Robert F. Kennedy Jr. was just a few weeks into his new job as health secretary in March 2025 when he unveiled a dramatic plan to remake the Department of Health and Human Services.
Kennedy quickly determined that the size and structure of his agency — which includes the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes for Health — was "incomprehensible." He said it was bloated and that explained why federal health officials had failed to improve Americans' health.
"We're going to eliminate an entire alphabet soup of departments and agencies while preserving their core functions," he said in a social media video. Those "core functions" would be preserved, he explained, "by merging them into a new organization called the Administration for a Healthy America or AHA."
The name plays off of Kennedy's "Make America Healthy Again" slogan.
Weeks into the second year of the second Trump term, many staff and departments of HHS have been eliminated in chaotic cuts handed down on April 1, 2025, but the Administration for a Healthy America does not yet exist.
There's no public information about when AHA might be created, and very little about what staff and programs it would include.
Not a normal process
The most recent public document from HHS about AHA was a budget request published in June. It says that the new agency will "focus on areas including primary care, environmental health, HIV/AIDS, maternal and child health, mental and behavioral health, and workforce development."
Those programs are spread out across health agencies, including at the Office of the Assistant Secretary for Health, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration and several centers at CDC.
Congress didn't include any money for AHA in the latest HHS funding bill. Staffers on committees with jurisdiction over HHS tell NPR there have not even been meetings with Kennedy's staff to help secure support for new funding or authorization to stand up the new agency in the future.
Instead, political appointees at HHS are holding secretive planning meetings about AHA, according to seven current and former employees at federal health agencies who spoke to NPR.
HHS would not answer NPR's questions for this story, but in a statement said that planning for AHA was still underway.
Behind the scenes, rushed and secretive meetings
At CDC in Atlanta, a senior official describes a constant demand for information about budgets, staff and public health work. It's not even clear who is asking for the data or what they plan to do with it, they say, but they understand it is related to AHA planning.
"All that you're told is that 'they' are asking for this information and they want it now — or they wanted it yesterday." The official asked NPR not to use their name because of fears of professional retribution for speaking publicly without authorization. "'They' can refer to a small circle of people around Kennedy that he trusts, who are either unnamed, or you'll receive a different name each time, so you're never really quite sure where the ask is coming from."
A different senior official at HHS, who also asked that NPR not to use their name for fear of professional retribution, echoed that description of political appointees connected to Kennedy holding "constant meetings in secret about what this new AHA is supposed to look like, but they don't share with anyone in the civil service." The source adds there are rumors that Kennedy's team is "going to stand up AHA in the next few months, like in the spring."
There's no public information about who is in charge of planning to create the agency, and HHS did not make anyone available to interview for this story.
"What does this mean?"
Dr. Karen Hacker says the process of restructuring HHS has been "like building and flying the plane at the same time," she says. When Kennedy began as secretary, Hacker was the director of CDC's National Center for Chronic Disease Prevention and Health Promotion. She was put on administrative leave on April 1 — along with thousands of others at HHS — then retired from CDC. She now works as an adjunct professor and health policy fellow at Emory University.
She says even though her center worked on chronic diseases, a central priority of AHA, her team was sidelined by the political appointees executing Kennedy's vision. "We never were asked about strategies for reductions, or about what would be best to move, or whether any of these programs were authorized [by Congress]," she says. "My center alone had over 40 line items with specific appropriations language."
None of that seemed to matter. A third of the staff in her center were cut during the April 1 reduction in force, and the entire center was slated to be eliminated in President Trump's 2026 budget, published in May. "I do remember having conversations about — 'What does this mean? Wait a second, are we not going to AHA?'"
Then and now, there are big logistical questions about how a center in Atlanta with hundreds of staff members and a $1.4 billion budget could become part of a new agency, possibly in Maryland or Washington, D.C.
When it comes to AHA, Hacker says: "The question remains — what are their plans? Are they planning to roll out a big reorg? Are they planning to consider other alternatives?"
A former secretary is "baffled"
If Kennedy and his team at HHS wanted to reorganize the Department of Health and Human Services and enlist Congress to authorize a new agency, the public would be seeing a very different process unfold.
When it comes to AHA, "there is no budget authority to create a new agency, there's no congressional framework for what that looks like, there's no staff numbers," says Kathleen Sebelius, the former governor of Kansas who served as health secretary under President Obama.
That lack of engagement with Congress, she says, also shows in Kennedy's disregard for lawmakers' intent when he eliminated staff and programs during the DOGE-fueled firings in April 2025.
"What I found when I was [secretary] is that a lot of the entities that seemed to me to be redundant had underlying congressional authorization — they passed a specific bill, it had specific appropriations — and in my day, with my president, we paid a lot of attention to that," she says. The firings directed by Kennedy and DOGE included many offices required by Congress that have not been reconstituted elsewhere at HHS, despite his promise that the "core functions" of the health agencies would be preserved.
"A lot of what I see at least in these restructuring documents under Secretary Kennedy just absolutely are baffling to me," Sebelius says. She mentions the plan to dismantle the Administration for Strategic Preparedness and Response (ASPR), which responds to natural disasters and pandemic threats, and the elimination of several HHS regional offices that states rely on.
Sebelius also has the perspective of having created a new agency during her tenure: the Administration for Community Living, which helps seniors and people with disabilities live at home.
"We took a year to have listening sessions to really bring a firm proposal," Sebelius says. "It ultimately was in a budget document, and had staff recommendations and jurisdiction recommendations."
She says by that time, "we had buy-in from — not only key members on the Hill — but key members in the communities across the country."
When it comes to the Administration for a Healthy America, "I don't see any of that going on," she says.
Incidentally, the Administration for Community Living is one of the entities slated to be dismantled as an independent agency and integrated into AHA.
Staff numbers confusion
While Trump administration officials work quietly on a plan to create an AHA entity at the agency without input or funding from Congress, the American public is left with health agencies diminished by a year of personnel cuts.
Exactly how much HHS has shrunk because of Kennedy's restructuring, DOGE-led buyouts, and retirements, is difficult to pin down. HHS has declined multiple requests from NPR to provide the current number of staff, but the stated goal when the reorganization was announced in March was to reduce the staff by 20,000 people or about 20% of the workforce.
When Kennedy took office, 88,731 staff worked across HHS, according to an official staffing plan from November 2024. The latest version of that plan, dated September 2025, shows 79,717 HHS employees, which represents a cut of only 10%.
It's not clear if that headcount includes staff whose firings have been blocked by the courts and are on administrative leave. Hacker, the former CDC center director, knows of employees who have been in that situation since April. "They're getting a paycheck, they're getting their benefits, they're just not working in their jobs," she says. Other staff who were fired have been brought back.
Just this week, 400 occupational safety staff at CDC who had been on administrative leave were suddenly ordered back to work without explanation. And about thousand HHS workers fired during the shutdown were brought back as part of a deal to reopen the government. They wonder if they'll be re-fired at the end of January when that deal expires.
All of the agencies that are slated to become part of AHA have had deep RIFs, or reductions in force, especially CDC and SAMHSA, the mental health and substance abuse agency. "There were people in my center [at CDC] that got riffed multiple times — some were brought back and then some were riffed again," says Hacker. "It's a very chaotic scenario."
An exercise in branding?
The current CDC official predicts that Kennedy and his allies will create a pilot or initiative at HHS "by hook or by crook" to be able to claim success in creating the Administration for a Healthy America. "They want things fast, they want it to be bright and shiny, they want to capture the attention of the public, and they want it to look like a success up front."
The official does not think it will be an actual new agency funded and backed by Congress. They think Kennedy will find teams and initiatives that were already happening at HHS related to nutrition, fitness and chronic disease prevention and "brand" them as "MAHA wins" to assert that the secretary accomplished the goals of the new AHA agency, without having to engage with Congress.
Sebelius is skeptical of the idea that Kennedy can create anything close to a new agency on his own. "You can do a lot on paper and play musical chairs all you want, but at the end of the day, they're gonna have to have some funding and some jurisdiction."
She says lawmakers in Congress are either going to buy into Kennedy's plan to create AHA or reject it. "It's really unclear to me what they're gonna do."
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