What Does The HHS Secretary Do? (Duties And Powers)
What is the role of the Secretary of Health and Human Services?
The Secretary of the Department of Health and Human Services is a presidential cabinet position in charge of a huge and complex organization comprising 11 separate agencies. The overall purpose of the department is to safeguard public health and provide essential services to all Americans. These services range from health insurance, to food safety, to Medicare and Medicaid, to preparing for and managing public health crises, and much more. It’s an immensely powerful and important position, and in some ways, it isn’t too much of an exaggeration to say that the Secretary has the lives and well-being of ordinary Americans in his or her hands.
The incumbent provides the leadership and overall direction for the department, with the heads of its 11 agencies reporting to him/her. As a cabinet member, the Secretary updates and advises the president on all issues related to health, welfare, and income security programs. The incumbent must be able to navigate the political waters of the Administration and Congress in order to keep the department on track, as well as satisfying the needs of agency heads.
How does one become HHS Secretary?
As someone who oversees this sprawling department’s deep and broad portfolio, the Secretary should have substantial relevant experience and education in public health, public administration, and medicine. The appointment process begins when the president selects a prospective appointee and sends a formal nomination to the Senate. Then follows what can be a lengthy and contentious confirmation process. The nomination is referred to any Senate Committees deemed relevant, who research the candidate.
Once a candidate is approved at the committee level, the nomination goes to the full Senate, which conducts hearings. Meanwhile, the public gets a lot of information from the various news media, and special interest groups of all political persuasions can put pressure on Senators to sway the vote one way or the other. Assuming the candidate doesn’t drop out because of negative information or public pressure, the Senate finally holds a vote, and confirms.Looking to make a difference? Consider signing one of these sponsored petitions:
What are the most important powers of the HHS Secretary?
Because the Secretary is in charge of such a huge organization that affects the lives and well-being of all Americans, he/she has enormous power. In a recent PBS interview, the current Secretary, Alex Azar, referred to it as “as a shocking amount of power” that gives him “incredible authority to regulate, to modify programs, to do demonstrations, to experiment,” adding that “we intend to use the full scope of the power contained in this pen on any of these rather than sitting back and waiting for Congress.” As you may well imagine, what can happen to the well-being of Americans under a particular HHS Secretary will depend vastly upon the agenda of the president to whom he/she reports.
Probably most relevant to us right now as we live through a world-wide pandemic, are the legal authorities to prepare for and respond to public health and medical emergencies. These powers are granted through several major pieces of legislation: the Public Health Service Act, The Federal Food, Drug, and Cosmetic Act, and the Social Security Act. As you can see just from this short list, the HHS Secretary’s decisions can affect not only our health outcomes, but also our food and pharmaceutical safety, and even the economic wellbeing of our seniors.
First off, the Secretary has the authority to declare a public health emergency. This is not to be confused with a presidential declaration of National Emergency or Disaster—when that happens the Secretary has even more powers. And even without either of these being in place, he/she has a broad legal mandate to take a wide variety of actions. It’s not in our purview here to name each and every one, but the following lists will give you an idea of the range of the Secretary’s authority, and thus responsibility.
Let’s begin with a brief look at what the Secretary can do in the absence of an ongoing emergency:
- Assist states and localities by developing and implementing strategic plans for emergencies or epidemics
- Enable CDC access to special funding when necessary to prepare for a potential infectious disease emergency
- Maintain the Strategic National Stockpile (SNS)
- Assist and promote research
- Waive restrictions on certain drugs
- Establish isolation and quarantine
- Provide assistance to needy families and those deemed at risk
Okay, that sounds like a lot! What happens if the Secretary declares a Public Health Emergency? In addition to the list above, he/she can:
- Open up funding sources to provide state and local governments with what they need to address the emergency, and to enable the CDC to ramp up its activities
- Conduct and support investigations into the causes, treatments, and prevention of whatever precipitated the declaration
- Enable deployment of military trauma care teams, in collaboration with the Secretary of Defense
- Waive a wide variety of requirements and deadlines for reporting and applications
And finally, when a president has declared a Major Disaster or National Emergency, it depends on which legislation the declaration falls under. Assuming it’s the Stafford Act, the Secretary can:
- Make federal equipment, supplies, facilities, and personnel available to state and local governments
- Authorize federal use of state and local government services and facilities
- Mobilize emergency support teams and coordinate hazard mitigation
- Coordinate with private sector disaster relief organizations
- Distribute food, medicine, and supplies, including overseeing mass feeding
In addition to all we’ve listed above (which is not exhaustive!), a declaration—either by the HHS Secretary or the president—activates certain emergency powers. These powers primarily allow the HHS Secretary to waive certain Medicare, Medicaid, CHIP, and HIPAA requirements in order to maximize the aid that comes to a suffering population.
What agencies are under the Department of HHS?
The Department of Health and Human Services’ mission statement is as broad as its huge, complex bureaucracy: “…to enhance the health and well-being of all American, by providing effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.” That’s a tall order. Nearly one-quarter of all Federal outlays are from the HHS, and departmental grants numbers are greater than all other Federal agencies combined.
With 11 separate agencies in its org chart, HHS is a sprawling behemoth that touches pretty much every aspect of American life having to do with health, food and pharmaceutical safety, income security, and welfare.
In addition to the Public Health Services Commissioned Corps, which is the military wing of the department and includes the Office of the Surgeon General, eight of the eleven agencies are in the US Public Health Service:
- Food and Drug Administration (FDA)
- Center for Disease Control (CDC)
- National Institutes of Health (NIH)
- Indian Health Services (IHS)
- Substance Abuse and Mental Health Administration (SAMSA)
- Health Resources and Services Administration (HRSA)
- Agency for Healthcare Research and Quality (AHRQ)
- Agency for Toxic Substances and Disease Registry (ATSDR)
- Public Health Services Commissioned Corps,
The remaining three are human services agencies:
- Centers for Medicare and Medicare Services (CMS)
- Administration for Children and Families (ACF)
- Administration for Community Living
Each of those agencies has a director who reports to the HHS Secretary, and who takes their direction from him with respect to how their agency’s efforts should be focused. Each agency has a national, state, local, and sometimes global (as in the case of the CDC) reach. Each agency has its own complex org chart, develops programs, maintains public communication via a website, etc. Many have satellite offices across the country. What each agency can contribute to American life is dependent upon decisions made or not made by the HHS Secretary, who in turn is dependent upon the leadership of the president.
In addition to its organizational structure, HHS as a whole collaborates with other Federal agencies and departments, State, local, and US territorial governments as well as those of other countries, private sector, academia, research institutions, trade organizations, advocacy groups, non-governmental organizations, and faith-based entities. With a reach like that, it is indeed the octopus of governmental agencies!
Who is the current HHS Secretary?
Alex M. Azar II is the current HHS Secretary, appointed by Donald Trump and sworn in on January 25, 2018. A former clerk to Supreme Court Justice Antonin Scalia, he is an attorney with a history of service in the department. He was its General Counsel from 2001 to 2005, and Deputy Secretary from 2005 to 2007. He spent the next ten years in the pharmaceutical industry, as a senior executive with Eli Lilly and Company. On his watch, prices for drugs rose considerably, and the cost of insulin tripled.
Since he is a Trump appointee, it’s not surprising to learn what his priorities are for the department. Generally speaking, he opposes abortion and supports the elimination of the ACA. He is currently doing what he can to weaken the ACA’s regulations on health insurance, weakening rules that require Medicare to cover all drugs for HIV and cancer, and working to enable states to require Medicaid recipients to work. A cursory glance at the HHS page introducing him reveals all the buzzwords and phrases the Trump Administration has attached to these “improvements”: “patient-centric…system that puts the patient in control,” “value-based transformation of the American healthcare system,” and “unprecedented regulatory relief,” to name a few. Not to mention: “empower able-bodied adults receiving Medicaid through community engagement.”
How is Azar performing in the current climate of the COVID-19 pandemic in the US? The best way to gauge that is to pay attention to what is done, not what is said. How are hospitals faring? Do they have enough PPE, respiratory equipment, beds, and staffing? How many tests are being made available, and what kind? How about respirators? How about states and communities still not under stay-home orders? How clear is the communication coming from the White House each day about where we are and where we’re headed?
Ultimately, those questions and their answers fall at the feet of Secretary Azar. But here is a brief recap:
- In January 2020 he said that the risk to Americans of COVID was minimal.
- In February, he sent HHS ACF employees to California to help with quarantine sites for travelers exposed to the virus. According to a whistleblower, they arrived in California with no training, and no PPE, working with CDC employees who did have the necessary gear. After their time in California, they were sent home without having been tested.
- Senator Ron Wyden subsequently wrote to Azar to question him about this.
In early March it became clear that testing was not happening in anywhere near the degree to which it was needed. The decision had been made to refuse the WHO testing protocols in favor of the CDC creating their own. Restrictive criteria for tests plus the necessity to have all local tests sent to the CDC for confirmation, defective tests, and limited numbers of tests available added to this perfect storm. It took weeks to get testing up to speed, and as of April, it was still far from other countries’ scale per capita.
History of the HHS Secretary.
In a way, the best way to outline the role of the HHS Secretary over time, and how it has evolved, is to give a brief account of the Department’s history and changing portfolio of responsibilities. At each juncture, the Secretary of the Department’s responsibilities changed as the organization morphed.
In its first incarnation, HHS was the Department of Health, Education, and Welfare, created by President Dwight D. Eisenhower on April 11, 1953, as a reorganization of what had been the Federal Security Agency. The latter was established on July 1, 1939, to combine all federal programs in health, education, and social security. By 1953 the FSA had vastly outgrown its original mandate, and President Eisenhower replaced it with the Department of Health, Education, and Welfare—now a Cabinet-level agency.
The new department comprised six components: the Public Health Service, the Office of Education, the Food and Drug Administration, the Social Security Administration, the Office of Vocational Rehabilitation, and St. Elizabeth’s Hospital. In addition to those, it also administered Howard University, the American Printing House for the Blind, and the Columbia Institution for the Deaf, which became Gaudet College in 1954.
In 1979, the Department of Education was created, and all the education functions of HEW were transferred there. HEW was renamed to the Department of Health and Human Services, and that’s when it began to resemble its current version. At that time it still included the Social Security Administration, but in 1995 that entity was removed from HHS and established as its own agency. Over time, the operating divisions that we now know as the eleven agencies under the umbrella of HHS came into being.
List Of HHS Secretaries
Alex Azar is the 24th HHS Secretary. The grid below shows his predecessors, going back to the beginning, when the department was Health, Education, and Welfare.
Secretaries of Health, Education, and Welfare
|Name||Dates of Office||President|
|Oveta Culp Hobby||4/11/1953 – 7/31/1955||Dwight D. Eisenhower|
|Marion B. Folsom||8/2/1955-7/31/1958|
|Arthur S. Fleming||8/1/1958-1/19/1961|
|Abraham A. Ribicoff||1/21/1961-7/13/1962||John F. Kennedy|
|Abraham A. Williams||7/13/1962-7/31/1962|
|Anthony J. Celebrezze||7/31/1962-8/17/1965||
John F. Kennedy/
Lyndon B. Johnson
|John W. Gardner||8/18/1965-3/1/1968||Lyndon B. Johnson|
|Wilbur J. Cohen||5/16/1968-1/20/1969|
|Robert H. Finch||1/21/1969-6/23/1970||Richard Nixon|
|Elliot L. Richardson||6/24/1970-1/29/1973|
|Caspar W. Weinberger||2/12/1973-8/8/1975||Gerald Ford|
|F. David Mathews||8/8/1975-1/20/1977|
|Joseph A. Califano Jr.||1/25/1977-8/3/1979||Jimmy Carter|
|Patricia Roberts Harris||8/3/1979-5/4/1980|
Secretaries of Health and Human Services
|Name||Dates of Office||President|
|Patricia Roberts Harris||5/4/1980-1/20/1981||Jimmy Carter|
|Richard S. Schweiker||1/22/1981-2/3/1983|
|Margaret M. Heckler||3/9/1983-12/13/1985|
|Otis R. Bowen||12/13/1985-3/1/1989|
|Louis Wade Sullivan||3/1/1989-1/20/1993||
George H.W. Bush
|Donna Shalala||1/22/1993-1/20/2001||Bill Clinton|
|Tommy G. Thompson||2/2/2001-1/26/2005||George W. Bush|
|Michael O. Leavitt||1/26/2005-1/20/2009|
|Charles E. Johnson||1/20/2009-4/28/2009||Barack Obama|
|Sylvia Mathews Burwell||6/9/2014-1/20/2017|
|Norris Cochran||1/20/2017-2/10/2017||Donald Trump|
|Don J. Wright||9/29/2017-10/10/2017|
|Alex Azar||1/29/2018- Incumbent|
The Rantt Rundown
The Secretary of the Department of Health and Human Services is an enormously powerful cabinet position in charge of a vastly complex and wide-reaching department with 11 distinct agencies that manage various aspects of public health and public welfare for Americans. It is not an exaggeration to say the incumbent has American lives in his hands, especially in our current multi-pronged crisis brought on by the COVID-19 pandemic. This role works closely with the president, sets the vision for the whole department, and by virtue of managing the directors, oversees all its agencies and their functions. In order to gauge how well the current incumbent and 24th Secretary, Alex Azar, is doing, we need to understand the powers within his reach and compare them to current outcomes.