The Impact of Federal Health Agency Cuts

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Brian Lehrer: Brian Lehrer on WNYC. We continue with our Health and Climate Tuesday section of the show, which will keep up at least through the first 100 days of the Trump administration so those issues don't get lost in the crush of other headlines. We'll focus on some health related stories today with NPR health policy reporter Selena Simmons-Duffin. She covers the Department of Health and Human Services, HHS, now being run by RFK Jr. She has a story out this morning called It's sexual assault awareness month and HHS just gutted its rape prevention unit. She had one last month called Segregated facilities are no longer banned in federal contracts.

Those are a few examples of how the war on DEI, diversity, equity and inclusion, could lead to its reverse initials IED, inequality, exclusion and discrimination. Low-income people also seem to be less of a consideration than in past administrations. Selena reported for NPR that among the cuts to HHS staff was some confusion over a team that works on lead poisoning. We know lead poisoning occurs disproportionately in low-income children. Selena reported that the CDC said, "Oops, the lead poisoning team was cut by mistake," but then reversed that and said, "No, it wasn't by mistake."

Another recent article by Selena as it relates to affordability and health, Five things to know as Dr. Oz prepares to lead Medicare and Medicaid. One of those things at his confirmation hearing, he seemed sympathetic to the Republican idea that Medicaid should be only for its original specific populations, pregnant women and people with disabilities, not low-income people in general as Republicans try to drastically shrink Medicaid to pay for President Trump's tax cuts. Some local indications of how big a change that could be.

Long Island's newspaper Newsday reported last week that the island is vulnerable to possible Medicaid cuts because 20% of people in the two counties, Nassau and Suffolk, get their health care that way. I'll add that in parts of New York City, it's considerably higher than that. I looked at stats on the State of New York website this morning, and about half of Queens gets health care through Medicaid and a clear majority of the people in the Bronx.

Separately, the New York Times and others reported that the Trump administration fired the entire staff of the Low-Income Heating and Cooling Energy Assistance Program. There are health implications for that, of course. They were also part of Health and Human Services. I could go on. Again, Selena Simmons-Duffin covers the Department of Health and Human Services for NPR. Selena, thanks for giving us some time today. Welcome to WNYC.

Selena Simmons-Duffin: Thank you so much for having me. I'm excited to be here.

Brian Lehrer: You want to start with your story that's new this morning, HHS gutted its rape prevention unit?

Selena Simmons-Duffin: Yes. I actually heard about this from a state health employee in the Midwest who sent a message that said, "We are all gearing up for Sexual Assault Awareness Month on April 1st, and we found out that our federal partners were gone." I asked around about it. I connected with some CDC employees who are fired, and I also talked to some nonprofit organizations, too.

The way it works is that Congress has given pots of money to different parts of HHS to run rape prevention education teams to help with domestic violence shelters. There's a HHS domestic violence hotline. There are all of these services and programs that come from HHS using hundreds of millions of dollars that Congress has given them for this purpose. Then those dollars filter down into state health departments and into these alliances of domestic violence shelters, service providers, local groups that are actually doing work on the ground.

Now, the money we think is still there. It was appropriated by Congress, but nobody who administers the grants is there to administer it. These local groups, the state health departments, the state health worker I spoke with said the state pretty much gives no money. All of their funding comes from the federal government. They have no idea what's going to happen next when they try to make payroll or pay for drawdown on their grants. They're really confused. I think the CDC staffers I spoke with who were fired are concerned about the groups that have been, as they said, left in the lurch by these changes.

Brian Lehrer: Does it look like Musk and company were going after rape prevention specifically as against anything that looked like DEI that singled out women for protection, or did those offices perhaps get swept up, maybe even inadvertently, as has happened with some things, as you report, in the big 20% reduction of HHS staff without realizing or considering who would be affected? Where on that spectrum would you put this?

Selena Simmons-Duffin: Oh, it's so hard to know. One person I spoke with said we had already had trouble executing our programs because we work in areas like gender based violence and gender disparities, some of these buzzwords that have clearly already been a target, that were already making the work a little bit more difficult. At the same time, the Violence Against Women Act has had bipartisan support. There were a lot of Republican senators that sponsored that reauthorization when it last happened in 2022.

I reached out to some Republican lawmakers to say, "Were you aware of this? You've spoken very passionately about the need for sexual assault prevention, and you worked hard to make sure that those programs were funded and were getting out to local communities, and now they're gone." I did not hear back from any Republican lawmakers who I reached out to.

I should say, too, I also reached out to HHS to ask a version of that question, which is, "Congress mandates this work be done. Congress has given hundreds of millions of dollars to this work. You have now fired everybody who is executing on that. What happens next?" The statement I received back didn't really address the specifics of this program or of this work. It just said, "All statutory requirements will be met." No one has any idea what that's going to look like and if that's true.

Brian Lehrer: They told you, I saw in your piece, this reorganization will be better positioned to execute on Congress's statutory intent, but if that's actually true, they're not telling you at all how.

Selena Simmons-Duffin: Right. The staffers at CDC who I connected with, were trying to make the point that this isn't plug and play, you find someone who knows how to execute a contract. These are relationships that have been built with local groups for many, many years. They know the ins and outs of these contracts. You can't just find a random staffer at HHS to plug a hole. You're losing that expertise when you lay off these people. It's just really hard to see how they can meet Congress's statutory intent with this approach to the restructuring.

Brian Lehrer: April, as you point out, is Sexual Assault Awareness Month. Many of our listeners were probably not aware of that. Declared by whom? That usually involves what?

Selena Simmons-Duffin: I don't know, the background of when it was declared, but it's a public health moment to say that sexual assault happens, with issues that are stigmatized, that people sometimes feel nervous about speaking up with. I think if you think about the MeToo movement, this is something that is often quiet in the shadows. These kinds of awareness months give an opportunity for people to speak openly about their experience and to maybe get into that prevention zone.

The work that the CDC team was doing wasn't just saying, "Sexual assault is bad, we don't like it," and putting out posters. They were helping schools and local communities craft programs that have shown to reduce sexual assault, like having community members map their spaces and marking hotspots, places where they feel unsafe that may be a poorly lit staircase or a school bus that's overcrowded where touching might happen, and make changes.

Let's add more buses to the schedule, let's add more lights, and let's change the way we staff our hallways to make sure this corner has a staff member or whatever it is. I think part of this awareness is not just know that sexual assault exists. It's know that there are ways that we as a society can act to mitigate this horrible thing that really affects a lot of people.

Brian Lehrer: They didn't cancel Sexual Assault Awareness Month in parts of the administration like they canceled Black History Month and Women's History Month and Holocaust Remembrance Day and things like that, but they are making it much harder to act on what this particular month is supposed to bring about in terms of actual safety?

Selena Simmons-Duffin: Right. The White House did release a statement on Friday about Sexual Assault Awareness Month, a proclamation, and most of the statement was about the threat of illegal aliens committing sexual assault.

Brian Lehrer: Listeners, we invite your phone calls, your questions welcome. For NPR health policy reporter Selena Simmons-Duffin, who covers the Department of Health and Human Services, 212-433-WNYC. We also invite you to help us report this story. We got that good call in the last segment from the guy in Baltimore who works on data sites that were being removed by the Trump administration.

In that context, listeners, anyone out there right now who works in any kind of public health or personal or family health being affected by these HHS cuts, tell us what's happening. Help us report this story. 212-433-WNYC, call or text 212-433-9692, or again, anyone who just has a question for NPR health policy reporter Selena Simmons-Duffin, who covers HHS, 212-433-WNYC, 212-433-9692.

Let's go to another of your recent stories that's related. Segregated facilities are no longer banned in federal contracts. They're not?

Selena Simmons-Duffin: This was a story that I heard about from a source of mine who works in federal contracting who said, "I just got this notice. It's like nothing I've ever seen before in my many years of working on contracts in the federal government." It was issued in what's called a class deviation, which is usually used by the federal government when there's an urgent need to adjust a lot of contracts. It included a list of clauses that would no longer be used in all federal contracts going out all across the federal government. This is massive. On that list was this clause that said, "Prohibiting segregated spaces in facilities." The clause dates back to the '50s and '60s.

It was part of the federal government's effort to move the country more towards integration. It lists the kinds of facilities like waiting rooms, drinking fountains, locker rooms that may not be segregated on the basis of and then there's a list of things including race, religion, national origin, and also, as of 2015, sexual orientation and gender identity.

A theory was that in trying to get rid of that part, the segregation on the basis of sexual orientation and gender identity, the administration was saying, "Let's just scrap the whole clause," but they didn't just get rid of that one part. They scrapped the whole clause. When I reached out to try to get comment about this, I did get a little bit of pushback. That story got a lot of readers. More than a million people read that story.

Brian Lehrer: Wow.

Selena Simmons-Duffin: The response that I got back was class deviations, this way of altering contracts, is not only for emergencies, it's not just when there are wars. That really contradicts what I heard from many people who've worked in contracting for decades. The second thing was that this clause was recently added by the last administration and this was just part of the administration putting its own kind of spin on federal contracts. That's also not accurate.

I actually went into a bit of a rabbit hole looking through the FAR, which is the the giant tome of contracting laws that dates back for many, many, many years. I found a version from the '80s in the Reagan administration that had the exact same clause almost word for word. I don't know what to say. It does seem like this many, many, many decades old clause that has been included as a matter of course on all federal contracts is not being included anymore. A recent NIH contract that I saw explicitly said that that clause was not part of its new contract. It's already being implemented.

Brian Lehrer: Listener writes in a text message apropos of both the previous segment and this one, "Gun violence is a leading cause of death of children in the US, yet for many years, even pre-MAGA, NRA-funded Republicans in Congress effectively block the government from collecting and sharing data on gun deaths." Another listener on the gutting of the rape prevention staff at HHS writes, "Terrifying to hear given the emergent 'Your body my choice,' chants from the red-pilled youth and young adults. Will they still have to take the training during orientations, or is that too DEI?"

There's a specific question at the end of that. Do you happen to know? Will, I guess, federal employees still have to take some kind of antisexual harassment training during orientations, including sexual assault training, or is that too DEI?

Selena Simmons-Duffin: I do not know the answer to that, but I do know-

Brian Lehrer: It's a good question.

Selena Simmons-Duffin: -that human resources departments across HHS have been fired. I think there are a lot of questions about how the workforce is going to be run that cannot be answered in this moment. The most immediate problem with not having HR staffers right now is that all these people who have been fired and are trying to figure out what their severance is and how to get COBRA and all of these other questions, have no one to ask. I don't know. I think that the whole federal workforce is in flux right now in many, many ways, and that's just one of them.

Brian Lehrer: A listener adds, "I'm not surprised they're taking away sexual assault protections of those working on them. The president is convicted of sexual assault." Well, that's actually more, accurately found liable in a civil suit by a jury of sexual abuse, but the point is clear and the point is taken. All right. We will continue in a minute with Selena from NPR. 212-433-WNYC, Selena Simmons-Duffin, who covers HHS. Calls are coming in. We have more of her reporting to go through. Stay with us.

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Brian Lehrer: Brian Lehrer on WNYC as we continue with NPR health policy reporter Selena Simmons-Duffin, who covers HHS, Health and Human Services. Let's take a caller at 212-433-WNYC, 433-9692. Connor in Louisiana, you're on WNYC. Hello, Connor.

Connor: Thanks for taking my call. Down here in Louisiana, our entire health care industry is practically subsidized by the federal government. I wanted to ask the reporter if she is hearing anything from people on the ground, former Trump supporters or congressmen in this upcoming reconciliation bill that is seeking to slash Medicaid, because I know people in my family, my extended family, everyone down here depends on federal subsidies. Our health care system is extraordinarily reliant on Medicaid, and it would be completely gutted if we lost those services.

Brian Lehrer: Connor, thank you. This goes to your article that I mentioned in the intro, Selena, on things that Dr. Oz said at his confirmation hearings, including that he seemed sympathetic, as you put it, to returning Medicaid to some kind of original target population, cutting a lot of people out, right?

Selena Simmons-Duffin: Yes. The Affordable Care Act expanded Medicaid eligibility to childless adults, low-income people, regardless of whether they were parents of young children, regardless of whether they were pregnant. That expansion population, as it's called, that was paid 90% by federal funds.

States, in the end, after some Supreme Court quick cases, were invited to expand Medicaid and many, many, many states have over the years. Now it's just 10 states that haven't expanded Medicaid, the biggest being Texas and Florida and Georgia.

Medicaid expansion, I think in a lot of ways has been a big success. It hasn't added a lot to state budgets because it has been pretty much entirely paid for by the federal government. It's meant that there are many, many, many fewer people without insurance. That helps local communities because it means that people, when they need health care, are going to the doctor instead of waiting for their condition to worsen and then going to the ER and potentially getting care that's uncompensated, that then the hospital has to find a way to pay for.

When people have insurance, that whole system can just work better. People can get care earlier on and have it paid for by their insurance. I wish I could say I have looked in a crystal ball or I'm a Politico insider and I know exactly how this is going to play out, but it is a huge open question what is going to happen with Medicaid.

Brian Lehrer: Right. If they kick millions of Americans off Medicaid, as Connor in Louisiana is pointing out for his state, and Connor, please call us again, that returns the country to the pre-Obamacare debate about there being so many uninsured people and how to best get them covered. That was never a good look or politically advantageous for Republicans besides the damage that it did to people's health and lives. Do you think Trump and the Republican Congress have the stomach for that?

Selena Simmons-Duffin: I don't know. It looks like Medicaid might be an easier political target than Medicare because historically seniors have had a lot of political clout, but Medicaid is what a lot of people in Trump country, you might say, rely on. The caller was from Louisiana. Senator Bill Cassidy of Louisiana, who is a physician and who is the chair of the Senate Health Committee, I think he's probably got a lot of pressure right now to navigate this problem.

House Republicans wanted to get $880 billion from Medicaid over the next 10 years. That is not streamlining fraud waste. That is probably eligibility and benefits, and it's going to affect a lot of people. I think that there is no bigger question right now than what happens with Medicaid and how does that spill out across the country, and as you say, really affect people's lives?

Brian Lehrer: Listener writes, "My nephew, a doctor working in the poisons department at the Centers for Disease Control, was fired last week along with the entire poisons research department." Another listener writes, "They laid off 90% of the National Institute for Occupational Safety and Health on April 1st." "A friend who is an epidemiologist in Cincinnati lost her job," writes Linda from Long Island. As we continue to list things here via our callers and texters, Avi in Flatbush, you're on WNYC. Hello, Avi.

Avi: Hi. Good morning. I was wondering about samples, samples of infectious diseases. I've seen reports that some things are being abandoned in refrigerators as people are let go. I wondered if Selena has asked about these things, how much risk that poses to the general public in terms of things that might be hazardous now, not having anybody looking after them.

Brian Lehrer: People working with samples. Do you know?

Selena Simmons-Duffin: Well, the way that this restructuring was originally pitched by Secretary Kennedy was that it was going to streamline administrative functions, but that is not what happened. There are labs that were shut down. I know of one; a source of mine who works in the Human Food Program at FDA and works with E. Coli was saying that a lab in San Francisco that tests imported food was shut down. Even though specifically in the outline it said that FDA inspectors were not going to be cut in the restructuring, the inspectors who inspect things now have no place to send the samples, to your caller's point, because the lab doesn't exist anymore.

The other person who called about the Cincinnati worker at NIOSH, the occupational health center at CDC, labs for NIOSH were also shut down in Morgantown, West Virginia, and in Cincinnati. In Spokane, Washington, another lab was shut down. There are labs that were doing work that are not doing that work anymore. I saw local news reporting that the mice and rats that were in the Morgantown facility will all need to be euthanized. It is a much, much more significant change to the operation of the federal health programs than consolidating HR departments or communications teams.

Brian Lehrer: When we talk about possibly cutting a lot of people out of Medicaid, is there an overtone of the so called undeserving poor philosophy in what you're hearing from Dr. Oz or others at HHS or in Congress? The argument says, if those lazy poor people would only work harder and pull their weight, they wouldn't be so poor and the rest of the taxpayers wouldn't have to carry them. That was very big in the Reagan years, for example. That argument always had racial overtones too. Are you hearing any of that undeserving poor idea implicitly or explicitly?

Selena Simmons-Duffin: If it's there, it's implicit. The thing that you hear is people say, "We want to preserve Medicaid for the most vulnerable." What they mean is not the childless adults who are low-income, but rather people who are pregnant or parents of young children. That is, in a way, a coded way of saying if you're poor but not in one of those special categories, you shouldn't have access to Medicaid. You should be trying to get health insurance through some other mechanism which, before the Affordable Care Act, didn't exist.

Now there is the marketplace like healthcare.gov and the state exchanges, and those are private plans that are subsidized, especially for people who are low-income. What advocates will say is that almost many, many, many people who are in Medicaid already work. People need income. Even if you have free insurance, you still want some income. People who can work are working. What work requirements do is require people to document that monthly, and that's really onerous. Especially for people who are working low-income jobs, that can turn into its own kind of job just to try to preserve your access to health care.

The problem is trying to square the circle of reducing the funding that's going to Medicaid while making it politically palatable. It seems like work requirements are the thing that Republican lawmakers have landed on that seems to maybe do that the best.

Brian Lehrer: Tony in Eastern Pennsylvania, you're on WNYC. Hi, Tony.

Tony: Hi. Thanks for taking the call. I'm a former emergency nurse. I worked in the cardiac lab and I've always been interested in the politics and the economics of health care. What's going to happen if Medicaid is cut back; there are hospitals in rural areas that are 15-bed, 20-bed hospitals, right now they're barely hanging on. They've had to close OB/GYN, they've had to close labor and delivery because they're very expensive. Sometimes if nobody's having a baby, you still have to staff it. These hospitals may be the only hospital within an hour, two hours of people, particularly in red states.

If they lose their funding because their patients don't have Medicaid anymore, these hospitals are going to close. I read an article recently where someone said, "Using the argument, 'People are going to die,' seems to have no residence."

Brian Lehrer: Tony, thank you. Selena?

Selena Simmons-Duffin: That's accurate. Hospitals will close when their populations don't have health insurance anymore and there's nobody to pay for the care. In addition, Medicaid gives a financial bed, and a predictable income stream for these places that are just barely hanging on. It's hard enough to operate right now that I think it's true that it would have a really devastating effect on these smaller hospitals across the country, and that would, in turn, affect people's access to care.

Brian Lehrer: That can wind up who from redder states winds up supporting what kinds of cuts, right?

Selena Simmons-Duffin: Yes. It really seems like Medicaid has been politically protected in the past because of these things, because it affects so, so many people across the country and so many people rely on it, not just people, but also institutions. Our health infrastructure relies on Medicaid. I feel like a lot of conventional wisdom, a lot of how things have gone in the past isn't that useful in the current moment, so it is hard to know how this is going to play out politically and what's going to happen to these places and to these people who rely on Medicaid.

Brian Lehrer: Can I throw in one more here before we run out of time? I don't know if you've reported on this, but I've seen stories that say RFK wants states to ban people on food stamps from buying soda. I saw that reported.

Selena Simmons-Duffin: That's a kind of interesting approach, and I think that it's starting to happen. There was an event in West Virginia. West Virginia was putting in a state law that would limit people's ability to buy soda on food stamps. There are some pushbacks to this. For example, if you can't use your food stamps for soda, you might use your food stamps for other things and still buy the soda with your cash. It's not clear that it would have a nutritional benefit. Also just the dignity of allowing people to choose what they want to eat and what they want to buy.

It's speaking to what he really wants to be focused on, which is healthy food and exercise, and the make America healthy again tent poles, but he is really coming up against some big challenges like the measles outbreak and this very chaotic restructuring of his department.

Brian Lehrer: What struck me there, and you indicated this in your answer, this supposed crusader against the processed food industry, RFK, is punishing the poor people on SNAP benefits or food stamps themselves to prevent them from having a simple pleasure, not going after big soda or others in the industry to change the dominance or corporate hyper-promotion of unhealthy foods or other things systemically, at least not yet. Is that a fair way to look at it? Then we're out of time.

Selena Simmons-Duffin: Yes, although he has said that he wants to go after subsidies for processed food makers as well, that is going to be politically challenging. I know that Senator Grassley said he wanted to educate the secretary about corn. We're going to have to see where that goes, but this is where they're starting. I think that they're going to be coming at it from all angles because this is really a priority for him.

Brian Lehrer: NPR health policy reporter Selena Simmons-Duffin, who covers Department of Health and Human Services. You've got quite a beat these days. Thank you for sharing so much of your reporting with us.

Selena Simmons-Duffin: Thank you for having me.

 

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