Health and Human Services, Department of

The roots of the Department of Health and Human Services (HHS) extend back to the health services of the nation's earliest years. In 1798 the first Marine Hospital, a forerunner of today's Public Health Service, was established to care for ailing seafarers. The National Institutes of Health (NIH)-an enormous complex of medical research centers in Bethesda, Maryland-sprang from a one-room laboratory that the federal government funded on Staten Island in 1887 to conduct research on disease. The NIH now constitutes the largest of HHS's 11 operating divisions.

Assuming cabinet-level status first as the Department of Health, Education, and Welfare (HEW) under President Dwight Eisenhower in 1953, HHS officially came into being on May 4, 1980, when the Department of Education Organization Act of 1979 split HEW into the Department of Education and the Department of Health and Human Services. HHS became the government's principal agency for protecting the health of all Americans and providing them with essential human services.

HHS's operating divisions address a broad scope of health and welfare needs. NIH is the world's premier research organization, supporting more than 35,000 research projects nationwide; the Food and Drug Administration, founded in 1906, inspects foods, cosmetics, and medicines to ensure safety; the Health Care Financing Administration administers the Medicare and Medicaid health insurance programs that provide health care to one out of four Americans. Encompassing more than 300 programs that range from providing early-education programs to children through Head Start to halting the spread of infectious diseases, HHS is the largest grant-making agency in the federal government, awarding more than 60,000 grants per year.

The other eight operating divisions of HHS are the Administration on Aging, Administration for Children and Families, Agency for Healthcare Research and Quality, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Health ReSources and Services Administration, Indian Health Service, and the Substance Abuse and Mental Health Services Administration.

The U.S. Department of Health and Human Services (HHS) officially opened on 4 May 1980 after the Department of Education Organization Act of 1979 removed the education components from the Department of Health, Education, and Welfare. As the federal government's chief organization for the provision of health care and social welfare services, in fiscal year 2002, HHS operated through eleven divisions, employed 65,000 people, and had a budget of $460 billion. Its major responsibilities included administering Temporary Assistance to Needy Families, a state-federal welfare program that succeeded the Aid to Families with Dependent Children program, and the Medicare and Medicaid health-care programs that reached about one in every four Americans.

The Federal Security Agency

The origins of the department go back to 1937, when the President's Committee on Administrative Management recommended that President Franklin D. Roosevelt be allowed to submit reorganization plans to Congress that would have the effect of law if Congress failed to act in sixty days. Although Congress refused to grant the president the power to create cabinet-level departments in this manner, it did allow him to start subcabinet agencies. Hence, in April 1939, Roosevelt sent Congress a reorganization plan that included the creation of the Federal Security Agency (FSA). The agency brought together the federal government's health, education, and welfare programs. In particular, it included the previously independent Social Security Board, which ran the nation's major social insurance and welfare programs; the public works programs of the New Deal; the Office of Education from the Department of the Interior; and the Public Health Service from the Department of the Treasury.

President Harry Truman tried and failed to elevate the FSA into a cabinet-level department of welfare. Congress decided not to enact the president's proposal in part because of fears that the FSA administrator, Oscar Ewing, would use the new department as a vehicle to promote the cause of national health insurance. In the meantime, the configuration of the department changed as the Food and Drug Administration was added from the Department of Agriculture in 1940 and the Children'S Bureau was added from the Department of Labor in 1946.

The Department of Health, Education, and Welfare

Although President Dwight Eisenhower was no supporter of national health insurance, he nonetheless submitted plans for the Department of Health, Education, and Welfare (HEW) in March 1953 and presided over the creation of the department in April. The name for the new department reflected in part the preferences of the Republican senator Robert Taft of Ohio, who strongly opposed starting a department of welfare and believed that an alternative, a department of human resources, sounded too totalitarian. Oveta Culp Hobby, the former commander of the Women's Air Corps and the publisher of the Houston Post, became the first secretary of health, education, and welfare. Her successors have included Marion Folsom (1955–1958), Arthur Flemming (1958–1961), John Gardner (1965–1968), and Elliot Richardson (1970–1973).

The most celebrated events during the life of HEW included the licensing of the Salk polio vaccine in 1955, the expansion of the social security program to include disability protection in 1956, the passage of major new welfare legislation to reorient Aid to Dependent Children (renamed Aid to Families with Dependent Children)from income maintenance to rehabilitation in 1962, the beginning of significant federal responsibility for funding the nation's public schools after enactment of the Elementary and Secondary Education Act of 1965, and the passage of Medicare and Medicaid in 1965. This last event created a major new federal presence in the area of health care finance and made the federal government the single largest health insurer in the country. Within HEW, it led in 1977 to the creation of the Health Care Financing Administration (HCFA), an important new operating agency that would hire more than four thousand employees by 1993. Along with the commissioner of social security, the director of the National Institutes of Health, the surgeon general, and the administrator of the Food and Drug Administration, the HCFA administrator became a prominent official within the department.

During the era of HEW, the Social Security program expanded to reach more people and pay more generous benefits to the elderly, people with disabilities, the families of the elderly and the disabled, and the survivors of workers who died before reaching retirement age. As one indication of its growth, the program collected $3.9 billion from the nation's workers in 1953 and $103 billion in 1980. Congress passed major social security legislation in 1954, 1956, 1958, 1965, 1968, 1969, 1971, and 1972, each time making the program more generous. During this same period, the federal government spent a growing amount of money to fund medical research. The budget of the National Institutes of Health, for example, grew at an annual rate of 30 percent during the 1950s and 1960s.

President Jimmy Carter supplied the impetus for breaking up HEW and starting the Department of Health and Human Services (HHS). Pressure to create a department of education came from the National Education Association, which had 1.8 million members and had endorsed Carter in 1976. Joseph A. Califano, Carter's choice as HEW secretary, tried to talk the president out of recommending the education department, arguing that it would only increase interest-group pressure on the president and that none of the groups that had studied government reorganization had recommended a federal department of education. Califano lost the internal argument within the Carter administration in part because of the enthusiasm of the Democratic senator Abraham Ribicoff of Connecticut, a former HEW secretary who had found the department to be unmanageable. Congress then agreed to create the Department of Education.

Health and Human Services in Operation

On 4 May 1980, Patricia Roberts Harris's job changed from secretary of HEW to secretary of HHS. She presided over a department with 140,000 employees and a budget of $226 billion. The structure of HHS in 1980 was the same as the structure of HEW in 1979, with only the Education Division and the vocational rehabilitation program missing. The four major operating agencies of HHS were the Office of Human Development Services, the Public Health Service, HCFA, and the Social Security Administration (SSA). Through February 2002, six people followed Harris in the job, including Otis R. Bowen, Louis Sullivan, and Tommy Thompson. During the 1980s, the major events at HHS concerned health care finance. President Ronald Reagan chose Richard Schweiker, a former U.S. senator, as his secretary of HHS. Schweiker worked on changing the way in which the federal government reimbursed hospitals under Medicare from retrospective, or payment after the fact based on costs, to prospective, or payment in advance determined by the diagnosis of the person being treated. Margaret Heckler, a former U.S. representative, took over on 9 March 1983 and implemented the reforms that Schweiker had put in place. She also coped with the political controversy surrounding the removal of thousands of people from the disability rolls maintained by HHS. The disability controversy related to a larger political dialogue over whether the Reagan administration had been fair in the cuts it had made in many social welfare programs as part of the Omnibus Budget Reconciliation Act of 1981.

During the 1990s, HHS lost one of its major operating agencies when the SSA became an independent entity on 31 March 1995. The Democratic Senator Daniel Moynihan of New York was a major sponsor of this legislation. The departure of SSA left the Public Health Service—with such major subdivisions as the National Institutes of Health, the Food and Drug Administration, and the Centers for Disease Control and Prevention—as the largest operating division of the department.

President William Clinton made health insurance and welfare reform his two priorities in the HHS realm. Despite a major publicity campaign and the active support of Donna Shalala, a former university president who served as his HHS secretary, the president failed in 1993 to get his health insurance proposals through Congress. He fared better with his initiative to end welfare as an open-ended entitlement and to substitute a program that left more discretion to the states than previously and made a job, rather than an income maintenance grant, the central objective of the welfare program.

Although presidents tried to highlight different issues at different times, the fact remained that HHS was the agency of the government responsible for federal policy in a bewildering number of areas, from curing and caring for those affected by acquired immune deficiency syndrome and leading public health campaigns to discourage people from smoking, to preserving the health insurance rights of people with disabilities, assessing the risk of cancer from additives to the nation's food supply, and assuring the long-range solvency of the Medicare program.

Bibliography

Altmeyer, Arthur J. The Formative Years of Social Security. Madison: University of Wisconsin Press, 1966.

Califano, Joseph A., Jr. Governing America: An Insider's Report from the White House and the Cabinet. New York: Simon and Schuster, 1981.

Miles, Rufus E. The Department of Health, Education, and Welfare. New York: Praeger, 1974.

Strickland, Stephen P. Politics, Science, and Dread Disease: A Short History of United States Medical Research Policy. Cambridge, Mass.: Harvard University Press, 1972.

Sundquist, James L. Politics and Policy: The Eisenhower, Kennedy, and Johnson Years. Washington, D.C.: Brookings Institution, 1968.