination of the crippling disease. In 1961, the Kennedy administration conducted the first White House Conference on Aging. The following year, Congress adopted the Migrant Health Act that provided support for clinics serving agricultural workers. In 1964, the Surgeon General released the first report on smoking and health, which launched a new debate on the dangers of a previously unquestioned habit enjoyed by millions of Americans. Even more dramatic was the decision in 1965 to create the Medicare and Medicaid programs, which for the first time made comprehensive health care available to millions of Americans. That same year, the Older Americans Act created the nutritional and social programs administered by today’s Administration on Aging. The Head Start program was also created. In 1966, the Public Health Service launched the International Smallpox Eradication program that would lead to the complete elimination of the disease by 1977. The late seventies saw the Carter administration remove education from the Department of Health, Education and Welfare (creating the Department of Education) and form the Department of Health and Human Services. What it Does The Department of Health and Human Services (HHS) is a cabinet-level agency that manages a wide array of health and welfare programs. HHS is responsible for regulating food products and new pharmaceutical drugs (Food and Drug Administration), implementing the nation’s biggest health care programs (Medicare and Medicaid), preventing the outbreak and spread of diseases (Centers for Disease Control and Prevention) and funding some of the most important medical research in the world (National Institutes of Health), among other programs. HHS’ primary offices are as follows: Services Centers for Medicare and Medicaid Services CMS is the federal body responsible for administering Medicare and Medicaid programs. CMS also runs the State Children’s Health Insurance Program (SCHIP), which is jointly financed by the federal and state governments and administered by individual states. Medicare is a federal social insurance program established in 1965 to provide healthcare coverage for people over 65. The program was expanded in 1972 to include people under 65 with permanent disabilities. Most Americans are entitled to basic coverage under Medicare if they or their spouse have contributed payroll taxes for more than 10 years. Medicare is financed by payroll taxes, FICA and the Self-Employment Contributions Act of 1954. Medicare currently covers more than 40 million people, but with significant coverage gaps—in vision, dental and long-term care. Accounting for a current 14% of the federal budget, Medicare is a highly debated system that draws bipartisan criticism. The gradual privatization of the system—including recently reformed prescription drug coverage—is also highly contested among advocates, lawmakers and lobbyists. Medicaid is a complex entitlement program for many people who can’t afford adequate health care, including single parents and their children, the disabled and the elderly (some of whom also receive Medicare benefits as so-called “dual eligibles”). It is funded as a joint venture by states and the federal government, with each state determining the exact scope of its program, payment rates and specific eligibility standards. The federal government, meanwhile, establishes general guidelines for the programs and monitors their enforcement through the Centers for Medicare and Medicaid Services (CMS). Participation is voluntary; however, every state has been signed up since the last holdout, Arizona, created its Medicaid variant in 1982. The major sticking point for Medicaid can be summed up in one word: money. Many people view with alarm the gradually escalating costs associated with the program, and some states have had to devote as much as one-fifth of their budgets to sustaining it. Fraud is also a major issue. Medicaid reform of some kind or another is therefore a perennial item on the political agenda. Administration for Children and Families ACF is a key division within the Department of Health and Human Services.ACF oversees and finances social and economic programs for vulnerable children and families designed to help them develop more independent, self-reliant lives. Targeted groups include Native Americans, persons with developmental disabilities, refugees and legalized aliens. Programs are carried out by state, county, city and tribal governments, as well as public and private local agencies. Critics argue that ACF, a relatively new administration, has been deployed as a forum to push the Bush administration’s more conservative initiatives—funneling money to (discredited) abstinence-only programs and marriage promotion grants. Health Resources and Services Administration HRSA is responsible for improving access to healthcare for those who are uninsured or otherwise marginalized and/or medically vulnerable. The agency identifies areas of the country that have a shortage of primary and dental care and medical professionals. HRSA administers about 90% of its funding in the form of grants directly to states and public and private healthcare providers, including health professions training programs and a network of 1,000 health clinics. Indian Health Service IHS provides preventive, curative and community health care to approximately 1.9 million of the nation’s 3.3 million American Indians and Alaska Natives. IHS currently provides health services to approximately 1.5 million of these American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. IHS services are administered through a system of 12 Area offices and 163 IHS and tribally managed service units. According to US Census data, American Indians and Alaska Natives die at higher rates than other Americans from tuberculosis (750% higher), alcoholism (550% higher), diabetes (190% higher), unintentional injuries (150% higher), homicide (100% higher) and suicide (70% higher). Substance Abuse & Mental Health Services Administration SAMHSA makes grants to various agencies to prevent and treat addictive and mental disorders and furthers its work through public campaigns, system reform, policy and program analysis. SAMHSA seeks to improve the quality and availability of prevention, treatment and rehabilitation services in order to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illnesses. At times the agency has taken public stances on controversial issues, such as treatment of heroin addiction and homosexuality and transgender identity. Administration for Community Living ACL is the official federal agency responsible for home and community-based services and programs related to aging. It also focuses on helping empower Americans before and during their later years to make informed decisions about health care options; ensuring the rights of the elderly to prevent their abuse, neglect and exploitation; and facilitating society to prepare for an aging population. ACL, funded by the Older Americans Act, is part of a federal, state, tribal and local partnership called the National Network on Aging, which currently helps about seven million older people and their caregivers, via 29,000 service providers and thousands of volunteers. Research National Institutes of Health NIH produces some of the most important medical and scientific research in the United States. Eighty three percent of NIH’s funding is distributed to scientists, medical researchers and university professors both in the US and abroad. NIH also conducts its own research at its 27 institutes and centers. Some of NIH’s researchers have been criticized for accepting money from pharmaceutical companies, while its leader has publicly criticized the policies of President George W. Bush. Centers for Disease Control and Prevention CDC leads public health efforts to prevent and control infectious and chronic disease, injuries, workplace hazards, disabilities and environmental health threats. It is also responsible for producing and distributing health information internationally. While the CDC is globally recognized for its scientific research and epidemiologic investigations, newly-emerging issues such as terrorism, environmental threats and a rapidly aging population continue to challenge its capabilities. Although the CDC is supposed to prevent and control infectious disease, it has been accused of blatantly withholding information regarding such diseases as syphilis, autism and Guillain-Barré Syndrome. Agency for Healthcare Research and Quality AHRQ sponsors research to improve the quality of health care in the United States. The agency works to elevate health care quality, reduce medical-related costs and expand healthcare access for more Americans. Almost 80% of AHRQ’s budget is awarded as grants and contracts to researchers at universities and other research institutions across the country. Early in its history, the agency became heavily involved in a controversial healthcare reform plan that almost led to AHRQ being eliminated. Since then, the agency has maintained a low profile, void of controversy. National Toxicology Program NTP is an interagency program that provides data addressing a wide variety of issues important to public health. NTP works to safeguard public health by identifying the effects of chemicals used in everyday items and at what level of exposure they have the potential of becoming hazardous to humans. NTP has attracted controversy because of its policy of allowing some industries to self regulate their own products and because of its extensive use of animals for testing. Agency for Toxic Substances and Disease Registry ATSDR is a federal public health agency under the umbrella of the Centers for Disease Control (CDC) based in Atlanta, Georgia. The agency’s mission is to prevent harm to human health and diminished quality of life from exposure to hazardous substances found at waste sites, in unplanned releases and in other sources of pollution present in the environment. ATSDR identifies communities where people might be exposed to hazardous substances in the environment. But as far as investigations go, ATSDR cannot enforce any regulations by closing down a plant or other business. It can only make recommendations to the Environmental Protection Agency. The ATSDR has worked on a variety of different cases and projects, including aiding New York City in establishing a registry to assess short and long term health effects from the World Trade Center collapse, sampling the dust and air after the collapse of the World Trade Center, testing the water and soil at Camp Pendleton for lead, copper and other chemicals, as well as monitoring the effects of asbestos and identifying sites that have high concentrations of it. Regulation Food and Drug Administration FDA regulates a wide range of medical and food products. From reviewing new medicines to inspecting food processing centers, the FDA plays a role in approximately $1 trillion worth of products each year. The FDA is comprised of chemists, pharmacologists, physicians, microbiologists, veterinarians, pharmacists, lawyers and other professionals. Despite all of the expertise employed by the agency, the FDA has struggled to carry out its mission to protect Americans from harmful drugs and foods. In recent years, the agency’s reputation has plummeted amid controversies involving the approval of certain pharmaceutical drugs and allowing tainted foods to reach consumers. Where Does the Money Go? According to USAspending.gov, the Health and Human Services Department has spent $67.4 billion so far this decade on contractors totaling 50,858. The biggest expenditures were for drugs and biologicals ($4.8 billion), computer and telecommunications services ($3.8 billion), biomedical basic research ($3.7 billion) and laboratory equipment and supplies ($3.1 billion). The biggest spenders among HHS departments were the National Institutes of Health ($26.2 billion), the Centers for Disease Control and Prevention ($14.6 billion) and the Centers for Medicare & Medicaid Services ($7.95 billion). The top 10 recipients of HHS dollars include major pharmaceutical companies and defense contractors:
Other contractors include High Performance Technologies, which received a $50 million contract in 2006 to provide information technology services to the Food and Drug Administration. Kaiser Permanente, United Health Group Inc., Vanderbilt University and Harvard Pilgrim Health Care won first-of-their-kind contracts from the FDA to help research the effects of pharmaceuticals on large patient populations after drugs go on the market. Each contractor will get $1.3 million over the next five years to provide data to the FDA from their databases. Some HHS funding is distributed in the form of research grants. The NIH is a prime distributor of such moneys to higher education, hospitals, medical schools, research institutes, and non-profits. Data for Department of Health and Human Services Sources
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