By Harris Meyer | June 21, 2018
As part of a sweeping
reorganization to make the federal government leaner, the White House proposed
Thursday to move all major public-assistance programs including food stamps
into HHS and renaming the bulked-up agency the Department of Health and Public Welfare.
The plan, spearheaded by Office of Management and Budget director Mick Mulvaney, also would create a new Council on Public Assistance, overseen by the renamed HHS, to restructure and coordinate welfare and workforce issues across all federal agencies.
The 132-page plan, titled Delivering Government Solutions in the 21st Century, said the council would become the executive branch's chief welfare policymaking vehicle and "would ensure that federal public assistance programs are well aligned and focused on promoting opportunity and economic mobility."
In a written statement, Mulvaney called it an effort to "drain the swamp," adding that the federal government is "bloated, opaque and inefficient."
The reorganization is part of the Trump administration's effort, backed by the Heritage Foundation and other conservative groups, to link popular means-tested entitlement programs like Medicaid and the Supplemental Nutrition Assistance Program to cash assistance programs pejoratively referred to as welfare.
Moving SNAP into the renamed HHS could facilitate the administration's effort to make work or "community-engagement" requirements consistent across all public assistance programs. Several states have proposed adding work requirements for Medicaid beneficiaries, though Kentucky's program has been challenged in court.
The proposed Council on Public Assistance would design uniform work requirements across all public assistance programs and work to eliminate barriers at the federal, state and local levels to getting beneficiaries to work.
Andy Slavitt, who headed the CMS during the Obama administration, questioned the goals behind the plan. "It always makes sense to unite programs around beneficiaries to improve service delivery," he said. "But that's not what's going on here. The intent is to put all these programs in one place and shrink them."
That would be consistent with White House and House Republican budget proposals to cut Medicaid spending by nearly $1.5 trillion over the next decade, Slavitt added.
The reorganization plan also seeks to "transform" the U.S. Public Health Service Commissioned Corps into "a leaner and more efficient organization that is better prepared to respond to public health emergencies and provide vital health services." It would reduce the size of the corps and build a reserve corps to respond to public health emergencies.
The overall reorganization touches nearly every cabinet department. It would merge the Departments of Education and Labor. And it would shift the food safety functions of the Food and Drug Administration to the Department of Agriculture.
The plan would require congressional approval, which is far from certain. It would mean reallocating congressional committees' oversight responsibilities. For instance, the House Agriculture Committee would oversee a greatly shrunken Department of Agriculture, where the $70 billion SNAP program comprises most of its budget.
In an interview, former New Hampshire Republican Sen. Judd Gregg said that reorganizing and downsizing the federal cabinet structure is long overdue, and that he likes the idea of moving SNAP into HHS. But he said the Trump administration will have a "very hard time" selling the plan to Congress, given the unwillingness of lawmakers who head appropriations committee to forfeit any political control.
"It's almost impossible to move these agencies around because the turf issues are so acute," Gregg said. "And this administration has lost most of its political capital up there."
HHS was last restructured during the Carter administration, when the Department of Health, Education and Welfare was split into HHS and the new Department of Education, in recognition of the old department's large scope of work. Since then, Republicans long have sought unsuccessfully to eliminate the Education Department.
Slavitt said consolidating more healthcare and public assistance programs within the renamed HHS could make it easier for the Trump administration to reduce spending on them. "If the money is in different pockets and is overseen by different committees, the administration sees it as offering too many 'loopholes' to get services to people," he said.
The plan, spearheaded by Office of Management and Budget director Mick Mulvaney, also would create a new Council on Public Assistance, overseen by the renamed HHS, to restructure and coordinate welfare and workforce issues across all federal agencies.
The 132-page plan, titled Delivering Government Solutions in the 21st Century, said the council would become the executive branch's chief welfare policymaking vehicle and "would ensure that federal public assistance programs are well aligned and focused on promoting opportunity and economic mobility."
In a written statement, Mulvaney called it an effort to "drain the swamp," adding that the federal government is "bloated, opaque and inefficient."
The reorganization is part of the Trump administration's effort, backed by the Heritage Foundation and other conservative groups, to link popular means-tested entitlement programs like Medicaid and the Supplemental Nutrition Assistance Program to cash assistance programs pejoratively referred to as welfare.
Moving SNAP into the renamed HHS could facilitate the administration's effort to make work or "community-engagement" requirements consistent across all public assistance programs. Several states have proposed adding work requirements for Medicaid beneficiaries, though Kentucky's program has been challenged in court.
The proposed Council on Public Assistance would design uniform work requirements across all public assistance programs and work to eliminate barriers at the federal, state and local levels to getting beneficiaries to work.
Andy Slavitt, who headed the CMS during the Obama administration, questioned the goals behind the plan. "It always makes sense to unite programs around beneficiaries to improve service delivery," he said. "But that's not what's going on here. The intent is to put all these programs in one place and shrink them."
That would be consistent with White House and House Republican budget proposals to cut Medicaid spending by nearly $1.5 trillion over the next decade, Slavitt added.
The reorganization plan also seeks to "transform" the U.S. Public Health Service Commissioned Corps into "a leaner and more efficient organization that is better prepared to respond to public health emergencies and provide vital health services." It would reduce the size of the corps and build a reserve corps to respond to public health emergencies.
The overall reorganization touches nearly every cabinet department. It would merge the Departments of Education and Labor. And it would shift the food safety functions of the Food and Drug Administration to the Department of Agriculture.
The plan would require congressional approval, which is far from certain. It would mean reallocating congressional committees' oversight responsibilities. For instance, the House Agriculture Committee would oversee a greatly shrunken Department of Agriculture, where the $70 billion SNAP program comprises most of its budget.
In an interview, former New Hampshire Republican Sen. Judd Gregg said that reorganizing and downsizing the federal cabinet structure is long overdue, and that he likes the idea of moving SNAP into HHS. But he said the Trump administration will have a "very hard time" selling the plan to Congress, given the unwillingness of lawmakers who head appropriations committee to forfeit any political control.
"It's almost impossible to move these agencies around because the turf issues are so acute," Gregg said. "And this administration has lost most of its political capital up there."
HHS was last restructured during the Carter administration, when the Department of Health, Education and Welfare was split into HHS and the new Department of Education, in recognition of the old department's large scope of work. Since then, Republicans long have sought unsuccessfully to eliminate the Education Department.
Slavitt said consolidating more healthcare and public assistance programs within the renamed HHS could make it easier for the Trump administration to reduce spending on them. "If the money is in different pockets and is overseen by different committees, the administration sees it as offering too many 'loopholes' to get services to people," he said.
Harris Meyer is a senior reporter
providing news and analysis on a broad range of healthcare topics. He served as
managing editor of Modern Healthcare from 2013 to 2015. His more than three
decades of journalism experience includes freelance reporting for Health
Affairs, Kaiser Health News and other publications; law editor at the Daily
Business Review in Miami; staff writer at the New Times alternative weekly in
Fort Lauderdale, Fla.; senior writer at Hospitals & Health Networks;
national correspondent at American Medical News; and health unit researcher at
WMAQ-TV News in Chicago. A graduate of Northwestern University, Meyer won the
2000 Gerald Loeb Award for Distinguished Business and Financial Journalism.
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