Trump, Musk plan 'large-scale' reduction of federal workforce: What will happen to health agencies?

President Donald J. Trump

Courtesy of the Library of Congress Prints and Photographs Division

President Donald J. Trump, flanked by Elon Musk, announced Tuesday an executive order calling for 'large-scale reductions in force' of the federal workforce, according to a new executive order.

It remains unclear how the U.S. Department of Health and Human Services and all of its agencies — from the U.S. Centers for Medicare and Medicaid Services (CMS) to the U.S. Food and Drug Administration and the U.S. Centers for Disease Control, among others — would be impacted by the reduction in force. The executive order did not mention any health agencies by name.

Details from the executive order include:

• "Agency Heads will coordinate and consult with DOGE (Musk's "Department of Government Efficiency") to shrink the size of the federal workforce and limit hiring to essential positions."
• The Order will significantly reduce the size of government: Federal agencies will only be permited to "hire no more than one employee for every four employees that depart from federal service."
• "Agencies will undertake plans for large-scale reductions in force and determine which agency components (or agencies themselves) may be eliminated or combined because their functions aren’t required by law."
• The order "exempts personnel and functions critical to national security, public safety, law enforcement, and immigration enforcement."

Trump said federal law enforcement agencies would be exempt from downsizing, but said nothing about the sprawling health apparatus of the U.S. government. Members of DOGE have spent time at CMS offices examining the agency's contracting and payment systems, according to media reports.

During the Oval Office comments, 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."

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.