Last spring and summer, The Fulcrum published a 30-part series on Project 2025. Now that Donald Trump’s second term, The Fulcrum, has started, Part 2 of the series has commenced.
Without a strategic plan, a conspiracy theorist at the helm, and a ransacking of its workforce, can America become healthy again? Doubtful.
Every four years, the Department of Health and Human Services (HHS) updates its Strategic Plan, “which describes its work to address complex, multifaceted, and evolving health and human services issues.”
President Donald Trump’s administration's strategic plan for HHS is still “forthcoming,” but certain trends are already evident.
On Feb. 13, 2025, Robert F. Kennedy, Jr. was sworn in as the 26th Secretary of Health and Human Services (HHS). Immediately following the ceremony, Trump, with Kennedy by his side, signed the “Establishing the President’s Make America Healthy Again Commission” Executive Order in order “to investigate and address the root causes of America’s escalating health crisis, with a focus on childhood chronic disease.”
The commission has 100 days to report childhood health issues to the president. The report will assess “the threat that potential over-utilization of medication, certain food ingredients, certain chemicals, and certain other exposures pose to children.”
Both Trump and Kennedy have suggested that the national focus should be on reducing chronic disease rates in the U.S., pointing to rising rates of cancer, obesity, diabetes, asthma, and autism spectrum disorder.
While Kennedy should be lauded for his commitment to the health and well-being of Americans with chronic illnesses, he seems to be dropping the ball on preventable diseases.
In less than a month from that declaration, and under the direction of long-time vaccine skeptic Kennedy, a mostly childhood disease, measles, is ravaging communities in Texas and has moved into New Mexico.
NBC News reports that as of March 7, the measles outbreak in West Texas has soared to 198 cases, per the Texas Department of State Health Services, and in New Mexico, 30 cases have been reported in Lea County, which borders Gaines County. A 6-year-old in Texas died, and Lea County health officials reported a suspected measles death in an adult.
Since becoming secretary, Kennedy’s statements on vaccines have been inconsistent, to put it graciously.
As Secretary of HHS, Kennedy oversees the following operating divisions: The National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and the Centers for Medicare and Medicaid Services (CMS).
While there is always some level of waste and fraud in large bureaucracies, the cuts to the agencies we have witnessed are like taking a chainsaw to what could be removed with a scalpel.
Dr. Reshma Ramachandran, a Yale health professor and researcher, board-certified family physician, and the Chair of the FDA task force of the nonprofit Doctors for America, told Politico, “On day one, the new HHS secretary is gutting the agencies that would be necessary to make America healthy again.”
CBS News reported on the day of this writing that “All employees in the U.S. Department of Health and Human Services (HHS) were notified Friday of the option to voluntarily resign in exchange for a $25,000 payment.”
Thousands of HHS employees had already been terminated before the buyout was offered.
Reuters said the Trump administration laid off 1,165 people from the NIH.
Between 700 and 750 employees were terminated at CDC, although recently, 180 of them were asked to return to work.
Reuters also reported that the Trump administration fired over 1,000 FDA employees over Presidents Day weekend.
Leaders at CMS, the federal agency that oversees Medicare, Medicaid, and other major healthcare programs, think at least 300 of the agency’s 6,700 employees have been let go.
The jobs that these terminated employees do cover a wide range of activities that keep Americans safe and healthy and include things like: oversight and administration of the health programs that care for half of Americans, research of chronic illnesses like Alzheimer’s, responsiveness to threats like the bird flu, and reviews of medical devices and drug safety, to name a few.
Arielle Kane, a terminated CMS official, told Politico she was working on a Medicaid pilot program active in 15 states to improve maternal health outcomes, an area in which the U.S. is lagging compared to other Western countries.
According to HHS.gov, “The mission of the U.S. Department of Health and Human Services (HHS) is to enhance the health and well-being of all Americans by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.”
How an agency can deliver on its mission when emptying those sound, sustained scientific advances remains to be seen.
In December 2024, as a Project 2025 follow-up, I wrote that it was ironic that President-elect Trump rejected most of Project 2025’s proposals with his pick of Kennedy for secretary of HHS. Still, the choice of Kennedy as the top protector of America's health might even be worse.
I am afraid it looks even worse than I thought.
Lynn Schmidt is a columnist and Editorial Board member with the St. Louis Post-Dispatch. She holds a master's of science in political science as well as a bachelor's of science in nursing.
What breaks the cycle: a practical bargain for longer, better lives
