U.S. Department of Health and Human Services

U.S. Department of Health and Human Services (HHS), The Department of Health and Human Services is the executive division of the U.S. federal government responsible for programs and policies designed to improve public health and well-being. The immensity of the mandate can be seen in its 2026 budget of $2.7 trillion, or more than 28 percent of the entire federal budget—larger than those of the Treasury or Defense departments. Among the most prominent agencies that fall under the HHS umbrella are:

• Centers for Disease Control and Prevention
• Centers for Medicare and Medicaid Services (which accounts for 85 percent of HHS spending)
• Food and Drug Administration
• National Institutes of Health

History and evolution

The department as it is currently configured dates to 1980, when the Department of Health, Education, and Welfare (HEW) was split into two cabinet-level departments: the Department of Education and HHS. But the recognition of the need for the government to provide a measure of care for its citizens dates to 1798, when Pres. John Adams signed the Act for the Relief of Sick and Disabled Seamen, creating a network of hospitals to care for merchant seamen. Over the course of the next century, departments that would be the precursors to today’s National Institutes of Health and Food and Drug Administration were introduced. In 1912 the limited-scope organization Adams had created became known as the Public Health Service, to reflect its expanding portfolio.

In 1939, in recognition of the social safety net brought about by Pres. Franklin Roosevelt’s New Deal, the Federal Security Agency was born, intended to oversee matters involving health, education, and the fledgling Social Security program. In 1953 HEW came into existence under Pres. Dwight Eisenhower, and the department became the hub for many domestic issues. To allow for greater focus on national education priorities, Pres. Jimmy Carter created the Department of Education and established HHS. In 1995, again to allow for more focus within the sprawling department, Social Security became its own agency.

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HHS milestones

HHS and its precursors have played pivotal roles in health care initiatives both domestically and globally, including:

• Creation of Medicare and Medicaid: Signed into law by Pres. Lyndon Johnson in 1965 as part of his Great Society, the programs provided basic health insurance for older Americans (Medicare) and for low-income individuals and families (Medicaid).
• Eradication of smallpox: In 1966 a team of American doctors from the Centers for Disease Control and Prevention partnered with doctors from the Soviet Union and the World Health Organization with an audacious goal: the elimination of smallpox, a deadly and debilitating disease. In 1977 the last case of smallpox was reported, and by 1980 smallpox was the first infectious disease declared officially eradicated.
• Mapping the human genome: The project to understand the sequence of all human chromosomes began in 1990 under the National Institutes of Health and the Department of Energy. By 2003 and with worldwide support, 90 percent of the human genome was mapped, allowing for the exploration of new treatments for disease as well as the use of DNA in criminal investigations.
• Affordable Care Act rollout: The largest expansion of public health care since Johnson’s Medicare and Medicaid plan, the Affordable Care Act (also called Obamacare) was intended to provide insurance options for those without access through their employers, Medicare, or Medicaid. HHS was charged with implementing a broad and complex technical system. It did not go well. Launched on October 1, 2013, HealthCare.gov was plagued by site crashes, glitches, and the inability of people to get online to sign up. Kathleen Sebelius, the HHS secretary tasked with overseeing the rollout of Obamacare, admitted in 2014 that the rollout was “terribly flawed.”
• Operation Warp Speed: Beginning in May 2020, as the global COVID-19 pandemic was killing thousands of people a day, HHS, the National Institutes of Health, the Food and Drug Administration, and the Department of Defense teamed up with pharmaceutical makers to develop and produce a vaccine. By December people were receiving vaccines.

Controversies

The management of public health crises by the federal government has, at times, been seen as lax or even inhumane. Some of these incidents include:

• Tuskegee syphilis study: The U.S. Public Health Service conducted a study from 1932 to 1972 in which hundreds of Black men with syphilis were not adequately informed of their diagnosis and were denied effective treatment. The study became one of the most notorious examples of unethical human-subject research in American history and contributed to major reforms governing medical research and clinical trials.
• Polio vaccine mistake: While the rollout of the polio vaccine was heralded, in 1955 one production facility produced vaccines with live, instead of inactive, viruses. The result was some 40,000 cases of polio that left 200 children paralyzed and 10 dead. In response to the tragedy, the government instituted new oversight procedures and set up a way to compensate victims of vaccine mistakes.
• HIV/AIDS response: During the 1980s the Ronald Reagan administration’s slow response to the AIDS epidemic drew widespread criticism. President Reagan’s surgeon general, C. Everett Koop, became a public advocate for sharing information that could slow the spread of the deadly disease (including the use of condoms), a position that did not align with many of the conservative positions of the administration.
• Vaccine schedules: During the second administration of Pres. Donald Trump, schedules that had been developed over decades for what, how, and when children would be vaccinated were dramatically altered. The move came as Trump and HHS Secretary Robert F. Kennedy, Jr., expressed skepticism of the efficacy of vaccines as well as false linkages between vaccines and autism. This coincided with a decline in the percentage of school-age children receiving measles vaccines, as well as an uptick in the number of cases nationwide.

List of health and human services secretaries