About a month ago (March 27th to be exact), the Department of Health and Human Services (HHS) announced a sweeping reorganization plan. The government will create a new umbrella agency: the Administration for a Healthy America (AHA). Some have hailed this as a bold step toward modernization. In effect, the AHA will absorb and restructure a collection of public health agencies and programs under one centralized body. Its mandate will touch nearly every facet of community health: primary care, maternal and child health, mental health, environmental health, HIV/AIDS, and workforce development. A new cross-cutting policy team and the Office of the U.S. Surgeon General will prop it up.
This move, we’re told, is all about efficiency. That word is being repeated with such reverence lately, as though invoking it alone is enough to make it true. But those of us who have worked in, with, or adjacent to these agencies know that “efficiency” is often bureaucratic shorthand. It can suggest something else entirely: consolidation without investment or rebranding without resourcing. Most cynically, it portends cutting programs under the banner of reform. One could be forgiven for seeing this latest maneuver not as a well-considered strategy for improving public health, but rather as a sleight of hand by an administration eager to appear as though it’s modernizing, while quietly gutting the infrastructure that supports health equity.
The Agencies “Integrated” into the Administration for a Healthy America
At the heart of the reorganization are several key agencies that will be folded into the AHA. These include the Office of the Assistant Secretary for Health (OASH), the Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and selected components of both the Agency for Toxic Substances and Disease Registry (ATSDR) and the National Institute for Occupational Safety and Health (NIOSH).
Each agency brings a distinct mission and history to the table. They have long-standing partnerships in the communities they serve and specialized expertise that cannot easily be replicated or “streamlined” into a single administrative entity.
Alphabet Soup
OASH, for instance, serves as a coordinating body within HHS, responsible for setting broad health policy goals like Healthy People 2030 and overseeing offices dedicated to minority health, women’s health, and disease prevention. It has traditionally acted as a bridge across various HHS functions, convening rather than administering, and relying on its unique position to elevate public health priorities at the federal level.
HRSA, by contrast, is deeply embedded in the nation’s healthcare safety net. It funds more than 1,400 health centers, including many that serve people experiencing homelessness, rural populations, and other medically underserved communities. It also administers the National Health Service Corps and the Ryan White HIV/AIDS Program, making it one of the most critical funders of community-based care in the country. HRSA’s identity is defined by its on-the-ground focus—supporting those who have long been left out of the traditional healthcare system.
SAMHSA’s mission centers on advancing behavioral health, funding a wide array of mental health and substance use services at the state and community level. Its grant-making structure supports flexible, community-informed approaches that address the opioid crisis, youth mental health needs, suicide prevention, and much more. SAMHSA’s supports programs in harm reduction, trauma-informed care, and direct engagement with people who use drugs or experience serious mental illness, populations too often misunderstood or stigmatized.
Then there’s ATSDR, a lesser-known but vital agency that responds to environmental and chemical exposures. They often work in communities facing industrial pollution or disaster-related contamination. Its role has grown more urgent with each wildfire season, each chemical train derailment, each water crisis. These events capture headlines for a week and then ruin lives for years. Alongside ATSDR, NIOSH works to protect workers from occupational hazards. Agency staff and programs draw from research and field investigations to inform standards that safeguard millions of Americans on the job.
Together, these agencies form a messy, deeply human, sometimes overlapping, but ultimately essential ecosystem. To flatten them into a single “streamlined” structure risks losing the nuance, the local relationships, and the domain-specific expertise that make them effective.
The Argument for Reorganization
To be sure, the case for reorganization [pdf] has its merits. The public health response to COVID-19 revealed just how fragmented our systems can be. Primary care, mental health, occupational health, and environmental health were all pulled into the emergency in different ways, often with minimal coordination. It’s reasonable to ask whether a more unified approach could make future responses faster, more nimble, and better aligned. Similarly, long-standing critiques of federal bureaucracy [pdf] point to siloed funding streams, redundant data collection systems, and administrative inefficiencies that sap energy from actual service delivery.
Proponents of the Administration for a Healthy America argue that a unified structure could help prevent these failures. By reducing administrative bloat and aligning overlapping missions, they believe AHA could streamline decision-making and foster more deliberate collaboration across sectors. With shared goals and unified metrics, programs could be more accountable [pdf], and federal responses more coherent. In theory, resources could be mobilized more quickly and public health interventions deployed with greater precision. This is especially true in moments when every day or even every hour counts.
Some also point out that AHA could finally bring programs like HRSA’s community health workforce efforts into closer collaboration with SAMHSA’s behavioral health supports and ATSDR’s environmental health surveillance—promoting a more holistic, place-based model of care.
But this argument assumes the merger will be adequately resourced, equitably led, and strategically managed. And those are very big ifs.
Concerns from the Field: What Gets Lost in Translation
But we’ve been here before. We’ve seen reorganizations that promised integration and delivered disarray. We’ve seen program “realignments” that resulted in defunding entire areas of public health under the guise of simplification. The fear—well-founded—is that this isn’t a consolidation for impact, but rather a centralization for control.
One of the clearest concerns is the potential loss of mission clarity. Each of the agencies being absorbed into the AHA has developed specific competencies over the decades. HRSA’s ethos of access and service is not the same as SAMHSA’s public health-informed behavioral health model. Neither aligns neatly with the policy-first orientation of OASH. Throwing them into a single pot doesn’t automatically produce synergy. It can just as easily produce confusion, turf wars, and diluted accountability.
Power of the Purse
More troubling is the lack of transparency about how this reorganization will be funded, implemented, and governed. We’ve heard lofty aspirations, but few concrete details. Will the Administration for a Healthy America receive new money to carry out its expanded mandate? Can it be expected to do more with less? Will local partners have a voice in shaping the transition? Or will decisions be made behind closed doors? How will we ensure that community-responsive models of care don’t get lost in the shuffle of national policy priorities?
These questions have taken on heightened urgency in light of recent developments. In March, the Department of Health and Human Services (HHS) abruptly terminated over $11 billion in public health funding. This included $1 billion in grants from the SAMHSA designated for mental health and substance use treatment. They justified these cuts by asserting that the funds were no longer necessary. Many of those programs focused on recovery from the COVID-19 public health emergency.
In response, a coalition of 23 states and the District of Columbia filed a lawsuit against HHS and Secretary Robert F. Kennedy Jr., alleging that the sudden termination of these funds is both harmful and unlawful. The lawsuit contends that the grants addressed broader public health needs beyond the pandemic and that their abrupt cancellation disrupts vital services. A federal judge in Rhode Island has since issued a temporary restraining order, blocking the $11 billion in cuts while the case proceeds.
What does it all mean?
These developments underscore the disconnect between the administration’s stated goals of efficiency and the realities on the ground. The formation of the AHA, coupled with significant funding cuts, raises concerns about the federal commitment to public health, particularly in areas like mental health and substance use treatment that rely heavily on sustained investment. As the restructuring unfolds, it is imperative to ensure that efficiency does not come at the expense of accessibility and equity in healthcare.
For those who rely on HRSA to fund essential primary care programs. Or those who collaborate with SAMHSA to support people living with addiction. Or those who draw on NIOSH’s workplace health guidance to prevent injury and illness. These questions are not academic. They are existential.
What Happens Next?
It is tempting to believe that restructuring will solve deep-rooted problems. It’s a narrative we’ve seen before. Bold reform will fix what funding couldn’t. The notion that collapsing agencies will somehow create collaboration. The tempting idea that cutting through “red tape” will magically make health systems more effective. But health equity doesn’t come from efficiency. It comes from investment. It comes from humility. Crucial to this issue, it comes from trusting the people already doing the work.
The Administration for a Healthy America could, in theory, become a powerful vehicle for integrated, community-centered care. But only if it builds rather than bulldozes the agencies and partnerships that have sustained public health for decades. Until then, the vision is heavy on structure and light on substance. Each update on AHA is wrapped in the language of modernization but shadowed by the familiar outlines of disinvestment.
Whether the Administration for a Healthy America is a force for health justice or just another exercise in bureaucratic rebranding remains to be seen. But one thing is clear: a truly healthy America cannot be administered into existence. It must be resourced, protected, and built from the ground up.
Ben King