JUANA SUMMERS, HOST:
This week, President-elect Donald Trump announced Robert F. Kennedy Jr. as his nominee to run the Department of Health and Human Services. It's a move that scared many science and health experts. Former HHS Secretary Kathleen Sebelius spoke on CNN yesterday.
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KATHLEEN SEBELIUS: To have someone coming into a scientific agency that is a vaccine skeptic and may well undo decades of public health work, I think, is terrifying for the American public.
SUMMERS: HHS is a massive federal agency responsible for oversight, funding and programs for public health and health care across the United States. To get a sense of just what leading such a vast apparatus might entail and how Kennedy might oversee it, we brought in Julie Rovner, chief Washington correspondent for KFF Health News. Hey, Julie.
JULIE ROVNER: Hey, Juana.
SUMMERS: So Julie, as we were just pointing out, HHS is just this massive agency with a budget of almost $2 trillion, some 90,000 employees. Help us unpack this. What are some of the public health agencies that come under the HHS umbrella?
ROVNER: Well, of course, we have the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control and Prevention, some smaller but still influential agencies like the Substance Abuse and Mental Health Services Administration, the Health Resources and Service Administration - they oversee programs like the Ryan White AIDS programs, community health centers, Maternal and Child Health programs. Of course, HHS does more than just public health. They oversee Medicare and Medicaid and the Affordable Care Act. And on the Human Services side, they oversee child care and TANF, what used to be welfare payments, and Head Start and programs like Meals on Wheels for older Americans. So it is really a vast, sprawling agency that affects almost every American.
SUMMERS: I want to just zoom in on one of the things you mentioned, and that's Medicare and Medicaid - of course, the federal health insurance programs for the elderly, the poor and the disabled. What kind of power does the HHS secretary have over those programs?
ROVNER: Fairly significant power. Now, those programs are what we call mandatory spending. So the secretary and, in fact, many people at HHS have actually less power to change those programs. That really needs to be done by Congress, but they can certainly influence how those programs are implemented. There is a lot of guidance and regulations that they can write. And they can also hire and fire employees. And I think we're going to be hearing a lot about that.
SUMMERS: Trump has said that he would allow RFK Jr. to, quote, "go wild" on medicines, food and health. He's long talked about some of his ambitions to overhaul health in the U.S. A few examples - he's talked about removing fluoride from public water systems despite agreed-upon health benefits. He's also a noted vaccine skeptic who wants to regulate their use. He wants to revamp the nation's food policy. If he is confirmed as head of HHS, how achievable are those kinds of goals?
ROVNER: Well, under existing norms, they wouldn't be very achievable. There are processes that you have to go through to do these things. Much of the workforce at HHS is protected by civil service rules. There are, you know, waves of people in between the secretary and where the policy gets made. What we don't know is, in the incoming Trump administration, whether they're going to try to throw all those things out, whether, you know, RFK Jr. has said he wants to fire hundreds of people at both NIH and FDA. It's unclear whether he's going to try to do that and, if he tries to do that, whether he's going to succeed. So there's really a lot that's unknown right now.
SUMMERS: Julie, to the extent that you've heard, what has been the response from workers within agencies that HHS oversees like the CDC or the FDA?
ROVNER: They're frightened. I mean, a lot of them, you know, stuck it out during the first Trump administration, which was not a great place to be for a lot of scientists. They felt like science was not taken very seriously and that directions came down from on high that were not necessarily based on evidence, that it was difficult for them to do their jobs. You know, I live in the Washington area. I work with a lot of people who work at these agencies, and a lot of them are talking about retiring early. And that is a big concern - that there could be an enormous brain drain from some of these agencies. Even people who, you know, would not get fired just don't want to do this for another four years.
SUMMERS: Julie, I want to end with this. Here's a question I've got for you. We both have a deep knowledge of Capitol Hill. What are Kennedy's chances, do you think, of being confirmed?
ROVNER: I honestly don't know. I think one of the wild cards that has not really come out yet is that he's been in favor of abortion rights, and that, you know, one would think would be an absolute disqualifier for a lot of conservative Republicans. We'll have to see, as this goes forward, how it all shakes out.
SUMMERS: Julie Rovner is the chief Washington correspondent for KFF Health News and host of the podcast "What The Health?" Julie, thank you.
ROVNER: Thank you. Transcript provided by NPR, Copyright NPR.
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