The HHS layoffs.

I’m Isaac Saul, and this is Tangle: an independent, nonpartisan, subscriber-supported politics newsletter that summarizes the best arguments from across the political spectrum on the news of the day — then “my take.”

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Today's read: 14 minutes.

ICYMI.

Last Friday, Isaac wrote a members-only edition on why due process matters. The week before that, he wrote an edition defending California Gov. Gavin Newsom, and before that, our staff answered reader questions in a mailbag edition.

Quick hits.

1. President Donald Trump hosted Israeli Prime Minister Benjamin Netanyahu at the White House, the first meeting between Trump and a foreign leader since the president’s tariffs announcement on Wednesday. At present, no deal has been reached. (The meeting) Separately, President Trump announced that the United States would begin direct talks with Iran on its nuclear program; Iran confirmed a meeting is set for Saturday but referred to it as “indirect high-level talks.” (The announcement)
2. The Supreme Court voted 5–4 to lift a pair of orders by a federal judge that barred the government from deporting noncitizens designated as members of the Tren de Aragua gang. The majority said individuals can bring challenges to their removal orders as habeas corpus claims but must do so in Texas, the state where they are being held. (The ruling) Separately, the Supreme Court stayed a federal judge’s order requiring the Trump administration to bring a Salvadoran man deported in error back to the U.S. by Monday. (The pause)
3. President Trump said he would impose additional 50% tariffs on Chinese imports if China does not withdraw its 34% levy on U.S. imports announced on Friday. (The comments)
4. A federal appeals court voted 7–4 to temporarily reinstate two independent agency leaders fired by the Trump administration last month. The administration is expected to challenge the decision to the Supreme Court. (The ruling)
5. The stock market rebounded on Tuesday morning following three days of losses. The Dow Jones Industrial Average, S&P 500, and Nasdaq Composite were all up 2% on the day as of 12:00pm ET. (The latest)

Today's topic.

The HHS layoffs. On Tuesday, April 1, the Trump administration began large-scale layoffs at agencies across the Department of Health and Human Services (HHS). HHS Secretary Robert F. Kennedy Jr. said he expected to cut 10,000 jobs in addition to the thousands of workers who have already resigned or been placed on leave. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have been among the most impacted by the layoffs, with entire offices and divisions eliminated. 

Kennedy announced the cuts on March 27, describing them as a “dramatic restructuring” in accordance with the Department of Government Efficiency’s workforce optimization initiative. “We aren't just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy said. “This Department will do more — a lot more — at a lower cost to the taxpayer.”

As part of the department’s downsizing, HHS announced it would combine multiple agencies into a single entity to “improve coordination of health resources” for low-income Americans, the elderly, and people with disabilities. Additionally, it will designate an assistant secretary for enforcement to oversee investigations into waste, fraud, and abuse in federal health programs. HHS claimed the moves would save taxpayers $1.8 billion per year. 

Leaders within affected agencies have criticized the moves, warning that they could threaten public health and scientific research. “You’re making what was already a challenging job virtually impossible, and the consequence is that public health is going to suffer,” Mitch Zeller, a former director of the FDA’s Center for Tobacco Products said. Additionally, former FDA Commissioner Robert Califf wrote that “most of the leaders with institutional knowledge and a deep understanding of product development and safety [are] no longer employed.”

The FDA Offices of New Drugs, Policy & International Engagement, and Regulatory Programs were among the agencies experiencing the most significant cuts. At the CDC, entire divisions that worked on workplace health and safety, HIV, injury prevention, reproductive health, smoking, and violence prevention were cut. The staffs of the Low Income Home Energy Assistance Program, which provides financial assistance to Americans to help with their heating and cooling bills, and the Administration for Children and Families, which supports a litany of programs related to child welfare and safety, were also terminated. 

The cuts have disrupted some services provided by HHS, including government hotlines for reporting adverse events from foods, supplements, and cosmetics. Kennedy suggested some employees had been fired by mistake and said the department would rehire roughly 20% of the workers it had laid off and, but sources within HHS say no such plans are in place. 

On April 1, Sens. Bill Cassidy (R-LA) and Bernie Sanders (I-VT) invited Kennedy to participate in a committee hearing this Thursday on the restructuring efforts at HHS; Kennedy has yet to formally respond but won’t testify this week. HHS staff will brief the House Energy and Commerce Committee this week on the overhaul. 

Today, we’ll explore arguments from the left and right about the cuts at HHS. Then, my take.

What the left is saying.

• The left opposes the cuts, arguing they are poorly conceived and executed.
• Some suggest Kennedy will find HHS harder to reorganize than he expects.
• Others say the cuts will do lasting damage to the U.S. public-health system.

The Washington Post editorial board wrote “slashing the public health workforce hurts the U.S. economy.”

“HHS officials have defended their planned 25 percent reduction in force (affecting about 20,000 employees) as a means to achieve efficiency. They claim it will save taxpayers about $1.8 billion annually. But this amount — minuscule relative to the multitrillion-dollar federal budget — could be wiped out by the economic damage that comes from discarding broad institutional knowledge,” the board said. “HHS insists these layoffs will not weaken the agency’s core functions, especially drug approvals — but given how many high-level positions now sit vacant, this is hard to believe.”

“Meanwhile, hundreds of other layoffs at the agency’s research centers threaten to diminish its scientific prowess. The National Human Genome Research Institute, for one, which has made countless discoveries about the roles genes play in diseases, lost dozens of staffers as well as its acting chief,” the board wrote. “This turmoil comes amid the administration’s attempt to slash funding that NIH provides to outside research institutions. The administration seems not to care about U.S. investments in science that have been essential to building and maintaining a strong economy.”

In KFF, Drew Altman explored “the HHS reorganization.”

“HHS is no stranger to reorganization. HHS itself was born from a reorganization when education was split off from the Department of Health, Education, and Welfare, and became a separate cabinet agency,” Altman said. “Prior reorganizations at HHS were mostly dedicated to building new capabilities and the federal role in health… Secretary Kennedy’s reorganization breaks sharply with the past. It represents an effort to cut back the size and role of the department as part of broader administration-wide efforts to reduce the role of the federal government in health.

“What is most significant about the reorganization is not the many ways in which it moves boxes around on the organization chart, but the cuts in staffing levels that go along with that—from 82,000 to 62,000. No doubt HHS can get along with fewer staff in many areas or fewer regional offices, but cuts of that magnitude will have a profound effect on the scope and effectiveness of operations,” Altman wrote. “Some of the changes are directed at consolidating Public Health Service agencies into a new Administration for a Healthy America… It isn’t at all clear how their restructuring with a name change will reduce chronic diseases and their causes such as obesity and diabetes, without new initiatives and substantive redirection.”

In Bloomberg, Lisa Jarvis said “this isn’t how you make America healthy again.”

“We take for granted much of the good work done at agencies like the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Institutes of Health. And that’s how it should be. Those who work in public health like to say that when everything is going right, their work is invisible,” Jarvis wrote. “But we benefit daily from the tens of thousands of people working behind the scenes. We grab food out of the fridge without worrying that it might make our kids sick. We go into the medicine cabinet for our cholesterol medication without wondering if the capsule is contaminated — or if the drug works. When a family member is diagnosed with cancer or a rare disease, we trust that somewhere out there, scientists are working on a cure.”

“Across HHS, the elimination of support staff, including human resources, lawyers, communications teams and lab managers, along with the ongoing depletion of supplies, is paralyzing,” Jarvis said. “Because little information has been shared about the cuts, including the reasoning behind the decisions or even details of who is gone (a situation in direct opposition to Kennedy’s vow of ‘radical transparency’), it will take time to grasp the true scope of the damage. But what’s already clear is that it runs deep and that what’s left cannot be easily cobbled back into a functional health infrastructure.”

What the right is saying.

• The right mostly supports Kennedy’s reorganization plan, with many saying HHS has grown bloated and ineffective. 
• Some support the reduction in force but question the shakeup among agency leadership.
• Others say HHS is a perfect target for waste and efficiency reforms efforts. 

In Cato, Michael F. Cannon argued “downsizing HHS is the right thing to do.”

“Many HHS employees deserve to lose their jobs. To take just one example, when COVID-19 came to the United States, HHS employees crippled the public health response,” Cannon wrote. “While other nations were removing regulatory barriers to COVID-19 diagnostic tests, Food and Drug Administration officials increased regulatory barriers to those tests. Scientists called the FDA’s actions ‘insane.’ Private companies and government labs developed dozens of effective tests. FDA officials blocked them all. They did not loosen their grip until President Trump ordered them to stop blocking tests and to let states approve tests themselves.”

“Such institutional incompetence is pervasive at HHS. The department implements countless regulations and spending programs that do more harm than good. HHS enforces regulations that deny patients the right to make their own health decisions. It denies patients with life-threatening illnesses the right to choose their treatments, including treatments available in other countries,” Cannon said. “Kennedy’s cuts are substantial but reasonable. The layoffs he announced (10,000; 12 percent of workforce) are comparable to Clinton’s reductions at HHS (8,900; 13 percent) from 1993 to 1996… After Kennedy’s layoffs, HHS would still employ more people than it did when George W. Bush left office.”

The Wall Street Journal editorial board backed the cuts but criticized Kennedy’s personnel decisions.

“Mr. Kennedy grabbed headlines on Thursday by proposing to consolidate sundry HHS agencies and cut 20,000 jobs. The bloated department could use some shrinking. Most of his plan, such as refocusing the Centers for Disease Control and Prevention on its core mission of preparing for and responding to infectious disease outbreaks, isn’t radical,” the board wrote. “What is disturbing are news reports that Mr. Kennedy has tapped David Geier, a longtime vaccine critic, to assist with a CDC study of vaccines and autism.”

“Another concern is that Mr. Kennedy will create a brain drain at HHS as he pushes out scientists who don’t toe his antivaccine line. We warned last month that Mr. Kennedy might try to fire Peter Marks, the head of the FDA biologics division who helped shepherd President Trump's Operation Warp Speed for Covid vaccines in the first term,” the board said. “On Friday Mr. Marks resigned, which is especially regrettable since he pushed the FDA bureaucracy to accelerate life-saving therapies for children with rare genetic disorders.”

In National Review, Ryan Long said “a 21st century HHS should serve people, not bureaucracy.”

“For too long, HHS has been bloated, redundant, and misaligned with the real needs of the American people. HHS has ceased to be a responsive, effective steward of public health. Instead, it has grown into a slow-moving leviathan, riddled with redundancy and soaked in taxpayer dollars. A course correction — one that consolidates overlapping agencies with the intent of a more streamlined, mission-focused department, puts mission before empire, and outcomes before bureaucracy — is long overdue,” Long wrote. “The disparate agencies at HHS often have duplicative functions leading to siloed approaches to addressing the department’s mission.”

“The reorganization plan calls for a reduction of 6 percent of the NIH workforce. A large percentage of the current NIH roles are administrative, not research positions. The reorganization at NIH can help reduce the diversion of research dollars that are funding bureaucratic positions at the expense of money flowing into research,” Long said. “We live in the 21st century information age economy, but the HHS bureaucracy moves with the speed of a 19th century steamboat. The private sector and the American people understand that we must be constantly improving and becoming more efficient.”

My take.

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• These cuts won’t make HHS more efficient or meaningfully reduce its budget.
• Kennedy has always spoken genuinely about the need for public health reforms.
• Slashing personnel won’t fix our public health crises.

I’ve already seen some really disingenuous, genuinely unconvincing arguments for these cuts.

Let’s start with the HHS Secretary himself, Robert F. Kennedy Jr., who has described the cuts as part of an effort to improve the long-term efficiency of the agency. This is one of the things about the Department of Government Efficiency (DOGE) efforts I’ve never totally understood: They equate fewer people to greater efficiency, always and forever. That’s their formula. If you fire people, efficiency goes up.

That doesn’t make sense to me. For instance, if we want to get experimental drugs to the market faster and at lower cost without sacrificing safety, one way to do that would be to increase the number of scientists at the FDA working on drug approval. That way, fewer drugs get stuck waiting for approval and decisions come more quickly, which means companies can adjust in a more timely fashion. Plus, if great drugs are getting to market sooner, they’re saving more lives, and we’re saving untold amounts of healthcare costs.

However, Kennedy reportedly just slashed the workforce responsible for drug approvals, which seems likely to slow the approval process and harm patients and the market. In case that sounds like a partisan talking point, you can take it from Scott Gottlieb, the FDA commissioner from Trump’s first term, who said that these firings could bring “frustrating delays for American consumers, particularly affecting rare diseases and areas of significant unmet medical need.”

Another unconvincing argument is that these cuts are a necessary budgetary move. Bob Hoge at RedState implied that federal savings are the bottom line when he argued that slashing HHS staff is necessary “as our nation’s $36 trillion debt continues to grow.”  Yes, the national debt is huge, growing and needs to be addressed, but these personnel cuts won’t put a dent in our debt or deficit. The cuts amount to 0.1% of the entire HHS budget — a savings of $1.8 billion, or $6.87 per U.S. adult (if you were to assume all government revenue comes from taxes and all all those savings get returned to Americans, which they don’t).

These much heralded savings look even more ridiculous when you zoom out to see that President Trump — just yesterday — proposed the first-ever $1 trillion military budget. Additionally, Congressional Republicans are pushing a spending bill that will add trillions to the debt and deficit. In that context, pretending that cutting $1.8 billion through workforce reductions is going to do anything to balance the budget is either sheer fantasy or rank dishonesty. Even if the savings argument were in play, though, I think it’s worth paying an additional $6.87 in taxes a year to ensure a functioning system for approving new drugs or testing our food or even having experts on hand during major health crises. 

I’m even less confident in the plan when I read reports that “analysts responsible for studying ways to save money on prescription medicines” were laid off (how is that helping efficiency?), or that among the fired are people responsible for responding to Freedom of Information Act requests (Kennedy promised transparency), or — now standard for DOGE — that HHS was scrambling to rehire people they mistakenly fired in the first place, like officials responsible for monitoring lead exposure levels among children. If these cuts were really aimed at efficiency, they might have focused on redundant and controversial positions, or avoided easily preventable errors, or freed up funding for efficiency initiatives. But we didn’t get that.  

To me, the more compelling case for cuts like this — or for major reforms at the HHS — centers around our response to Covid-19. 

If the pandemic was a stress test for the government, then we flunked. A lot of liberals want to blame that all on Trump, but the truth is our public health officials, our Congress, and our literal pandemic preparedness teams all failed on multiple fronts — and their failures extended into the Biden administration. 1.2 million Americans died of or with Covid, our children were crushed by learning loss and anxiety, the CDC bungled its initial rollout of testing kits, and our national stockpile of masks and ventilators quickly depleted. Perhaps the most grievous failure of all was an utter breakdown of public communications, which started with the now notorious CDC flip-flop on the efficacy of masking and persisted as a general lack of trust in public health information throughout the pandemic. 

In a lot of ways, we got the worst of all worlds: A lot of death, long-term health issues, economic damage and societal fraying, all to achieve middling health outcomes and while spending an absurd sum on our response. Given all that, I find it totally reasonable that a new HHS Secretary could come into office and say “something has to change.” 

I have always understood RFK Jr.’s appeal as an unafraid changemaker. He sees our country's ills clearly: obesity, addiction, depression, anxiety, over-prescription of pharmaceuticals, and the crushing after effects of a world-altering pandemic. He also knows our health systems need major reforms. Candidly, I share those parts of his worldview, and I believe his actions here are meant to be a stand against the agencies that were supposed to keep us safe from those threats but failed. 

For me, though, this kind of action is where we diverge. I don’t blame our health agencies for Americans’ love of sugary drinks and tobacco — I blame Americans and advertising and corporations that pump soft drinks full of corn syrup. I don’t blame a communications director at the CDC for people trusting a Twitter influencer more than an immunologist, I blame the Twitter influencer and the information ecosystem that makes him famous. I happen to think the HHS, FDA, and CDC are still creating daily miracles for Americans that we take for granted. Deadly outbreaks of food contamination here are quite rare; advances in treatment for diseases like cancer have been miraculous; and perhaps most notably, we actually do pretty well fighting preventable diseases. 

When looking at the whole, I see a country that is failing mostly against chronic diseases (like heart disease) and diseases of despair (like addiction). But these are also diseases of freedom and poverty. Wealthier American consumers can access all the food and drugs they want, with few limits, while poorer Americans often have their choices reduced to cheap and unhealthy options. These challenges, to me, are not solvable by firing a bunch of scientists and communication directors at HHS.

Even if I think RFK Jr. has rightly identified some of our ailments, and even if I believe our health departments have earned a close look for reforms, running the DOGE playbook at HHS doesn’t make me feel like a great American health renaissance is coming. 

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Your questions, answered.

Q: Can you explain how federal courts allow judge shopping instead of a procedural rotation?

— Richard from Sacramento, CA

Tangle: Interestingly, and perhaps sadly, judge shopping occurs not instead of procedural rotation but in spite of it.

Let’s start with a definition of terms. First, federal courts have different levels: At the base level are 94 U.S. district courts, then 13 circuit courts above them, and one Supreme Court at the top. Second, procedural rotation — or assignment of federal judges to cases — is a process of assigning a judge from the jurisdiction where a suit is filed to that case. This can be done randomly or by assignment of the clerk of the court, but in either case that process prevents the prosecution from selecting their preferred justice. 

The process, in theory, works like this: A litigant who wishes to sue the federal government files a lawsuit in their specific court district. The court assigns one of its federal judges to the case, and after that judge issues their ruling it may be appealed to the circuit court. If they decide to hear an appeal, the same process would repeat up to the Supreme Court. This assures locality of initial review and authority of appeal.

However, this system has three loopholes that create the opportunity for judge shopping. First, litigants with resources and forethought commonly incorporate organizations in areas where they’re likely to have friendly judges. Second, court districts are also broken down into specialized divisions (areas of law), and some of those divisions have only one or two federal judges who can hear cases. Many districts randomize their federal judges across divisions, but many do not, making it easier to tailor a case to land in front of a specific judge. Third, not every U.S. district (or U.S. circuit) is the same, and every informed litigant knows the relative leanings of each district and where they’d be best suited to bring their case to optimize their chances of success.

As an example, the northern district of Texas does not randomize judges across divisions and has one federal judge for cases brought in the city of Amarillo. That judge, Matthew Kacsmaryk, who holds anti-abortion views, and many challenges to federal abortion law are designed to go through his court first. Judicial assignment isn’t preventing that — only more judges, assignment across divisions, closing incorporation loopholes, or changing court districts can actually prevent judge shopping.

Want to have a question answered in the newsletter? You can reply to this email (it goes straight to our inbox) or fill out this form.

Under the radar.

On Thursday, Russian Foreign Minister Sergei Lavrov said the country would supply arms and military training to a joint West African force of Mali, Niger, and Burkina Faso as part of a broader campaign to extend its influence in the region. The three nations signed a mutual defense pact in 2023, and their forces will now be trained by Russian military instructors. The Wagner Group, a mercenary organization linked to the Kremlin, has been operating in the region since 2021 as Russia has attempted to capitalize on political and social instability to cultivate anti-Western sentiments. Bloomberg has the story.

Numbers.

• $1.7 trillion. The Department of Health and Human Services’s (HHS) approximate budget for fiscal year 2024. 
• 80,000. The approximate number of HHS employees prior to the start of departmental reorganization efforts on April 1. 
• 2,400. The number of Centers for Disease Control and Prevention (CDC) employees expected to be laid off, roughly 18% of its staff. 
• 3,500. The number of Food and Drug Administration (FDA) employees expected to be laid off, roughly 20% of its staff. 
• 5 of 27. Of the total institutes within the National Institutes of Health, the number of directors who have been removed as part of HHS cuts. 
• +42%. The percent increase in full-time equivalent positions at HHS from 1996 to 2023, according to Cato. 
• +21%, +3%, and +8%. The percent increase in HHS’s workforce during the Obama administration, first Trump administration and first three years of the Biden administration, respectively. 
• 55%. The percentage of U.S. adults who say they have a “great deal” or “fair” amount of trust in the HHS to make the right recommendations on health issues, according to a January 2025 KFF poll.

The extras.

• One year ago today we wrote about six months of war in Gaza.
• The most clicked link in yesterday’s newsletter was the Supreme Court upholding cuts to teacher-training programs.
• Nothing to do with politics: A Nevada man was arrested after authorities seized seven “emotional support tigers.”
• Yesterday’s survey: 3,183 readers answered our survey on President Trump’s tariffs with 34% believing they’ll be enacted with some changes. “Trump will pretend to continue in full steam ahead’ mode, but will be unable to resist deals, allowing cracks to form in the big idea he is trying to push forward,” one respondent said.

Have a nice day.

Homelessness in the U.S. increased by 18% in 2024. However, a new program in Denver is succeeding in helping people find shelter by connecting them to support services focused on workforce training, mental health care, and substance misuse treatment. Since the All In Mile High initiative started, over 2,200 people have found shelter, and 857 have secured permanent housing. Recently, the initiative reached a striking milestone: successfully providing shelter for all veterans in the area. Good Good Good has the story.

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