OMB said it released the proposal in response to an executive order President Trump signed in March 2017 that directed OMB to comprise a plan to redesign the federal government for greater efficiency. OMB said it created the plan with input from federal agency heads and the general public, which had submitted more than 100,000 comments on how the administration could reorganize the federal government.
Proposed changes to health care agencies
The plan includes proposed changes for both HHS and FDA.
For instance, the plan would move all federal public assistance programs—including the federal Supplemental Nutrition Assistance Program (SNAP), which the U.S. Department of Agriculture (USDA) currently oversees—under HHS. The plan also proposes renaming HHS, which stands for the Department of Health and Human Services, as the Department of Health and Public Welfare.
The renamed department would include a new Council on Public Assistance (CPA), which would oversee federal safety-net programs, including SNAP and Medicaid. The plan states that CPA "would ensure that federal public assistance programs are well aligned and focused on promoting opportunity and economic mobility." According to The Hill, CPA would have the authority to implement uniform work requirements on individuals enrolled in federal safety-net programs.
In addition, the plan would move most of the federal government's role in overseeing food safety from FDA to USDA, and rename FDA, which stands for the Food and Drug Administration, as the Federal Drug Administration. OMB said the change would help to streamline food safety oversight, noting that, currently, the process can be disjointed. For instance, OMB said, "A poultry company in Georgia has to fill out separate paperwork because chickens and eggs are regulated by different federal agencies. And because of the toppings, a frozen cheese pizza and a pepperoni pizza are regulated by different agencies. There needs to be a better way."
The plan also states that it 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." According to Modern Healthcare, the plan would reduce the corps' size and create a reserve corps that could respond to public health emergencies.
Proposal likely to face opposition in Congress
According to The Hill, the plan likely will face opposition in Congress, particularly from congressional committees that could lose some authority under the proposed reorganization.
Sen. Patty Murray (D-Wash.)—the ranking member on the Senate Health, Education, Labor, and Pensions Committee—dismissed the proposal as "futile reorganizations of the federal government just to have a new talking point." She said, "Democrats and Republicans in Congress have rejected … Trump's proposals to drastically gut investments in education, health care, and workers—and he should expect the same result for this latest attempt to make government work worse for the people it serves."
Senate Agriculture Committee Chair Pat Roberts (R-Kan.) pushed back on the plan's proposal to shift oversight of federal nutrition programs to HHS. "We're not doing that," he said, adding, "We administer it better than HHS would do, and it dovetails right in to farmers, ranchers, and growers and hunger."
However, Sen. Ron Johnson (R-Wis.)—who chairs the Committee on Homeland Security and Governmental Affairs, which would oversee many of the plan's proposed changes—praised the administration for "thinking big and 'outside the box' to bring effective reform and reorganization to a government structure developed for the previous century."
OMB Deputy Director Margaret Weichert said the Trump administration plans to work with lawmakers throughout the summer to get Congress to approve provisions in the plan that require legislative action, such as the proposed changes to HHS. But she added that the administration can implement some of the proposed changes without Congress' approval (Sullivan, The Hill, 6/21; Meyer, Modern Healthcare, 6/21; Rein, Washington Post, 6/21; Sewtlitz, STAT News, 6/21; OMB release, accessed 6/22; Ferguson/McIntire, CQ News, 6/21 [subscription required]).
How to build a sustainable Medicaid strategy
No matter what comes next politically, intensifying financial pressures across all payer segments today are forcing hospital and health system leaders to adopt a more intentional Medicaid strategy
Download our report to learn how to stabilize the community safety net under current Medicaid economics, how navigate the transition to Medicaid risk, and the fundamentals of succeeding this risk