Department of Health and Human Services
The Department of Health and Human Services (HHS) is a major executive branch of the U.S. government, primarily responsible for enhancing the health and well-being of Americans. Established in 1953 and restructured from the previous Department of Health, Education, and Welfare in 1979, HHS administers vital social welfare and health programs, including Medicare and Medicaid, which provide healthcare services to millions of Americans. The agency's activities are categorized into three main areas: direct service provision, dissemination of public health information, and support for scientific research.
HHS oversees numerous subagencies that cater to specific populations and health issues, such as the Centers for Medicare and Medicaid Services and the Substance Abuse and Mental Health Services Administration. Other prominent agencies, like the Food and Drug Administration and the Centers for Disease Control and Prevention, focus on safety regulations and public health awareness. Despite potential budgetary uncertainties tied to Congressional reviews, HHS remains critical for addressing issues like substance abuse, public health emergencies, and healthcare access, including the challenges and changes brought about by healthcare reforms such as the Affordable Care Act. The department's mission reflects a commitment to social responsibility, aiming to meet diverse health needs across the United States.
Department of Health and Human Services
Definition: A division of the executive branch of the US government, with representation in the cabinet of the president, that is responsible for public health
History and Mission
Although several efforts were made in earlier decades to create a federal authority responsible for public health, it was not until Dwight D. Eisenhower’s administration in the 1950s that a formal agency became part of the executive branch of government. Presidents Franklin D. Roosevelt and Harry S. Truman in particular had hoped, but failed, to create a federally administered health program as an added component of the Social Security Act put in place by Roosevelt in 1935. The Department of Health, Education, and Welfare (HEW)—restructured in 1979 (and taking effect in 1980) as the Department of Health and Human Services (HHS)—began operations in April 1953. The Social Security Administration remained under the HHS until 1995. A number of legislative reorganization acts expanded and diversified responsibilities assigned to the HHS. Among these was the major milestone when, as part of the Social Security Act of 1965 (a piece of President Johnson’s Great Society legislation), two government-funded healthcare programs—Medicare and Medicaid—were placed under the administration of the Secretary of HEW.
The shift in party control of the executive branch of government that came with Republican Richard M. Nixon’s election in 1968 raised some question that there might be declining support for HHS activities. This would not occur, however, mainly because public perceptions of the need for government responsibilities for health and social welfare had become a political given. In fact, there would be an expanding pattern of activities of, as well as budgetary allowances for, HHS in the latter decades of the twentieth and first part of the twenty-first centuries.
The Department of Education Organization Act of 1979 provided for the creation of a separate Department of Education, while the HHS retained responsibilities for operations relating to public health and welfare. In part, the evolving scope of HHS operations reflected changing perceptions of the social definition of public health, as well as the impact on US agencies of global health concerns, particularly those relating to HIV/AIDS and the avian and H1N1 influenza pandemics.
Since its inception as HEW and following restructuring as HHS, in 2014, when Sylvia Mathews Burwell was sworn in, twenty-five secretaries have been appointed to head this executive branch of the US government.
Overview
Overall responsibility for the activities of the HSS rests with the secretary of Health and Human Services, assisted by the Office of Inspector General, whose task it is to report to the secretary and to Congress detailing both the budgetary soundness and managerial effectiveness of the activities assigned to more than ten subagencies of the department.
In general terms, work carried on by the HHS falls into three categories: provision of direct services to specific groups within the overall population; gathering and disseminating technical information vital to the maintenance of optimal public health and safety standards within the United States; and support for scientific research that can contribute to the same health-related goals.
Closer examination of activities sponsored by several key HHS subagencies suggests that many of their activities can be complementary. A first grouping, for example, consists of agencies providing direct assistance: Centers for Medicare and Medicaid Services (CMS), the Administration for Children and Families (ACF), the Administration on Aging, the Indian Health Service, and the Substance Abuse and Mental Health Services Administration (SAMHSA). In particular, SAMHSA is an example of complementary functions bridging several agencies.
Medicare and Medicaid clearly occupy the most public and politically sensitive position among all of HHS’s agencies. Unlike Medicare, which is fully funded by the federal government through withholding taxes on individual incomes, Medicaid programs involve budgetary and organizational cooperation between HHS and each state. This fact of decentralization means that HHS has the responsibility of monitoring a wide variety of state-run programs that set up eligibility standards (for example, low-income resources, disabilities, pregnancy) before providing free health care to Medicaid applicants. Some states include as much as half the cost of Medicaid services in their budgets, but others depend on HHS for well over half of their expenditures. Approximately fifty-eight million persons received Medicaid services across the country in 2015 at an estimated federal (HHS) cost of more than $476 billion in fiscal 2014. Because many state programs have faced budgetary cuts that could decrease their ability to maintain Medicare services, measures were put in place at the end of 2008 to allow participating states to introduce minimal premiums and higher copayments for Medicaid recipients. The Patient Protection and Affordable Care Act (PPACA) of 2010 expanded Medicaid eligibility in 2014. As part of the PPACA millions of previously uninsured people are able to receive benefits, specifically, non-elderly adults whose incomes are at or less than 133 percent of the federal poverty level, which in 2015 was about $24,000 for a family of four.
The ACF, organized with ten regional offices across the country, provides financial assistance to needy families, enforces child support obligations, and assists children held back by various economic or developmental disadvantages. Head Start is ACF’s widely recognized program to help prepare children of qualifying economically disadvantaged families for entry into the regular school system. Grants are made available to local public and private nonprofit institutions to develop methods—ideally methods involving parent participation with their children—to develop necessary social and cognitive skills that may be lacking as a result of disadvantaged social and economic environments. Enrollments in Head Start since its inception in 1965 increased (although not steadily) from about 500,000 to around 1 million participants in 2014. Budgetary support also rose steadily, passing the billion dollar mark in 1985. By 2014, appropriations were close to $8.6 billion.
The activities of other important agencies of HHS involve support for scientific research and dissemination of research findings to the general public. The National Institutes of Health (NIH) is the best known such agency focusing on “pure” scientific research. For its part, the Agency for Health Care Policy and Research, created in 1989 and reauthorized in 1999 as the Agency for Healthcare Research and Quality (AHRQ), supports research that gauges the effectiveness of existing or proposed health care programs around the country. These programs are studied, for example, in terms of costs, accessibility, and reduction of safety risks for patients. One should also note the social relevance of a number of AHRQ research projects, including studies of ethnic and racial disparities in access to health care. AHRQ also makes vital practical health care information available to the public. This is clear in the activities of one program in particular: the Office of Consumer Assessment of Healthcare Providers and Systems.
In the broader domain of informational services relating to public health, two agencies—the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC)—stand out. The FDA is responsible for testing and approving (or rejecting) a broad spectrum of products proposed by manufacturers for the consumer market. These range from the obvious—vaccines and new pharmaceutical products or generic equivalents of brand-name drugs—through many categories of food additives and dietary supplements to cosmetics and tobacco products. FDA recommendations reach the public through a variety of media, most notably regular publications outlining the characteristics of individual drugs or providing advice on buying medicines online (including warnings on counterfeit products). Potentially the most direct protective impact of the FDA is the power to recall drugs or food items that, although they succeed in reaching the consumer market, later reveal dangerous health or safety risks. A number of FDA activities extend beyond US borders, both with the aim of sharing vital research information and encouraging cooperation when international public health safety questions (most notably in combating pandemic diseases) are involved. In these areas, the FDA coordinates its functions with the CDC, which has a program providing relevant disease risk information to travelers going abroad.
The CDC not only deals with common widespread infectious diseases such as influenza, hepatitis, and HIV/AIDS (as well as major debilitating chronic diseases such as diabetes and cancer) but also maintains specialized branches responsible for health and safety in the workplace as well as emergency preparedness in the event of bioterrorism, chemical and radiation disasters, and health hazards that stem from natural disasters.
SAMHSA has a wide range of programs that are either preventive or, when drug or alcohol abuse or mental health issues require treatment, provide referrals to appropriate public health institutions. It also maintains an online database, the National Registry of Evidence-Based Programs and Practices, which reviews modes of preventing or treating, or both, the most common mental disorders and cases of substance abuse. SAMHSA also provides funding to support qualified community programs involved in either substance abuse prevention or treatment. Grants in 2014, for example, included almost $5.6 million awarded via the Suicide Prevention Resource Center grant to state governments and private organizations to help develop programs that assist in suicide prevention.
Other agencies of HHS carry on programs whose importance to public health can be said to be visible in the very names they bear. For example, the Agency for Toxic Substances and Disease Registry (ATSDR) is responsible not only for monitoring dangerous substances that are easily recognizable by the general public (asbestos, lead, DDT, and mercury, for example), but for conducting research that can reveal new dangers in unsuspected places. Another responsibility of ATSDR is to monitor both public and specialized toxic waste sites across the country. The Indian Health Service and the Administration on Aging are two other agencies whose work within important subsectors of the US population is easily recognized as a vital public service.
Perspective and Prospects
Because the budget for HHS must be reviewed by Congress, a certain degree of uncertainty may surround the ongoing work of its several agencies. Some programs, like Medicare and Medicaid, are subject to close scrutiny not only because of their critical place within the total US budget but also because of their importance as part of the health care reform debate, which came to center stage following the election of President Barack Obama in 2008 and has continued to be debated after the Patient Protection and Affordable Care Act, commonly called Obamacare, was signed into law in 2010. Other HHS agencies, without being as politically charged as Medicare and Medicaid, are clearly identified in the public’s mind because they represent easily visible dilemmas affecting everyday life. Within the brief period of two decades, questions of substance abuse and dysfunctional families, for example, have become the focus of major media attention. Because budgetary and political debates over the relative importance of the multidimensional activities of the HHS can arise at any time, its administrators must be prepared for possible calls for prioritization.
Bibliography
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Institute of Medicine. An Assessment of the CDC Anthrax Vaccine Safety and Efficacy Research Program. Washington: National Academy, 2003.
Kaiser Family Foundation. “Medicaid Moving Forward.” Henry J. Kaiser Family Foundation, 6 Jan. 2015. 18 Feb. 2015.
Medicaid.gov. Centers for Medicare and Medicaid Services. US Dept. of Health and Human Services, 2016. 30 Apr. 2016.
Medicare.gov. Centers for Medicare and Medicaid Services. US Dept. of Health and Human Services, 2016. 30 Apr. 2016.
Moon, Marilyn, and Janemarie Mulvey. Entitlements and the Elderly. Washington: Urban Institute, 1996.
National Research Council, Committee on the Organizational Structure of the National Institutes of Health. Enhancing the Vitality of the National Institutes of Health. Washington: National Academy, 2003.