Cara V. James, PhD, President and CEO, Grantmakers In Health
This week marks 100 days since the start of the current administration. In that time, we have experienced a wave of harmful policies; devastating funding cuts; significant federal workforce reductions; and direct threats to freedom of speech, democracy, and the rule of law. As a country, we have witnessed the use of unlawful executive actions to intimidate, restrict, or punish organizations for addressing important societal challenges. While much remains uncertain, it is clear these changes will not make us healthier, and they threaten the foundation of our democracy. In the end, it is people—especially the most vulnerable—who will suffer the consequences.
It is impossible to concisely describe the myriad changes, even if we only focus on health. We have seen the elimination or significant reductions in funding for global health, public health, health equity, reproductive and maternal health, and injury prevention, among others. We have made it harder for the people served by the government to get the help they need through the elimination of Department of Health and Human Services (HHS) regional offices, Social Security offices, and programs such as the State Health Insurance Program. We have disinvested in our future by gutting workforce training programs, firing scientists in the middle of experiments, and cutting biomedical research funding that not only supports important studies, but also funds graduate students and faculty at colleges and universities across the country. And, we have turned our backs on data, science, and privacy by promoting misinformation and disproven theories; allowing unprecedented access to highly sensitive data to individuals who may not have undergone a background check; and removing datasets, reports, and certain words from publications and websites. We, the American people, deserve far better than what we have witnessed over the past several months.
As a researcher by training, a former federal civil servant, and someone who has dedicated my career to improving health outcomes, especially for vulnerable populations, the two things that bother me most about the last few months are the utter disregard for civil servants and the important work they do, and the fact that the cuts to HHS disproportionately targeted vulnerable populations and appear aimed at dismantling our social safety net.
During my eight years at the Centers for Medicare & Medicaid Services (CMS), I worked with numerous highly dedicated individuals across HHS who fielded calls from beneficiaries, worked with providers to resolve issues, helped maintain continuity of services during disasters, reviewed innumerable comments submitted by the public during rulemaking season, organized listening sessions in communities, addressed issues of fraud and abuse, and stayed late when needed to ensure deadlines were met. Although I left in 2020, these same individuals worked tirelessly during the COVID-19 pandemic to support the response. The manner in which they were let go, in some cases not being able to gather their personal belongings, was inhumane and appears to have been done to maximize pain and disruption. They deserve better.
These cuts undermine the department’s ability to fulfill its mission, and it is naïve to think they will not impact services. The cuts also disproportionately target programs serving those most in need. The Administration for Community Living, which supports older adults and people with disabilities, has been eliminated. Some programs the agency ran will move to other agencies, although it is unclear which ones. The Duals Office at CMS, which sought to improve integration between Medicare and Medicaid for beneficiaries who are eligible for both programs, was eliminated, with some work moving to another part of CMS. Several Offices of Minority Health, including the one I led at CMS, have been eliminated or had their staff significantly reduced. They were authorized in the Affordable Care Act, although several existed before it was enacted. While each was unique, they all worked to eliminate disparities experienced by various populations, including communities of color, rural populations, and individuals with disabilities.
Cuts to critical programs in maternal health, HIV prevention, and injury prevention will exacerbate known health disparities in these areas. Ending training programs, many of which were predicated on providers working in underserved areas, will make it harder to recruit providers to those areas and impact access to care for residents in those communities. The removal of programs and reports with certain words will make it extremely difficult to track health disparities, and very likely that analyses stratified by demographic characteristics will not be produced by HHS. The removal of the staff whose job was to address the needs of vulnerable populations makes it less likely those communities will be represented when policy decisions are made or when implementation plans are developed, thereby increasing the chances for unintended consequences.
The cuts to HHS in combination with cuts in other agencies related to social needs such as food, housing, and transportation are negatively impacting the vital conditions needed to achieve health and well-being in our society. Their effects are already being felt in communities throughout our country, and their long-term impacts will be felt for years to come.
While there is much to be concerned about, I am heartened by the growing number of voices pushing back and evidence of people coming together to support each other. I am encouraged by conversations in which people are asking what we need to do differently, recognizing that the moment will not be met with business as usual. I am also glad to see that philanthropy is stepping up and speaking out. We consistently respond in times of crisis, supporting communities, investing in innovation, building resilience, and fostering recovery. Some foundations have already announced increased funding to support the losses, but philanthropy cannot—and should not—replace the essential role of government. There simply are not enough resources to fill the gaps being created.
At Grantmakers In Health, we are taking action consistent with our vision and values. We are working to maintain the freedom for funders to support the communities they serve. We are keeping our Funding Partners informed and helping them navigate the current environment. We have launched new learning communities to foster shared knowledge and collective action. We are encouraging health funders to engage their communities, convene local leaders, collaborate with those outside of philanthropy, and co-create solutions for a healthier future. Finally, we are also asking funders to use their voice to speak up for the communities they support and speak out against harmful policies and attacks on our fundamental freedoms.
Now more than ever, we must protect the freedom to give in ways that are consistent with our values. We remain committed to our vision of better health for all. We know that by having the courage to stand together, support each other, and hold fast to our values, we can and will meet this moment—and emerge stronger on the other side.