The Trump Administration Goes To War With Health-Care Quality
Inside its plan to destroy a small agency that keeps you safe.
On March 14, the same day Senate Democratic leaders cast their fateful votes to fund the government, other Democrats were bracing for Donald Trump to continue his assault on Article I: indiscriminately firing federal workers, abandoning policy mandates enacted by Congress, and impounding lawful appropriations.
In a Friday letter to Health and Human Services Secretary Robert F. Kennedy, Jr., Sen. Richard Blumenthal (D-CT), along with Reps. Jamie Raskin (D-MD) and Don Beyer (D-VA) wrote with an urgent request that the Trump administration abandon its plan to dismantle a small agency with two big mandates: First, to reduce medical errors (that is, to make you safer when you’re hospitalized or need to see the doctor); second to compile data for health-care providers so that they can deliver a high standard of care.
The Agency for Healthcare Research and Quality—or AHRQ or “ark”—is like an in-house think tank for HHS and, thus, the public at large. As the lawmakers wrote, “AHRQ is the only federal agency with statutory authorization to generate health services research. Their work improves health care quality, effectiveness, and accessibility by determining what works, how, for whom, and at what cost—driving meaningful change.”
AHRQ’s contribution to “government efficiency” is hard to measure, but it certainly improves efficiency within the health care system, and probably saves both the government and consumers money by reducing waste and malpractice.
“The surveys that they do are critical to developing cost containment and value-based purchasing strategies,” said Chip Kahn, president of the Federation of American Hospitals. “You can draw a straight line between that and how payment is evolving.”
The letter to Kennedy alludes gently to the fact that crippling this agency would be illegal, and contradict Kennedy’s written, sworn testimony to the Senate. “The research supported by AHRQ not only improves health but also increases the efficiency of and effectiveness of our healthcare system, saving the government billions of dollars annually,” wrote Blumenthal et al. “During your confirmation hearing, you said that you ‘will align medical research and patient engagement initiatives to end the chronic disease epidemic and make Americans healthy again.’ You also told Congress that you will be ‘working with AHRQ to hear their proposals on how they will make Americans healthy again.’ The elimination of the Agency or its staff would undermine the promises you made to the Senate Finance Committee. We ask that you immediately reverse any planned cancellation of federally appropriated and lifesaving research at AHRQ, and work in a bipartisan manner with Congress and research stakeholders in any reforms of this lawfully appropriated Agency.”
Their concerns are well founded. The Trump administration has been especially fixated on crushing government-funded and in-house medical and health-care research, and AHRQ is its latest victim. AHRQ was fully funded on inauguration day, and remains funded by the continuing resolution Republicans just passed with help from Senate Democrats. Mass layoffs are not required by any law, and the agency is obligated by statute to undertake specific kinds of research—requirements it can not fulfill if it falls victim to DOGE treatment.
Having abandoned hardball efforts to force the Trump administration into compliance with the law and constitution, members of Congress have little immediate recourse now other than to plead with cabinet officials to spare government functions and services in piecemeal fashion. For AHRQ the fear is that, by Friday, it was already too late.
THE AHRQ OF HISTORY
I can confirm that Blumenthal, Raskin, and Beyer are correct—indeed, the Trump administration is already in the process of dismantling AHRQ.
And quite apart from the facts, allegations, and requests in the letter, what’s happened behind the scenes illustrates the manipulative ways the administration has sought to sabotage agencies large and small irreversibly, before Congress or outside stakeholders can effectively intervene.
Multiple sources tell me that the process began weeks ago: First with indiscriminate, DOGE-directed firings of probationary employees, then with a carrot-and-stick approach to driving more senior people out of the agency. The carrot, an early retirement inducement or buyout offer; the stick, a warning that the overwhelming majority of those remaining will be terminated in a “reduction in force,” until perhaps 90 percent of the original staff has been eliminated. The deadline for AHRQ employees to choose one or the other was Friday—the day the lawmakers wrote to Kennedy—and remaining employees have been told to expect the RIF by mid-April if not much sooner.
One week ago, when management broke news of the RIF to staff, they suggested that the DOGE team taking aim at the agency appears to have little idea what the agency does, and even less interest in finding out. The gist was: ‘We can’t understand what you do so we’re not going to keep you around.’
Once AHRQ is shattered, it will be all but impossible to rebuild. Its work is of high value to doctors, hospitals, research academics, and other government agencies like the VA (to say nothing of patients) but it is a public good. If the government doesn’t provide it, most likely nobody will. And why would highly specialized analysts, economists, and data scientists seek employment there in the future, knowing it’s vulnerable to the chainsaw.
“What’s happening now is unprecedented,” Kahn added, “and I don’t know what happens on the other ends when policymakers say, ‘actually, we need these functions.’”
That’s why scores of hospitals, research and medical institutions, and nonprofit organizations like the American Heart Association align to ensure that AHRQ receives adequate funding from Congress. But Congress has been neutralized.
THE DOGE THAT CAUGHT THE CAHRQ
Why Trump, Musk, and Kennedy have targeted AHRQ for destruction is a matter of speculation—HHS did not respond to a request for comment. But much of the speculation is informed.
For instance, in the past, conservative House Republicans have suggested zeroing out AHRQ funding in their budgets.
Some suspect Kennedy sees it as a soft target compared to more politically bulletproof HHS agencies like the ones that administer Medicare, Medicaid, and the Affordable Care Act. Fire staff at those agencies indiscriminately, and constituents will experience problems with their benefits, probably very quickly. Fire experts who compile best practices for patient safety, and most Americans will never know. Hospital-acquired infections might go up; people might die unnecessarily of heart disease; but those kinds of consequences lie far downstream. The connection between eroding health-care quality and the demolition of this state capacity will be impossible for most people to detect.
Others see it as of a piece with a larger Trump administration war on government data. When the government collects, analyzes, and publishes data, the consequences of various policy decisions become clearer to Congress, journalists, and, ultimately, the public. If administration policy harms the public interest in some way, officials can argue that it was worth implementing anyhow—or they can try to bury evidence of their culpability.
Yet others suspect that, in their CTRL+F skim-read through the federal code, DOGE minions discovered that AHRQ’s charter obligates it to research health-care delivery improvements for women, minority groups, and people with disabilities (in addition to children, the elderly, and citizens of rural America).
Crushing AHRQ could also be of a piece with the administration’s efforts to degrade the quality of federal services, so that they become easier to attack at the root. Cutting Social Security Administration staff might backfire politically, but it could also increase public frustration and distrust, making government programs riper for cuts. Likewise, in a more attenuated way, if reducing the quality and value of health care drives up public health-care expenditures, it will increase pressure on future lawmakers and administrations to unload those costs on to beneficiaries.
That has been a Republican goal for a very long time. In the past, they hoped to do it by passing controversial legislation. But a lot changes when the president has no intention of taking care that the law be faithfully executed. Now the plan is to break it.