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RFK Jr

How Kennedy's FDA And CDC Cuts Imperil Your Family's Health

Robert F. Kennedy, Jr. swung his meat axe at the Health and Human Services Department on Thursday, leaking plans to theWall Street Journal that he plans to lay off 10,000 workers or about 12 percent of the department’s workforce.

If he follows through on the plan, the largest layoffs will come at the Food and Drug Administration and the Centers for Disease Control and Prevention — the two sub-agencies that drew his greatest ire while running for president. The leaked plan calls for eliminating 3,500 full-time positions at FDA and 2,400 at CDC, which represents nearly 60 percent of the total employment cuts.

“If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Preserve your records, and 2. Pack your bags," Kennedy wrote on X last October after endorsing the Trump campaign.

The memo said the three divisions at FDA that approve new drugs, biologics and medical devices, which depend largely on industry user fees for their funding, would be exempt from the cuts. Those three sub-agencies employ 11,800 of the FDA’s total workforce of 19,700.

That means the bulk of the layoffs will come in the agency’s Human Food Program, which employs a little less than 8,000. Eliminating 3,500 its workers would nearly halve a sub-agency that protects the nation’s food supply; oversees food additives and dietary supplements; and crafts nutrition guidelines and food labels.

Staff who work in foods who were not exempted from the cuts include people who work on solving, communicating, and preventing outbreaks; testing foods for contaminants like heavy metals or bacteria; developing nutrition and food labeling policy; and take enforcement against companies who break the law.

Roughly two-thirds of Human Food Program funding goes towards inspection or ‘field’ personnel aimed at keeping our food supply safe, said Sarah Sorcher, director of regulatory affairs at the Center for Science in the Public Interest, in an email. (Full disclosure: I worked there from 2004-2009.) “Cuts are likely to hit heaviest on the foods program,” she said. “There are a few reviewers working on pre-market approval of additives, including food contact substances, (so) this is a very small fraction of the workforce.”

A corporate field day

No doubt the food additives regulatory function that Kennedy’s Make America Healthy Again campaign put in its crosshairs will be decimated. Eliminating workers without having an alternative regulatory scheme in place could prove disastrous for the American public.

First, the food and chemical additives industry will fight any attempt to ban or regulate their products, using its small army of lobbyists to slow the regulatory process before going to the business-friendly courts to prevent implementation. Second, the supplements industry will enjoy a field day after a sharp reduction in staff at FDA.

With fewer personnel to conduct oversight, shyster-led companies will fill the airwaves and internet with ads making unproven health claims for products that have never been tested for safety and efficacy. In addition to Kennedy’s long history questioning vaccine safety, Kennedy in recent years backed unproven medical claims such as taking cod liver oil for measles and ivermectin and hydroxychloroquine for Covid.

If the Trump administration follows through on the cuts, Dr. Martin Makary, the newly confirmed head of FDA, will be handed a shattered agency incapable of carrying out many of its core functions. During his confirmation hearing, which took place shortly after the initial Elon Musk-ordered employment cuts at the agency were rolled back, Makary promised senators he would do his own assessment of personnel needs at the agency. This latest plan raises the obvious question of whether he played any role at all in evaluating staffing.

A surgeon by training, Makary during his hearing also revealed an affinity for blaming the marginal issues championed by his new boss for the rise in childhood illness, where the main problems in recent years have been identified as rising obesity caused by junk food diets and lack of exercise, environmentally-caused asthma and the return of once-conquered childhood illnesses due to vaccine hesitancy. When asked by a MAHA-friendly senator about the role food additives play in causing inflammation and gut microbiome alterations, Makary replied, “Half of our nation's children are sick and nobody has really been doing anything meaningful on this front … We have to look at those ingredients.”

States will be hit hard by CDC cuts

The employment cuts at CDC contained in the new Trump administration plan will eliminate an estimated 19 percent of all agency jobs. Many research functions, like the reports that go into the Morbidity and Mortality Weekly Report, may fall by the wayside. Here’s the internet front page of a recent issue:

Public health agencies across the country, journalists and academic researchers rely on MMWR reports to identify emerging trends, deploy scarce resources, and identify issues that need further study. But Russell Vought, one of the key architects of Project 2025 and President Trump’s current director of the Office of Management and Budget, told Michigan’s Hillsdale College forum last September that most CDC workers “don’t even do public health. They are researchers that publish material. Who knows if it’s even relevant or not?”

Earlier this week, the administration announced it will cancel tens of billions of dollars in CDC grants to state and local health departments, which are dependent on federal funding to track infectious diseases, health disparities, vaccinations, mental health services, and other public health issues. It sent stop-work-immediately notices to the states, according to a news report in The Hill.

Many of the grants were authorized in the Covid relief bills passed during the Biden administration, which expire this September. Besides fighting the pandemic, state and local health officials used the money to also track the ongoing measles outbreak, improve their antiquated computer systems, and invest in other public health priorities.

States will soon become wholly dependent on their own resources to carry out these functions even as their residents continue to send most of their tax money to the federal government.

Merrill Goozner, the former editor of Modern Healthcare, writes about health and politics at GoozNews.substack.com, where this column first appeared. Please consider subscribing to support his work.

Reprinted with permission from Gooz News.


Why Medicaid Patients May Not Know Their Health Care Is At Risk

Why Medicaid Patients May Not Know Their Health Care Is At Risk

They go by different names in different states. In Tennessee, it is TennCare. In Ohio it is the Buckeye Health Plan. In California, it is Medi-Cal.

In Florida, it “sounds like an orange juice brand: Simply Healthcare,” wrote N. Adam Brown, an emergency room physician and professor at the University of North Carolina business school, in a commentary posted earlier this week on the MedPage Today website.

What they have in common is that they are Medicaid plans run by private insurance companies. Over the past several decades, 41 states and the District of Columbia have turned over their low-income health insurance programs to what industry jargon refers to as Medicaid managed care organizations or MCOs.

The nation’s 280-plus MCO plans cover an estimated 75 percent of the 85 million people (as of March 2024) on Medicaid, the joint federal-state program targeted for massive cuts by the GOP-run Congress. While many are run by non-profits or government agencies (like CountyCare in Chicago where I live), five for-profit private insurers (Centene, UnitedHealth Group, Elevance, Molina and Aetna/CVS) account for more than half of all Medicaid MCO enrollment, according to the Kaiser Family Foundation.

While the websites of most of these firms indicate their plans are connected to Medicaid, a significant share of their clientele have no idea they are covered by a government-financed program. A recent study published in JAMA found that between 2019 and 2022 when enrollment increased by 5.2 percentage points, surveys that asked where people obtained their health insurance showed only a 1.3 percentage point growth in Medicaid.

“Because Medicaid is not branded as Medicaid, if you tell a patient in South Carolina they might lose Medicaid, their eyes may glaze over,” Brown wrote. “Tell them Healthy Connections is at risk? You have their attention.”

His solution? “In every state, we need to call Medicaid by its real name,” he wrote. Instead of saying “‘Republicans want to reduce Medicaid by $880 billion,’ try ‘If Republicans' Medicaid plans come to fruition, you could lose your Buckeye Health Plan health insurance.’”

Where are the lobbyists?

No one is in better position to call Medicaid by its real name than the private insurers in charge of the program. Yet with the sole exception of Centene, the largest MCO operator, most companies have remained silent in the face of the GOP’s assault on the program.

For instance, I can’t find a single press release or public statement by a private insurer that counters claims contained in a specious hit piece released earlier this month by conservative think tanks that estimated Medicaid made $1.1 trillion in improper payments over the past decade. Since they’re managing at least half the money that flows through Medicaid, they ought to be offended.

The Paragon Health Institute and Economic Policy Innovation Center paper based its claims on eligibility reviews conducted during the last two years of the first Trump administration. It then applied that percentage to all Medicaid spending. However, the government estimated just a five percent improper payment rate or about $31 billion in 2024, which, if eliminated in every year over the next decade, would only save half of what conservatives claim.

Nor have those insurers risen to defend the the 92 percent of adults under 65 who are on Medicaid despite working full or part-time. More than a quarter of all workers in the private sector are not offered health insurance as a benefit, most whom are earning poverty- or near-poverty wages and are eligible for Medicaid, especially in the 41 states that have expanded the program (with 90% federal funding) to cover people earning up to 138 percent of poverty wages.

Even among those offered health insurance on the job, only three-quarters purchase plans. Why? Most can’t afford the premiums being taken out of their paltry paychecks.

So let’s begin describing Medicaid for what it is: A massive subsidy for employers who rely on low-wage labor. This subsidization is necessary because we have what, theoretically at least, is an employment-based health insurance system. Yet the government doesn’t require all employers provide and pay for health insurance.

Of course that’s not what you hearing from Republicans like Rep. Eric Burlison (R-MO). During hearing held earlier this month, he, like the president he slavishly follows, said there would be no cuts to Medicaid. “My definition of cutting does not include getting people who are fraudsters and getting people who are not supposed to be on the list as recipients.”

Democrats should answer with the following: “When we make Florida’s orange growers pay for their orange pickers’ health insurance, we’ll be able to shrink ‘Simply Health’ as much as they shrank the amount of juice put in each bottle.”

Reprinted with permission from Gooz News.

Medicaid Cuts Loom As House Republicans Declare War On Red States

Medicaid Cuts Loom As House Republicans Declare War On Red States

Last week, at the House hearing opening this year’s federal budget deliberations, Rep. Earl L. “Buddy” Carter (R-GA) promised, “We will not kick anybody off Medicaid.” The GOP leader promised to save money instead by rooting out waste, fraud, and abuse in the program.

Carter could have something to say in the matter since he chairs the health subcommittee of the House Energy and Commerce Committee. But, then again, maybe not. House Speaker Mike Johnson (R-LA) might bypass his committee and ram through across-the-board cuts in the bill needed to lift the debt ceiling, which must be passed in the next few weeks to avoid a government shutdown.

Those concerned with health care have a lot to fear from the blueprint released by the Budget Committee. It showed the GOP will seek $2.2 trillion in cuts to Medicaid and “other Health” programs (but not Medicare — more on that below) over the next ten years. It starts slowly: cuts of $49 billion or seven percent of health spending in this fiscal year, rising to $355 billion or 32 percent of projected spending in 2034. For Medicaid alone, that comes to a $40 billion cut this year and $1.8 trillion over the next decade.*

There is no way they can eliminate that much Medicaid spending without throwing tens of millions of people off the rolls. The program currently provides health insurance for 80 million souls. That’s nearly a quarter of the nation, more than a third of them children.

As I pointed out last week, the GAO estimated federal auditors and investigators would find at best around $52 billion in potential waste in the Medicaid program. That is barely enough to cover the first year’s proposed cuts.

Even if they were highly successful in eliminating waste during the next few years — hardly likely given they just fired the Inspector General at HHS and decimated the Department of Justice’s investigative arm — it would reduce the amount of savings available in later years to zero or near zero. Deep programmatic cuts are inevitable under their blueprint.

Given Carter’s role in determining Medicaid’s fate, let’s turn to a fellow southerner (albeit fictional) for the most appropriate response to his assertion in that Capitol Hill hearing room that there will be no one thrown off Medicaid. “Didn't you notice a powerful and obnoxious odor of mendacity in this room?” Big Daddy hollered in Cat on a Hot Tin Roof. “There ain't nothin' more powerful than the odor of mendacity. You can smell it. It smells like death.”

The biggest losers

The Congressional Budget Office has identified a number of ways that the MAGA-cowered Congress could impose cuts of that magnitude, whose primary purpose, let us not forget, is to help pay for another round of tax cuts for corporations and wealthy individuals. They could cap federal support for Medicaid, which currently stands at 69% of expenditures with states picking up the rest. They could do that either by instituting block grants, the long-time GOP goal, or slap a per capita cap on support for each beneficiary.

Either way, the program would be legislated to grow at the rate of inflation, which is substantially below economic growth or the growth in health care spending. That would put state health departments in the unenviable position of doing the Feds’ dirty work. They would have to either throw people off the rolls or raise taxes sharply on their own residents.

Who would be hurt most by this? If you’re guessing Massachusetts, California and most of the blue-run states in between, guess again. Fully 20 of the top 24 states most dependent on federal funding to run their Medicaid programs voted for Donald Trump in the last election. Eleven of those states have more than a quarter of their populations on Medicaid.

Top 14 states most reliant on federal matching funds for Medicaid

Other options to cut spending

The CBO offers other options for cutting spending. Congress could eliminate the federal match for taxes that 49 states and the District of Columbia levy on providers, which would save the federal government an estimated $630 billion over ten years. The states use that money to help pay for their share of the Medicaid program.

As the Congressional Research Service pointed out in this issue brief, these taxes are progressive in that they redistribute money from hospitals, nursing homes and physician offices with few Medicaid patients to those institutions that care for a disproportionate share of the poor. Eliminating the federal match is a shell game: It would force states to either pick up those costs or repeal the taxes, which would be doubly punishing for safety net institutions.

The GOP-run Congress could also lower the federal match for people in the 40 states and District of Columbia who expanded the program under the Affordable Care Act to cover people earning up to 138% of poverty wages. The federal government pays 90 percent of the cost of covering those workers and their families. Turning that into the standard match rate of 50 percent to 77 percent would reduce federal Medicaid spending by $596 billion over ten years, according to the CBO.

This would strike a major blow to the Medicaid expansion. At least a dozen states have laws that repeal their Medicaid expansions if the federal match rate drops. The Kaiser Family Foundation estimated anywhere from 19 percent to 49 percent of people on Medicaid in expansion states would lose coverage under this proposal. Some, maybe many, would purchase ACA plans on the exchanges. The more that do, the less the savings for the federal government since all would be heavily subsidized — unless the GOP Congress reduces those subsidies, too.

The path not taken

The most costly boondoggle in health care is never mentioned in the House Budget Committee report. The CBO estimates that Medicare could generate substantial savings if it simply paid private insurers covering Medicare Advantage (MA) beneficiaries the same amount as if they had remained in traditional fee-for-service Medicare.

As I’ve reported here many times, Medicare pays insurers a risk-adjusted monthly premium to cover seniors who choose an MA plan. The “risk” is determined by how sick people are, which insurers can game by coding for illnesses they never treat. The Medicare Payment Advisory Commission estimates Medicare loses over $80 billion a year from insurer upcoding — and that’s after slapping an across-the-board 5.9 percent reduction in payments to insurers.

Increase that reduction to 20 percent and it would save Medicare $1.0 trillion over the next decade — more than any other option identified by CBO. Of course, this would result in higher cost sharing, higher premiums, and fewer supplemental benefits for Medicare Advantage enrollees (so those plans looked more like traditional Medicare) or it would reduce profits for Medicare Advantage insurers.

How’s that for a popular slogan? Don’t throw people off Medicaid to pay for your tax breaks for big corporations and the wealthy. Stop private insurers from ripping off Medicare.

Merrill Goozner, the former editor of Modern Healthcare, writes about health and politics at GoozNews.substack.com, where this column first appeared. Please consider subscribing to support his work.


Drugs Are Top US Import -- And Tariffs Will Drive Up Their Cost

Drugs Are Top US Import -- And Tariffs Will Drive Up Their Cost

I was stunned this morning when I looked at the data. Drugs — the legal kind — are the U.S.’s single largest import category.

The U.S. in the first 11 months of 2024 imported over $222 billion in pharmaceutical products, which includes both finished drugs and the chemicals used to make drugs domestically. That’s $25 billion more than the value of all imported cars, the next largest category, and larger still than imports of crude oil; car parts; computers; and cell phones, the next four.

China is the single largest exporter of drugs and drug chemicals to the U.S. Yet China was only subjected to a 10 percent across-the-board tariff under the Trump edict, which, as of this writing, is still slated to go into effect tomorrow. That will be in addition to targeted tariffs on specific Chinese goods (steel, solar cells, EVs) imposed by the first Trump and Biden administrations.

Mexico and Canada, on the other hand, were slated for a 25 percent tariff on all its U.S. exports. This morning, the Mexican tariff was postponed for at least a month after a phone call between Trump and Mexican president Claudia Sheinbaum. Canadian Prime Minister Justin Trudeau was also in telephone contact with Trump (which led to a similar postponement). Both neighbors’ economies would be devastated by 25 percent tariffs since they are far more dependent on exports than the U.S.

Both countries are major suppliers of medical devices (knees, hips, heart values, stents, etc.) and medical equipment (imaging equipment, bioreactors, microscopes, etc.), which accounted for $57 billion in U.S. imports in the first 11 months of 2024, according to the Commerce Department. Medical equipment was the 13th largest category among all U.S. imports.

The ostensible reason for imposing high tariffs on our neighbors is to stop the flow of fentanyl into the U.S. Seeing fewer dangerous street drugs is the least likely outcome of any trade war. Interdiction efforts like tariffs that fail to focus on eliminating demand (i.e., getting U.S. drug addicts into treatment programs) wind up doing nothing more than enriching drug cartels and harming Americans. How? By raising the street price of illegal opioids and increasing the level of crime needed to pay for those higher-priced drugs.

The opacity of chaos

Speculation is rife as to why Trump went soft on China but hard on our northern and southern neighbors. A Paul Krugman post over the weekend suggested it might be due to the influence of Trump whisperer Elon Musk, who has extensive business dealings with China. He also noted news reports that 40 unnamed “whales” bought 94 percent of the $Trump and $Melania tokens, a personal grift worth tens of millions of dollars to the Trumps since the tokens “clearly have no intrinsic value.” Were they Chinese? he wondered.

Tim Noah in The New Republic suggested the huge tariffs are part of the president’s obsession with eliminating the income tax and returning to 19th century government financing that relied on tariffs. Unless Trump plans to completely eviscerate non-defense federal spending with huge cuts to Medicare and Medicaid, that’s fiscally absurd.

Noah also raised the specter that a bankrupt Trump may simply be running a grift on his newfound billionaire friends, many of whom have corporate interests and stock market holdings that will be severely damaged by the new tariff regime. They will ask Trump to reverse or at least moderate the tariffs, which he might do for a price. “These whales, whoever they are, want something in return,” Noah wrote. “They’ve created a path for other influence-buyers to follow.”

The big losers from Trump’s tariff games will be those who joined the administration hoping to use tariffs strategically as part of an industrial policy aimed at restoring long-lost domestic manufacturing capacity. There was some hope Trump might move in that direction when he appointed Jamieson Greer to be the next U.S. Trade Representative (USTR).

Greer was chief of staff to Robert Lighthizer, Trump’s first-term USTR. In Lighthizer’s most recent book, reviewed by American Prospect founding editor Robert Kuttner in a hopeful essay in the December issue of The New York Review Books, the former USTR called for a 25 percent across-the-board tariff on Chinese-made goods. Trump also appointed Peter Navarro, his former trade adviser and an avowed China hawk, to be his senior counselor for trade and manufacturing.

While expressing hopes that there might be a positive rethinking of trade policy during a second Trump term, Kuttner issued this prescient warning:

“Several other Trump appointees, who span a right-wing spectrum that runs from poorly informed nativists to Wall Street globalists, suggest that trade policy in Trump’s second administration is likely to display the same kind of internal conflicts as his first. Xi will again be looking for ways to undermine US anti-China policy by personally enriching Trump, his family, and his close advisers, such as Elon Musk, with their own financial interests in China.”

It seems clear that Lighthizer and his acolytes inside the new administration had little input into the weekend’s tariff announcement. Rather than imposing strategic tariffs to promote domestic manufacturing, the main economic impact will be higher prices.

Drug and device makers’ price card

Why are higher prices a given in health care? The drug and device companies in health care that will be subjected to the new tariffs have an almost unlimited power to raise prices to cover their increased costs because their products are patent protected. Moreover, manufacturers in both sectors have been outsourcing their manufacturing for decades. Even if they wanted to, it would take years for them to shift production back to the U.S.

“You can’t expand capacity overnight,” said Mark Hendrickson, director of supply chain policy for Premier Inc., a hospital group purchasing organization. “That takes year and millions of dollars.”

The drug and device makers are already signaling that their likely response will be price increases. “We have shared with the Administration our concerns about the potential impact tariffs could have on the medical technology supply chain that American patients depend on for their care,” said Scott Whitaker, CEO of Advamed, which represents device and equipment makers, in a statement to StatNews over the weekend.

The Pharmaceutical Research and Manufacturers Association was more circumspect in its statement when I reached out this morning. “We are eager to work with the Trump Administration to find solutions that reduce costs for patients and improve access,” their statement said. “However, policymakers have historically excluded medicines from tariffs because they increase costs and reduce access.”

Not this time, at least not so far. Perhaps if they buy a hefty bag of $Trump tokens, whose price dropped precipitously over the weekend and during today’s trading, things might change.

Reprinted with permission from Gooz News. Please consider subscribing.

Trump's Illegal Firing Of Inspectors General Undermines Fight Against Fraud

Trump's Illegal Firing Of Inspectors General Undermines Fight Against Fraud

It’s enough to give one a migraine.

Last Friday, just hours before President Trump illegally fired Christi Grimm as Inspector General of the Health & Human Services Department (along with 16 other inspectors general), her office and the Department of Justice successfully forced Pfizer Inc. to pay $60 million to settle charges it improperly marketed an anti-migraine drug.

A 2022 law strengthening the independence of in-house watchdogs at federal agencies requires the president to give Congress at least 30 days advanced notice before firing an IG. POTUS must also provide Congress with a detailed legal justification for any dismisssal.

The president’s contempt for the law parallels Pfizer’s alleged illegal activity. According to the settlement reached Friday, the company’s drug salespersons paid physicians “in some cases more than a hundred thousand dollars” to speak on behalf of Nurtec ODT, an anti-migraine drug. The speeches took place at dinner meetings attended by the speakers' family members, friends and colleagues from their own practice.

“Providers received no educational benefit from attending these meetings,” the settlement said. The subsidiary “intended the purchase of meals and drinks to induce these providers to prescribe Nurtec ODT.”

Why must Pfizer give financial inducements to doctors to convince them to prescribe a drug that helps people with a debilitating condition like migraines? One doesn’t have to look far for the answer to that question. Nurtec ODT’s topline celebrity promoter — Lady Gaga — offers only a half-hearted endorsement on the company’s website. “If you're, like me, one of the millions suffering from pain caused by migraine, Nurtec ODT may help,” she says.

“May” is the operative word. According to the Food and Drug Administration label on Nurtec, popping the pill ended migraine pains within two hours for just 21 percent of patients. That compared to 11 percent among those taking a placebo. It reduced major symptoms like nausea and light sensitivity in 35 percent of patients taking the drug compared to 27 percent among those taking a placebo.

In other words, Nurtec ODT was barely better than nothing. Two-thirds of patients received no benefit at all.

Cracking down on illegal marketing is only one of the crucial functions played by the Office of the Inspector General at HHS. Since 2007, the OIG and the Department of Justice have been operating a special joint task force to root out waste, fraud and abuse in a dozen major metropolitan areas.

“The Health Care Fraud Unit has charged more than 5,400 defendants with fraudulently billing Medicare, Medicaid, and private health insurers more than $27 billion,” a recent DOJ blog post noted. “In recent years, the average loss associated with the schemes prosecuted by the Health Care Fraud Unit has steadily risen, underscoring our focus on the most egregious offenders.”


Pill mills a target

One of the more significant recent cases took place in Alabama, where in 2023 an opioid pill-mill operator and his wife were sentenced to 20 years in prison for illegally distributing controlled substances and committing health care fraud. This was one of the first cases that Grimm, who has been with the agency since 1999, brought to a successful conclusion after becoming IG the previous year.

“At trial, evidence showed that the physician and his wife operated pain clinics in which patients often received pre-signed prescriptions that were issued to patients who went months or years without being seen by the doctor,” the joint task force’s most recent annual report said. “The doctor was responsible for writing prescriptions for over 10 million opioid pills and he and his wife also participated in fraud and kickback schemes that billed public and private insurance programs for over $270 million in fraudulent claims.”

You would think someone who wants to make American healthy again, and help some of his most loyal constituents avoid being victimized by illegal pill-mill operators, would want someone like Grimm to run HHS’s watchdog agency. The OIG’s semiannual reports to Congress estimated the agency recovered close to $10 billion for Medicare and Medicaid in 2024, nearly 20 times the 1,500-person agency’s annual budget.

Much of the HHS-DOJ task force’s efforts in recent years has focused on cracking down on opioid abuse. It set up special offices in New England and Applachia. It also stepped up efforts in traditional hotbeds of Medicare fraud: Texas and Florida, both of which have two major task force offices dedicated to combating illegal billing.

Here’s hoping a federal judge capable of reading the plain letter of the law will force Trump to rescind these illegal firings and submit the necessary paperwork. He offered nothing last Friday to justify removing these career professionals, almost all of whom came up through the ranks and dedicated their professional lives to protecting taxpayers, program integrity and current and future beneficiaries of important government programs.

Since I’ve began covering health care more than two decades ago, the HHS OIG has always been headed by a career professional. Dan Levinson, who retired in 2019, had been there for 15 years. When he left, Alex Azar, HHS secretary during Trump’s first term, said “Under Dan’s leadership, the HHS Office of Inspector General (OIG) has done tireless, invaluable work to protect program beneficiaries and taxpayer funds, improve the management and integrity of HHS programs, and respond to emerging challenges such as the ongoing opioid crisis.”

This time around, there’s widespread fear that the mission of the OIG will be undermined if Trump gets away with turning the job into a political appointment. “President Trump is dismantling checks on his power and paving the way for widespread corruption,” Sen. Elizabeth Warren (D-MA), said on Friday after the president’s announcement.

Merrill Goozner, the former editor of Modern Healthcare, writes about health care and politics at GoozNews.substack.com, where this column first appeared. Please consider subscribing to support his work.