The CDC could shrink under a second Trump administration

Fueled by a distrust of the CDC’s handling of Covid-19 and the recommendations it made on measures like masking and vaccines, many conservatives want the agency dismantled — and hope a second Trump administration could make it happen.

Their proposed approach, outlined in the 2025 Presidential Transition Project offered by the conservative Heritage Foundation think tank, would drastically reduce the CDC’s size by splitting it in two: One agency responsible for public health surveillance work, like data collection on outbreaks, and another responsible for “limited” public health recommendations — with a strict firewall between them.

“We have to move away from social engineering and more towards good outcomes,” Roger Severino, former director of HHS’ Office for Civil Rights under the Trump administration, told POLITICO.

He lambasted the Biden administration’s focus on promoting health equity — particularly policies to protect transgender people from discrimination in health care — and doubling down on tackling Covid-19, by promoting masking and vaccination, for having a “harmful effect on the reputation of the CDC, and the public health apparatus as a whole.”

But such an agency reorganization could have far-reaching consequences on the CDC’s ability to offer strategies to prevent or mitigate the spread of disease and, according to one former CDC director, slow down its coordination when tracking and stymieing an outbreak.

“If you have different agencies, you're not going to make it easier to deal with an outbreak. You're going to make it harder to deal with an outbreak and you're going to reduce the likelihood that Americans will be resilient and healthy enough to withstand it,” said Dr. Tom Frieden, who led the CDC under the Obama administration.

‘Mission drift’

Conservative concerns about the CDC often focus on its scope. One expert at a conservative think tank, who was granted anonymity to speak about a conservative reform of the CDC, said the agency has had “massive mission drift” in the past 30 years and suggested a Trump administration would review all CDC functions to determine which programs could be moved to other departments.

One example, he said, is moving the National Institute for Occupational Safety and Health, which makes recommendations to prevent work-related illness — and was behind recommendations for face masks during the pandemic — to the Department of Labor.

Severino suggested major changes to CDC functions, particularly its data collection. He wants the agency to get rid of its reporting networks related to vaccine safety, fund studies on the “risks and complications of abortion,” and end data collection related to gender identity.

Severino argued that research on gender identity is “subjective."

The CDC collects this type of data now because it can help address health care disparities for LGBTQ+ people and, particularly for transgender patients, foster a more trusting provider-patient relationship.

“Without this information, lesbian, gay, bisexual, and transgender (LGBT) patients and their specific health care needs cannot be identified, the health disparities they experience cannot be addressed, and important health care services may not be delivered,” the CDC’s website says.

A second agency, Severino said, should cover public health, but must have a “severely confined ability to make policy recommendations.”

“By statute or regulation, CDC guidance must be prohibited from taking on a prescriptive character,” Severino wrote in the Heritage Foundation plan “For example, never again should CDC officials be allowed to say in an official capacity that school children ‘should be’ masked or vaccinated … Such decisions should be left to parents and medical providers.”

The CDC, which is overhauling some of its operations and leaning on trusted communicators like doctors to spread public health messaging, did not respond to requests for comment.

Frieden said there’s precedent for improving oversight of the agency but called the idea that the CDC should deal only with infectious diseases “very dangerous and very wrong.”

“We don't split up the military because it's too big. We don't split up corporations because they're too big,” he said. “Big organization needs a big management structure and also flexibility.

Frieden pointed to his leadership during the 2016 outbreak of Zika, a disease transmitted via mosquitoes that can cause birth defects. “To address Zika, I had to coordinate with our birth defect center, our environmental health center. … We couldn’t have done that unless [CDC] was one agency,” he said.

Frieden also pushed back on criticism from Republican circles that the agency makes recommendations for political reasons rather than for public health reasons.

“We have to be really clear: CDC makes very limited recommendations to the public. The CDC says, ‘Here’s what the science shows,’” he said. “CDC should be empowered to make those statements with no interference of any kind.”

‘May take a little longer’

Currently appointed directly by the president, CDC directors will need Senate confirmation starting in January, as Congress directed in a 2022 law.

Jennifer Kates, senior vice president at KFF, a health research group, said that will politicize the agency.

She also said she expects that a Trump-led CDC won’t request funds for some of President Joe Biden’s priorities, such as the agency’s program examining the impact of climate change on health.

Still, splitting the agency would require legislation, said Bill Hoagland, senior vice president at the Bipartisan Policy Center, a centrist think tank. “So, it may take a little longer,” he told POLITICO. “But it’s clear their intent is to really look at the CDC … so I would expect some real efforts here.”

If legislation doesn’t move fast enough, Hoagland said he could see the return of an executive order that the Trump administration issued in its first term: It designated certain civil servants in policy-related positions as “Schedule F” employees. That allows the administration to fire them more easily.

“If you can't legislatively move to split the CDC, you certainly can modify the staffing over there in such a way that you have political appointees,” Hoagland said.

‘The nature of them’

Other ways a Trump-led HHS could change the department is by proposing rules to narrow civil rights protections.

Severino has called for a shift toward restoring religious conscience rules. Those would make it easier for providers to refuse to provide abortions or dispense birth control, among other things.

Severino and other conservatives also oppose a 2022 Biden administration proposal to expand civil rights protections in health care, including a provision that says providers cannot discriminate against someone based on their gender identity.

If Biden doesn’t finalize the rule by sometime this summer, it could become subject to the Congressional Review Act, which allows Congress to rescind recent rules. If Trump wins the election along with a GOP Congress, any rules finalized later this year will be vulnerable.

“Rules, executive actions, and regulations can be changed: That is the nature of them,” said Michael Linden, who served as executive associate director of OMB during the Biden administration and is now senior policy fellow at the Washington Center for Equitable Growth, a grant-making group that promotes economic development.

But the courts could protect some.

The Biden administration, for example, has leaned on a 2020 Supreme Court decision upholding gender identity protections in the workplace.