HHS Milestones
HHS has a long, illustrious history beginning with the 1798 opening of the first Marine Hospital in Boston to care for sick and injured merchant seamen. Under President Abraham Lincoln, the agency that would become the Food and Drug Administration was established in 1862. The National Institutes of Health (NIH) dates back to 1887, and later became part of the Public Health Service. The 1935 enactment of the Social Security Act spurred the development of the Federal Security Agency in 1939 to direct programs in health, human services, insurance, and education. In 1946 the Communicable Disease Center, which would become the Centers for Disease Control and Prevention (CDC), was established, and almost twenty years later, in 1965, Medicare and Medicaid were enacted to improve access to health care for older, disabled, and low-income Americans. The same year, the "Head Start" program was developed to provide education, health, and social services to preschool-age children.
In 1970 the National Health Service Corps was established to help meet the health care needs of underserved areas and populations; the following year the National Cancer Act became law, which established cancer research as a national research priority. In 1984 the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), was identified by the U.S. Public Health Service and French research scientists. The National Organ Transplant Act became law in 1984, and in 1990 the Human Genome Project was initiated.
During 1994 NIH-funded research isolated the genes responsible for inherited breast cancer, colon cancer, and the most frequently occurring type of kidney cancer. In 1998 efforts were launched to eliminate racial and ethnic disparities (differences) in health, and in 2000 the human genome sequencing was published. In 2001 the Health Care Financing Administration (HCFA) was replaced by the Centers for Medicaid & Medicare Services, and HHS responded to the first reported cases of bioterrorism—the 2001 anthrax attacks—and developed new strategies to prevent and detect threats of bioterrorism.
FIGURE 4.1
HHS Agencies and Institutes Provide Comprehensive Health and Social Services
In addition to the CDC and NIH, the following HHS agencies research, plan, direct, oversee, administer, and provide health care services:
- Administration on Aging (AoA) provides services aimed at helping older Americans retain their independence. The AoA develops policies that support older adults and directs programs that provide transportation, in-home services, and other health and social services. In fiscal year 2004 the AoA had a budget of $1.4 billion and 120 employees.
- Administration for Children and Families (ACF) provides services for families and children in need, administers Head Start, and works with state foster care and adoption programs. ACF ran about sixty programs with a budget of $49 billion and 1,425 employees in 2004.
- Agency for Healthcare Research and Quality (AHRQ) researches access to health care, quality of care, and efforts to control health care costs. It also looks at the safety of health care services and ways to prevent medical errors. Figure 4.1 shows how AHRQ researches health system problems by performing a continuous process of needs assessment, gaining knowledge, interpreting and communicating information, and evaluating the effects of this process on the health problem. Figure 4.2 shows the process that transforms new information about health care issues into actions to improve access, costs, outcomes (what happens to patients as a result of the care they have received), and quality. AHRQ had a budget of $304 billion in fiscal year 2004 and 294 employees. AHRQ has invested $165 million in patient safety research and currently manages a patient safety research portfolio of more than one hundred projects.
FIGURE 4.2
- Agency for Toxic Substances and Disease Registry (ATSDR) seeks to prevent exposure to hazardous waste.
- Centers for Medicare & Medicaid Services (CMS) administer entitlement programs that provide health insurance for about seventy-five million Americans who are either age sixty-five or older or in financial need. It also operates the State Children's Health Insurance Program (SCHIP), which covers about ten million uninsured children, and it regulates all laboratory testing, except testing performed for research purposes, in the United States. CMS had a $453 billion budget in fiscal year 2004 and 4,586 employees.
- Food and Drug Administration (FDA) acts to ensure the safety and efficacy of pharmaceutical drugs and medical devices and monitors food safety and purity. The FDA had a budget of $1.7 billion in fiscal year 2004 and nearly 10,700 employees.
- Health Resource and Service Administration (HRSA) provides services for medically underserved populations such as migrant workers, the homeless, and residents in public housing. HRSA oversees the nation's organ transplant program, directs efforts to improve maternal and child health, and delivers services to persons with AIDS through the Ryan White CARE Act. More than eighteen hundred people work for HRSA; its fiscal year 2004 budget was $7.2 billion.
- Indian Health Service (IHS) serves more than 550 tribes through a network of forty-nine hospitals, 236 health centers, 309 health stations, and thirty-four urban Indian health centers. IHS employed 16,145 workers in 2004 and had a budget of $3.7 billion.
- Office of the Secretary of Health and Human Services (OSHHS) provides the department's leadership and oversees the eleven operating divisions of HHS. It also advises the president about health, welfare, human service, and income security issues.
- Program Support Center (PSC) administers operations, financial management, and human resources for HHS as well as other departments and federal agencies. The PSC staff of about twelve hundred processes approximately $200 billion in grant payments, provides personnel and payroll services for more than sixty-six thousand HHS employees, and performs accounting, management, information technology, and telecommunication services.
- Substance Abuse and Mental Health Service Administration (SAMHSA) seeks to improve access to, and availability of, substance abuse prevention and treatment programs as well as other mental health services. SAMHSA was budgeted $3.4 billion in fiscal year 2004 and had 546 employees.
HHS agencies work with state, local, and tribal governments as well as public and private organizations to coordinate and deliver a wide range of services including:
- Preventive health services such as surveillance to detect outbreaks of disease and immunization programs through efforts directed by the CDC and the NIH
- Ensuring food, drug, and cosmetic safety through efforts of the FDA
- Improving maternal and child health and preschool education in programs such as Head Start, which served more than nine hundred thousand children in 2004
- Preventing child abuse, domestic violence, and substance abuse, as well as funding substance abuse treatment through programs directed by the ACF
- Assuring delivery of health care services to nearly 1.6 million Native Americans and Alaska Natives through the IHS, a network of hospitals, health centers, and other programs and facilities
- Medicare (federal health insurance program for older adults and persons with disabilities) and Medicaid (state and federal health insurance for low-income people) are administered by the CMS
- Financial assistance and support services for low-income and older Americans, such as home-delivered meals ("Meals on Wheels") coordinated by the AoA.
SUBSTANTIAL BUDGET HELPS HHS TO ACHIEVE ITS OBJECTIVES. Figure 4.3 displays how the FY (fiscal year)
FIGURE 4.3
2005 HHS budget will be allocated, and Table 4.1 shows budgets for the HHS agencies during 2003, 2004, and 2005. More than 80% of the FY 2005 HHS budget is designated for the Medicare and Medicaid programs. The FY 2005 budget aims to provide additional funds to assist state and local public health agencies to protect the nation against bioterrorism. The budget also is intended to: increase access to care for three million people through 614 new and expanded health center sites; complete the doubling of the NIH budget; modernize and strengthen Medicare by provision of subsidized prescription drug benefits; advance welfare reform efforts by supporting the Temporary Assistance to Needy Families (TANF) program; and improve public health by intensifying prevention programs to reduce the occurrence of diabetes, asthma, and obesity. HHS agencies also plan to improve budget and management performance of the agencies and to add approximately 185 employees to their ranks in 2005.
THE U.S. PUBLIC HEALTH SERVICE COMMISSIONED CORPS. The uniformed service component of the early Marine Hospital Service adopted a military model for a group of career health professionals who traveled from one marine hospital to another as their services were needed. A law enacted in 1889 established this group as the Commissioned Corps, and throughout the twentieth century the corps grew to include a wide range of health professionals. In addition to physicians, the corps employed nurses, dentists, research scientists, planners, pharmacists, sanitarians, engineers, and other public health professionals. The corps assisted the Marine Hospital Service to prevent infectious diseases from entering
TABLE 4.1
| Health and Human Services budget by operating division, 2005 | ||||
| [Dollars in millions] | ||||
| 2003 | 2004 | 2005 | 2005 +/−2004 | |
| 1In fiscal year 2004 Temporary Assistance to Needy Families includes; 1) $2 billion for the Contingency Fund to remain available for five years; and 2) $500 million for employment achievement bonuses providing $100 million per year to the States. | ||||
| 2Public Health and Social Services Emergency Fund | ||||
| SOURCE: "HHS Budget by Operating Division," in Budget in Brief FY 2005, U.S. Department of Health and Human Services, June 2004, http://www.hhs.gov (accessed July 2, 2004) | ||||
| Food & Drug Administration: | ||||
| Program level | $1,652 | $1,695 | $1,845 | +$149 |
| Budget authority | 1,381 | 1,386 | 1,495 | +109 |
| Outlays | 1,395 | 1,333 | 1,466 | +133 |
| Health Resources & Services Administration: | ||||
| Budget authority | 6,741 | 6,695 | 6,099 | −596 |
| Outlays | 6,118 | 6,370 | 6,411 | +41 |
| Indian Health Service: | ||||
| Budget authority | 2,950 | 3,072 | 3,117 | +45 |
| Outlays | 2,942 | 2,899 | 3,202 | +303 |
| Centers for Disease Control & Prevention: | ||||
| Budget authority | 4,340 | 4,440 | 4,180 | −260 |
| Outlays | 4,563 | 4,096 | 4,446 | +350 |
| National Institutes of Health: | ||||
| Budget authority | 27,166 | 28,028 | 28,757 | +729 |
| Outlays | 22,916 | 25,913 | 27,983 | +2,070 |
| Substance Abuse & Mental Health Services: | ||||
| Budget authority | 3,138 | 3,234 | 3,429 | +195 |
| Outlays | 3,038 | 3,133 | 3,295 | +162 |
| Agency for Healthcare Research & Quality: | ||||
| Program level | 309 | 304 | 304 | 0 |
| Budget authority | 0 | 0 | 0 | 0 |
| Outlays | 203 | 0 | 0 | 0 |
| Centers for Medicare & Medicaid Services: | ||||
| Budget authority | 420,005 | 457,241 | 474,567 | +17,326 |
| Outlays | 414,438 | 453,003 | 482,088 | +29,085 |
| Administration for Children & Families: | ||||
| Budget authority1 | 47,305 | 49,016 | 46,640 | −2,376 |
| Outlays | 47,648 | 47,789 | 47,739 | −50 |
| Administration on Aging: | ||||
| Budget authority | 1,367 | 1,374 | 1,377 | +3 |
| Outlays | 1,367 | 1,313 | 1,377 | +64 |
| Departmental Management/Civil Rights/PHSSEF2: | ||||
| Budget authority | 2,669 | 2,558 | 2,698 | +140 |
| Outlays | 1,766 | 2,691 | 2,652 | −39 |
| Office of Inspector General: | ||||
| Budget authority | 37 | 39 | 40 | +1 |
| Outlays | 22 | 42 | 40 | −2 |
| Program Support Center: | ||||
| Budget authority | 380 | 393 | 402 | +9 |
| Outlays | 383 | 390 | 403 | +13 |
| Proprietary Receipts: | ||||
| Budget authority | −1,346 | −1,230 | −1,223 | +7 |
| Outlays | −1,346 | −1,230 | −1,223 | +7 |
| Total, Health & Human Services: | ||||
| Budget authority | $516,133 | $556,246 | $571,578 | +$15,332 |
| Outlays | $505,453 | $547,742 | $579,879 | +$32,137 |
| Full-time equivalents | 64,919 | 66,620 | 66,805 | +185 |
| Commissioned corps detalied outside HHS | 1,171 | 1,179 | 1,179 | 0 |
the country by examining newly arrived immigrants and directing state quarantine (the period of time and place where persons suspected of having contagious diseases are detained and isolated) functions.
By 1912 the Marine Hospital Service was renamed the Public Health Service (PHS) to reflect its broader scope of activities. Today PHS is part of the Department of Health and Human Services. PHS-commissioned officers played important roles in disease prevention and detection, acted to ensure food and drug safety, conducted research, provided medical care to underserved groups such as Native Americans and Alaska Natives, and assisted in disaster relief programs. One of the uniformed services in the United States (others are the Navy, Army, Marines, Air Force, and Coast Guard), the PHS Commissioned Corps continues to perform all of these functions and also identifies environmental threats to health and safety, promotes healthy lifestyles for Americans, and is involved with international agencies to help address global health problems.
In 2004 the PHS Commissioned Corps numbered approximately six thousand health professionals. These people report to the U.S. Surgeon General, who holds the rank of vice admiral in the U.S. PHS Commissioned Corps. Corps officers work in PHS agencies and at other agencies including the Bureau of Prisons, U.S. Coast Guard, Environmental Protection Agency, and the Commission on Mental Health of the District of Columbia. The Surgeon General is the physician appointed by the U.S. president to serve in a medical leadership position in the nation for a four-year term of office. The Surgeon General reports to the assistant secretary for health, and the Office of the Surgeon General is part of the Office of Public Health and Science. Sixteen surgeons general have served since the 1870s. In August 2002 Dr. Richard Carmona was sworn in as the seventeenth Surgeon General.
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