TRACKER: Major Proposed and Enacted US Federal Government Changes Impacting Public Health and Health Communication Infrastructure and Funding (2025–2026)

Executive orders and the proposed FY 2026 budget have initiated significant legislative and administrative restructuring in the US Federal Government in 2025, with some requested changes awaiting Congressional approval, that will alter the funding, scope, and structure of public health services. These changes primarily fall into three categories: restructuring and funding reductions for the Department of Health and Human Services (HHS), cuts and eligibility changes to the social safety net and health insurance, and administrative, policy, and regulatory shifts in global health policy and health-related and supporting federal departments and agencies.

1. HHS Restructuring and Funding Reductions

2025 began with a temporary freeze on external communications for major HHS agencies, requiring White House review of content before publication. [1] Simultaneously, several datasets and webpages—including those on HIV prevention, adolescent health, and gender identity—were taken offline. [2] Now, HHS has begun a sweeping proposed restructuring intended to centralize operations, streamline oversight, and reduce staffing across multiple divisions by 16%. [3]  The Proposed FY 2026 Budget outlines the intended restructuring and requests $94.7 billion in discretionary budget authority for HHS, a 25 percent reduction from the enacted FY 2025 levels. [4]

A. Workforce and Administrative Centralization

• Personnel Reductions: A reduction of approximately 20,000 HHS staff (from 82,000 to 62,000 full-time employees), with cuts affecting the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Food and Drug Administration (FDA), and Centers for Medicare & Medicaid Services (CMS).
• Organizational Consolidation: Consolidation of the department’s 28 divisions into 15, and a reduction in the number of regional offices.
• Administrative Centralization: Proposed centralization of administrative functions (HR, IT, Procurement) across the department.
• Centralization of Messaging and Communications: Creation of the Assistant Secretary for Public Affairs and Office of the Assistant Secretary for Public Affairs, centralizing control over external communications.

B. Agency Mergers and Mission Shifts

• Formation of the Make America Healthy Again (MAHA) Commission: This commission was established by Executive Order 14212 and is led by the Secretary of HHS; it focuses on reversing trends in chronic childhood diseases by addressing poor diet, environmental toxins, insufficient physical activity, chronic stress, and overmedicalization. [5]
• Creation of the Administration for a Healthy America (AHA): A new entity to focus on “chronic illness, safe/wholesome food, clean water, elimination of environmental toxins,” formed by consolidating several key agencies focused on non-communicable diseases and primary care, including:
  • Health Resources and Services Administration (HRSA),
  • Substance Abuse and Mental Health Services Administration (SAMHSA),
  • Office of the Assistant Secretary for Health (OASH), and
  • National Institute for Occupational Safety and Health (NIOSH), which is to be moved from the CDC.
• Refocusing the CDC:
  • Reorientation primarily toward infectious disease, epidemics, and outbreak preparedness.
  • Elimination of over 60 programs, including those focused on cancer, diabetes, chronic disease prevention, global HIV/AIDS prevention, and global immunization.
  • Transfer of the Administration for Strategic Preparedness and Response to the CDC.
• ​Major Changes to the NIH:
  • Consolidation or realignment of several institutes and centers into an eight-institute structure.
  • Elimination of the National Institutes for Nursing Research, National Center for Complementary and Integrative Health, Fogarty International Center, and National Institute on Minority Health and Health Disparities.
  • Relocation of the Advanced Research Projects Agency for Health, previously housed within the NIH, to the Office of Science and Technology Policy.
• ​Other Reorganizations:
  • Merger of the Assistant Secretary for Planning and Evaluation with the Agency for Healthcare Research and Quality to create the Office of Strategy.
  • Elimination of the Administration for Community Living as a standalone agency, with its programs dispersed to other entities.​​

C. Funding Reductions and Reallocations​

• CDC and the Agency for Toxic Substances and Disease Registry (ATSDR): Reduced funding for the CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) by 53 percent compared to FY 2024, and reallocation of about one-quarter of the lost funding to the two newly proposed HHS divisions: AHA and the Office of Strategy.
• Public Health Programs and Funding Lines: Termination of more than 100 public health programs and funding lines for cancer, diabetes, heart disease, and stroke prevention; obesity and nutrition; global and domestic HIV/AIDS prevention; global immunization; and opioid-use disorder prevention and recovery.
• Elimination of the Prevention and Public Health Fund: Removing dedicated funding for prevention and public health programs, including grants to states, counties, cities, tribes, and health-related non-governmental organizations.

2. Cuts and Eligibility Changes to the Social Safety Net and Health Insurance

Along with the HHS restructuring, legislative and regulatory changes are redefining how Americans access and pay for health care and food. The 2025 Budget Reconciliation Act (the One Big Beautiful Bill Act) implements deep cuts and stricter eligibility criteria for social safety net and health insurance programs. [6]
​​
A. Medicaid and the Children’s Health Insurance Program (CHIP)

• Funding Reductions: A $1 trillion cut to federal Medicaid funding over 10 years.
• Work Requirements: Creation of a requirement for most Medicaid beneficiaries, requiring at least 80 hours per month of work, volunteering, or schooling.
• Exclusion of Immigrants: Restrictions on Medicaid eligibility for certain legally present immigrants, including those with temporary protected status and certain refugees/asylees.​
• Reduced Federal Matching Funds: Reduction of federal matching funds for provider payments and optional services offered by states.

B. Medicare

• Lower Medication Subsidies: Reduced Low-Income Subsidies for Medicare Part D prescription drugs.
• Stricter Eligibility: New restrictions limiting Medicare eligibility to U.S. citizens, green card holders, and specific legal immigrants.

C. Affordable Care Act Marketplace

• Tax Credit Removal: Failure to extend the expanded premium tax credits.
• Elimination of Automatic Plan Re-Enrollment: Requires individuals to manually re-enroll each year.
• Exclusion of Deferred Action for Childhood Arrivals (DACA) Recipients: Restrictions on DACA recipients' ability to purchase subsidized Marketplace coverage.

​D. Supplemental Nutrition Assistance Program (SNAP)

• Funding Reductions: States will have to cover 75% of administrative costs (up from 50%) in FY 2027.
  
• Elimination of SNAP-Ed: Eliminated funding for the SNAP-Ed nutrition education program.
• Stricter Work Requirements: Expansion of the time limit to individuals aged 55 through 64 and removal of exceptions for areas with high unemployment, veterans, homeless individuals, and certain young adults.
  
• Stricter Eligibility: New restrictions removing eligibility for SNAP benefits from refugees, asylees, and certain humanitarian parolees, and limiting the exemption for caring for a dependent to those with a child under 14.

​3. Shifts in Global Health Policy and Health-Related and Supporting Federal Agencies

Beyond HHS restructuring, several administrative, policy, and regulatory shifts in global health policy and health-related and supporting federal agencies are also reshaping the broader infrastructure of international and domestic public health collaboration and communication.

A. Withdrawal from the World Health Organization (WHO): Executive Order 14155, "Withdrawing the United States from the World Health Organization", directed U.S. withdrawal from the WHO, halts funding, and recalls personnel, reducing access to international data and coordination on global health crises. [7]

B. Withdrawal from International Climate Commitments: Executive Order 14162, "Putting America First in International Environmental Agreements," directed U.S. withdrawal from the Paris Agreement and other international climate commitments. [8]

C. Rescission of Prior Public-Health Orders: Executive Order 14148, “Initial Rescissions of Harmful Executive Orders and Actions,” revokes several previous directives related to climate change, immigration, and diversity, equity, and inclusion (DEI), including the Public Health Data Modernization Initiative and the federal task force on health misinformation. [9]

D. Elimination of Federal Funding for Public Broadcasting: Executive Order 14290, "Ending Taxpayer Subsidization of Biased Media," directs the Corporation for Public Broadcasting and all federal agencies to cease all direct and indirect federal funding to National Public Radio and the Public Broadcasting Service. [10]

E. Binary Gender Identity Definitions: Executive Order 14168, "Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government", redefines “sex” as strictly binary and biologically determined for all federal programs, prompting the removal of gender-identity fields from data collection. [11]

F. Ending DEI Programs: Executive Order 14151, "Ending Radical And Wasteful Government DEI Programs And Preferencing," calls for the defunding and dismantling of offices, positions, initiatives, plans, grants, contracts, and research related to DEI and environmental justice. [12]

G. Restoring Freedom of Speech: Executive Order 14149, "Restoring Freedom of Speech and Ending Federal Censorship," forbids federal employees from directly or indirectly (through third parties) inhibiting the free speech of Americans, including on online platforms. [13]

H. Preventing Federal Funding of Elective Abortion: Executive Order 14182, "Enforcing the Hyde Amendment," revokes Executive Orders 14076 and 14079 from the Biden Administration and bans the use of federal funds for elective abortions. [14]

I. Changes Across Health-Related and Supporting Federal Departments and Agencies:

• Department of Agriculture (USDA): Proposed 23% budget decrease (with reduction of funding and more than 15,000 employees from programs including the National Institute of Food and Agriculture, Rural Development Programs, Farm Production and Conservation-Business Center, National Forest System Management, Forest Service Operations, and Conservation Services and Programs) and an announced reorganization to relocate federal employees out of the Washington, DC area to five regional hubs, eliminate or consolidate several regional and administrative layers across multiple services and programs to align with those regional hubs, and consolidate administrative services and operations. [15], [16]
• Federal Emergency Management Agency (FEMA): Proposed cut of $646 million to FEMA grant programs, shift in disaster aid focus from non-disaster preparedness grants to the FEMA Disaster Relief Fund, elevation to a cabinet-level agency, and reform to agency structure and processes. [17], [18], [19]
• Department of the Interior (DOI): Proposed $5 billion in budget cuts (with $1 billion in cuts from the National Park Service, the elimination of funding for the Land and Water Conservation Fund, elimination of renewable energy programs, and over 2,000 layoffs), increased access for hunting and fishing on National Wildlife Refuge System and National Fish Hatchery System lands, increase in domestic energy (oil, gas, coal, and mineral) production, and the centralization of all federal wildland fire management to a new U.S. Wildland Fire Service (taking over wildland fire activities previously housed in the USDA's U.S. Forest Service). [20], [21]
• Department of Commerce (Commerce): Proposed $1.368 billion in budget cuts, including the elimination of the National Oceanic and Atmospheric Administration (NOAA)'s Office of Oceanic and Atmospheric Research (with a shift of some activities to the National Weather Service and the National Ocean Service) and the Minority Business Development Agency and a 12.3% cut to Current Surveys and Programs in the Census Bureau. [22]
• Department of Labor: Proposed $4.5 billion in budget cuts (with the reduction of more than 10,000 employees and the elimination of the Office of Federal Contract Compliance Programs) and the relocation of the Bureau of Labor Statistics into Commerce. [23]
• Environmental Protection Agency: Proposed $4.97 billion in budget cuts (with the elimination of 16 Categorical Grant Programs and significant cuts to the Clean Water and Drinking Water State Revolving Funds Programs, the Superfund Remedial Program, the Sustainable and Healthy Communities and Air and Energy research programs, and the Civil Enforcement Program and a reduction of 1,274 full-time equivalents (FTEs)) and broader deregulatory measures. [24]
• Department of Veterans Affairs: Proposed $42.2 billion budget increase (with funding increases for Medical Care programs, including the Expansion of Mental Health Residential Rehabilitation Treatment Programs, Pain and Opioid Management/Jason's Law Subtitle A, Rural Health Initiative, Substance Use Disorder, Suicide Prevention Outreach Programs, and Veterans Homelessness Programs, and for the Cost of War Toxic Exposures Fund) and commitment to Medical Care and Veterans Health Administration FTEs. [25]
• Department of Transportation: Proposed 7% budget increase, with increased funding for Federal Aviation Administration operations and infrastructure (including hiring up to 2,500 new air traffic controllers), for the Maritime Administration Port Infrastructure Development Program and Assistance to Small Shipyards, for Federal Railroad Administration Rail Safety and Infrastructure grants, and for the Federal Highway Administration and decreased funding for the National Electric Vehicle Infrastructure Formula and Charging and Fueling
  Infrastructure Grants programs. [26]
• Federal Trade Commission: Proposed $42.1 million in budget cuts, with a reduction of 135 FTEs, including 51 FTEs for the Bureau of Competition and 32 FTEs in the Bureau of Consumer Protection. [27]​

Last updated: October 30, 2025
First published: October 30, 2025