Trump Government Reorg Proposes Overhaul of FDA, NIH

Alicia Ault

June 25, 2018

The Trump Administration is proposing a massive overhaul of the federal government that includes a restructuring of the National Institutes of Health (NIH) and the Food and Drug Administration (FDA), as well as a reduction in the size of the US Public Health Service Commissioned Corps.

Under the plan, announced on June 20, the administration said it is proposing "the largest change management initiative in the history of NIH," which will "break down administrative silos through standardization of structures and processes agency-wide."

The plan also proposes to move the Agency for Healthcare Research and Quality (AHRQ); the National Institute for Occupational Safety and Health (NIOSH); and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) into the NIH, making them into new NIH institutes.

The plan would also move food safety issues from the FDA to the Department of Agriculture (USDA), and to then call the FDA the "Federal Drug Administration." The new FDA would focus on drugs, devices, biologics, tobacco, dietary supplements, and cosmetics. An estimated 5000 FDA employees — and $1.3 billion — would migrate from the FDA to the USDA.

"In the long term, the Administration expects this proposal would result in improvements in food safety outcomes, policy and program consistency, and more efficient use of taxpayer resources," said the plan.

The government restructuring proposal has been expected. In March 2017, President Donald J. Trump charged the White House Office of Management and Budget (OMB) with coming up with a plan to streamline government.

In unveiling the plan — which, among many other things, also aims to consolidate the Education and Labor departments into a single entity — the OMB stated that its aim is to cut bureaucracy and redundancy and streamline inefficient processes.

"For example, a poultry company in Georgia has to fill out separate paperwork because chickens and eggs are regulated by different Federal agencies," said OMB. "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 reorganization proposal also takes aim at the US Public Health Service Commissioned Corps, which consists of about 6500 uniformed public health professionals, who, according to the plan, often receive higher total compensation than noncommissioned colleagues doing the same jobs, and also get benefits similar to those of military personnel. The Corps' "mission assignments and functions have not evolved in step with the public health needs of the nation," stated the plan.

The Trump administration is proposing to cut the number of commissioned officers down to 4000 or so and to create a "Reserve Corps" that would be able to provide surge capacity during public health emergencies.

Drug Stockpile, Nutrition Programs to Move to HHS

The Strategic National Stockpile (SNS), which houses the nation's largest supply of potentially life-saving pharmaceuticals and medical supplies for use in public health emergencies, would be moved from the Centers for Disease Control and Prevention (CDC) to the Assistant Secretary for Preparedness and Response (ASPR) at the Department of Health and Human Services (HHS). The move would enhance effectiveness "by more fully integrating the Stockpile with HHS' other preparedness and response capabilities," according to the plan.

The HHS would be known going forward as the Department of Health and Public Welfare (DHPW). Before HHS became a cabinet-level department in 1980, it had been known as the Health, Education and Welfare agency in the Department of Education.

The new DHPW would now run several nutrition assistance programs that are currently under the aegis of the USDA, including the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The plan also calls for the establishment of a permanent Council on Public Assistance, which would be part of the new DHPW and composed of all agencies that administer public benefit programs, including USDA, the Centers for Medicare & Medicaid Services, and the Department of Housing and Urban Development.

This is not the first time an administration has attempted to reduce the size of government and streamline the bureaucracy. In recent history, President Barack Obama twice tried to merge six agencies into one department, and Vice President Al Gore helmed the National Partnership for Reinventing Government in 1993.

Many of the changes being proposed by the Trump Administration would require congressional approval.

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