Elon Musk’s DOGE and its impact on federal health agencies, explained

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President Donald J. Trump recently created the Department of Government Efficiency, or DOGE, and this quasi-agency with a big mission to cut government waste has sparked debate in Washington and beyond, with many observers focusing on its potential effects on major federal agencies — including those overseeing the nation’s health care programs.

DOGE, established by an executive order on January 20, 2025, and led by tech entrepreneur Elon Musk, is Trump’s pick to lead his restructuring (critics would say dismantling) of the federal workforce in the name of streamlining operations, reducing redundancy and optimizing the federal workforce.

While it is still early in the Trump administration and DOGE’s efforts, the initiative is expected to significantly impact how a host of federal agencies conduct their daily operations and manage staffing levels. Major health agencies that are part of the Department of Health and Human Services (HHS) have already seen layoffs. These include the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Centers for Medicare & Medicaid Services (CMS) and the National Institutes of Health (NIH), among others.

This explainer provides what we know about Musk’s DOGE, the controversy around it, and what the future may hold.

Why is it called DOGE?

The name DOGE is a nod to a cryptocurrency memecoin that made headlines worldwide. Long before DOGE the sort-of federal agency existed, a meme featuring a Shiba Inu dog sporting comic sans text captivated the internet. This colorful meme, labeled “doge,” spread through social media in 2013, its quirky captions generating laughs worldwide.

Some enterprising software developers converted the playful meme into a cryptocurrency called Dogecoin that same year. The pair launched the project as a tongue-in-cheek response to the hype surrounding Bitcoin, never imagining it would evolve into one of the world’s most recognizable digital coins.

As Dogecoin’s profile grew, so did its real-world uses. Supporters combined their digital tokens to fund charitable causes, ranging from sponsoring an Olympic bobsled team to raising money for clean water initiatives. The coin’s philanthropic flair and meme-inspired identity helped it stand out in a crowded crypto market.

Enter Musk, whose tweets and public endorsements catapulted Dogecoin further into the mainstream. His online jokes about sending Dogecoin “to the moon, ”sometimes literally referring to spaceflight, prompted significant price swings and fueled debates over cryptocurrency speculation. Musk’s involvement also reinforced Dogecoin’s reputation for straddling the line between serious investment and internet novelty.

DOGE took on another life on Jan. 20, when it became the subject of an executive order, signed by the newly inaugurated President Trump.

DOGE’s purpose

The Jan. 20 executive order published on the White House website, “Implementing the President’s Department of Government Efficiency Workforce Optimization Initiative,” outlines DOGE’s primary objectives as part of the Trump administration:

• Streamlining Federal Agencies: The department is charged with identifying overlapping programs and unnecessary administrative layers, with an eye toward cost savings.
• Workforce Optimization: DOGE will work in conjunction with the Office of Personnel Management (OPM) to “evaluate, realign or reduce federal positions” across multiple agencies, according to the executive order.
• Technological Integration: Under Musk’s leadership, DOGE is expected to promote increased use of artificial intelligence and data-driven analysis for government decision-making.

A Feb. 11 executive order further clarified DOGE’s role in Trump’s efforts to remake the federal workforce. Titled “Implementing the President’s Department of Government Efficiency & Workforce Optimization Initiative,” the directive instructs agency heads to evaluate employee performance, revise hiring protocols and reduce administrative redundancies.

An accompanying fact sheet says: “Agency Heads will coordinate and consult with DOGE to shrink the size of the federal workforce and limit hiring to essential positions.”

Trump administration officials described the move as a key step toward “transforming the culture of government,” asserting that it would improve public trust and align agency missions more closely with measurable outcomes. Critics, however, voiced concern over potential workforce reductions and the impact on long-standing civil service protections.

Impact on federal health agencies so far

The U.S. Department of Health and Human Services (HHS) dismissed roughly 5,200 probationary employees on Feb. 14 as part of the Trump administration’s workforce reduction efforts, according to an internal National Institutes of Health (NIH) meeting recording. The cuts include 1,300 U.S. Centers for Disease Control and Prevention (CDC) staff — about 10% of its workforce — and all first-year officers in the Epidemic Intelligence Service (EIS) — a disease response unit. Some terminated employees may receive four weeks of paid leave, though HHS has not disclosed specifics.

On Feb. 5, the U.S. Centers for Medicare and Medicaid Services released a statement affirming the agency’s cooperation with DOGE.

“CMS has two senior Agency veterans – one focused on policy and one focused on operations – who are leading the collaboration with DOGE, including ensuring appropriate access to CMS systems and technology,” the statement read. “We are taking a thoughtful approach to see where there may be opportunities for more effective and efficient use of resources in line with meeting the goals of President Trump.”

On Feb. 7, Democratic lawmakers wrote a letter demanding federal inspectors investigate to DOGE's activity at CMS. The letter was authored by Sen. Ron Wyden (D-Oregon), ranking member of the Senate Finance Committee; Rep. Frank Pallone (D-New Jersey), ranking member of the House Energy and Commerce Committee; and Rep. Richard E. Neal (D-Massachusetts), ranking member of the House Ways and Means Committee.

“Disruptions or improper access to these systems risk destabilizing our nation’s health care system — DOGE’s actions represent an attack on both the health care system and privacy of tens of millions of Americans,” the letter read.

What Musk has said about DOGE’s efforts

Musk has mostly taken to X, formerly twitter, the social media platform he owns, to make statements on DOGE’s, some of them inflammatory, about agencies that have been dismantled and employees fired, including USAID, and the Consumer Finance Protection Bureau.

During an Oval Office appearance with Trump on Feb. 11, Musk defended DOGE's efforts to shrink the federal bureaucracy, which he called an “unelected, fourth, unconstitutional branch of government, which has ... more power than any elected representative,” Musk said, according to the New York Times. “It does not match the will of the people."

What do we know about the future of DOGE? What we know for certain is the efforts of Trump, Musk and DOGE to impact the federal workforce, and numerous federal health agencies, is just getting started.