Who’s Who in Public Health

Much of the federal public health bureaucracy is contained within the Department of Health and Human Services (HHS) and its component agencies. The Department of Veterans Affairs provides health care and benefits for veterans of the nation’s armed services.

A variety of components within HHS manage, implement, operate, and oversee the aspects of the public health bureaucracy. These include the Agency for Healthcare Research and Quality (AHRQ), Agency for Toxic Substances and Disease Registry (ATSDR), Administration for Strategic Preparedness and Response (ASPR), Centers for Disease Control (CDC), National Institutes for Health (NIH) and its National Institute of Allergy and Infectious Diseases (NIAID), Health Resources and Services Administration (HRSA), Centers for Medicare and Medicaid Services (CMS), Food and Drug Administration (FDA), and Surgeon General’s Office.

The activities of these HHS offices, divisions, and components generally fall into three areas: Guidance, Regulation, and Enforcement; Insurance and Care; and Research and Development.

Guidance, Regulation, and Enforcement: The public health bureaucracy interprets legislation passed by Congress and signed by the President to create rules that govern the behavior of participants in the health care industry – such as insurance providers, hospitals and other medical facilities, doctors, pharmaceutical companies, and others. These may take the form of formal regulations that can have the force of law, or informal guidance. The components involved in this aspect also may have the power to identify, investigate, and punish violations and violators of these rules. The components who primarily engage in guidance, regulation, and enforcement include: ASPR, HRSA, CDC, ATSDR, FDA and the Surgeon General’s Office.
Insurance and Care: Federal agencies oversee and operate programs that provide health insurance for people meeting certain criteria. Programs such as Original Medicare, Medicare Advantage, Medicaid, CHIP, Basic Health Plan, and ACA Exchanges are included among these. The passage of Obamacare created and expanded the reach and eligibility of several of these programs. The component primarily engaged in Insurance and Care is: CMS.
Research and Development: The federal government is one of the largest funders of health care research and development. NIH alone “invests most of its nearly $48 billion budget in medical research for the American people.” Federal funding is used not only for outside researchers but for research conducted by employees of federal agencies. HHS components whose mission includes funding and/or participating in Research and Development include: AHRQ, CDC, NIH, NIAID and the FDA.