The Clinton administration is redesigning HHS by cutting headquarters staff, consolidating dozens of programs and giving states more responsibility for improving the health of many Americans.
The proposed changes are part of Vice President Al Gore's drive to "reinvent" the federal government. According to administration officials and documents, Gore's blueprint would save $453 million by 2000 while cutting 2,400 jobs from a work force that now totals 62,000 employees.
With a budget of $311 billion a year, HHS operates and finances a greater number and variety of programs than any other civilian department-from welfare and Medicare to drug approvals and food inspections.
Under Gore's plan, HHS will turn a piece of its work over to private business, give states more control over health programs and eliminate a layer of the headquarters bureaucracy.
GOP proposals to cut the federal deficit target some of HHS' programs, such as Medicare, Medicaid and welfare, but make few specific recommendations for cuts in the agency's bureaucracy (See related story, p. 2).
Some of the Gore changes will require legislation, while others can be done administratively. The White House announced part of the plan two weeks ago, a stepped-up effort to root out Medicare fraud in California, Florida, Illinois, New York and Texas (May 1, p. 8).
HHS also plans to consolidate 107 health programs and turn them over to the states as grants or "performance partnerships" in the areas of mental health, substance abuse, preventive health, AIDS, chronic diseases and disabilities prevention, and immunization.
Under these partnerships, HHS will outline long-term health objectives while allowing states and local governments to determine the most effective ways of achieving results.
The department also will eliminate a layer of bureaucracy at its headquarters by consolidating the offices of the secretary and assistant secretary for health into a "single corporate headquarters."
The budget proposal, by Senate Budget Committee Chairman Pete Domenici (R-N.M.), also assumes the elimination of the office of the assistant secretary for health, as well as consolidation of 19 Public Health Service programs into a state health block grant.
The vice president's plan also calls for studying the possibility of turning part of the hospital at the National Institutes of Health over to private management.