On Tuesday, May 20, 2025, The Century Foundation senior fellows Chiquita Brooks-LaSure and Carole Johnson, former administrator for the Centers for Medicare and Medicaid (CMS) and former administrator for Health Resources and Services Administration (HRSA), respectively, testified at Senate Democrats’ forum on the far reaching consequences of the Trump administration’s reckless HHS cuts and the impact of the House Reconciliation BiIl. Since taking office, President Donald Trump and Secretary of Health and Human Services Robert F. Kennedy Jr. have tried to cut health care investments everywhere from Alzheimer’s and cancer treatment to the experts that track illnesses and pandemics.
Below are the testimonies as prepared for delivery for Chiquita Brooks-LaSure and Carole Johnson on how those cuts impact Americans across the country. Video from the event is available here.
Chiquita Brooks-LaSure’s remarks as prepared for delivery:
Thank you for inviting my fellow colleagues and me to speak today about the impact of the HHS workforce cuts on our respective agencies.
I could talk at length about the harm these cuts will have on the Centers for Medicare and Medicaid Services’s current operations. However, I believe it is my duty to instead discuss these cuts in the context of the House Reconciliation Bill that poses a greater threat to the functioning of both Medicaid and the Affordable Care Act Marketplaces, and by extension, the people these programs serve.
The Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) estimate that at least 14 million people will lose their health coverage as a result of the House Reconciliation Bill—a number that I suspect could be greater when we account for CMS staff reductions that could hinder oversight.
The current proposals drown both Medicaid and the Affordable Care Act (ACA) Marketplace in excessive red tape that will hurt everyone, including seniors, mothers, children and those with disabilities, and cause more uncertainty, more churn, and more people delaying lifesaving treatments.
We have already learned this lesson. After the pandemic, many children eligible for Medicaid and the Children’s Health Insurance Program (CHIP) lost their coverage from difficult renewal processes that required a coordinated effort from states, health plans, advocates and CMS to get them reenrolled. A Harvard study on Arkansas work requirements found that 95 percent of Medicaid enrollees met work requirements, were in school, or otherwise exempt, and yet, 30 percent lost coverage. And if these people lose their Medicaid, they will only face more red tape trying to enroll in Marketplace coverage.
In fact, the current provisions in the bill will drastically destabilize and lower the competition necessary for the Marketplace to provide adequate coverage to the over 24 million people enrolled. At the same time, if enhanced tax credits expire, premiums could increase by over 75 percent. Many of these proposals would take effect in a little over six months.
One of the proposals is ending Marketplace auto-reenrollment, which requires all Marketplace consumers to actively reverify eligibility for health care coverage every year.
This could destroy the market and make it unattractive for plans and providers to participate. No other insurance market does this—not employer sponsored, not auto insurance—none.
And as people try to navigate through this red tape, CMS has fired the very people who were hired to help consumers, like the over 100 staff members fired from CMS’s Office of Program Operations and Local Engagement, Marketplace navigators and Marketplace probationary staff.
The bill also includes a provision that eliminates the cap on the dollar amount the IRS can recapture for individuals who overestimate their income and are covered through the Advanced Payments of the Premium Tax Credit (APTC).
We design APTC coverage to be predictive rather than retroactive because if people only received these dollars at the end of the tax year, most would never be able to purchase health insurance to begin with. And we put these caps on what can be reconciled because it’s hard to predict your income if you’re self-employed or in a seasonal or hourly job.
For context, if a single woman opens her own bakery and predicts she will make an income of $25,000 a year but receives more business than expected that increases her income to $40,000, she will now owe almost $1,700 when she files her taxes, a 78 percent increase. For people starting a new business, this amount of money can be critical for their business’s success.
The proposals in the House Reconciliation bill that target both Medicaid and the Marketplace seek to undermine the very progress that the Affordable Care Act sought to achieve in making our health care system more affordable and accessible to everyone regardless of their income or health needs. The bill aims to increase friction in the health care system for enrollees and does so at the same time that many of the staff, who could help reduce this friction, were fired.
These changes will hurt not just the millions of people that rely on those programs, but our entire health care system.
Carole Johnson’s remarks as prepared for delivery:
Senators Welch, Baldwin, and members of the Caucus, thank you for convening today’s discussion to shine a light on the dramatic changes occurring at the Department of Health and Human Services and the implications for the health and well-being of all Americans.
I am Carole Johnson. From January of 2022 to February of 2025, I served as the administrator of the Health Resources and Services Administration.
The Trump administration has announced its intention to eliminate HRSA, and the president’s proposed budget for Fiscal Year 2026 zeroes it out.
To put that in perspective, HRSA is the HHS agency that:
- supports federally qualified health centers that provide health care services to 32 million people in the nation’s highest need communities;
- trains and deploys tens of thousands of new physicians, nurses, dentists, mental health and substance use disorder providers, and other health professionals annually;
- helps rural hospitals remain viable and builds physician training capacity in rural areas;
- provides lifesaving drugs and treatment to more than half of a million people living with HIV; and
- leads the fight to combat maternal mortality, including running the national maternal mental health hotline, which has answered more than 50,000 calls and texts.
Rather than strengthen this essential safety net, the Trump administration is prioritizing dismantling it. The Trump administration has already slashed health center program staffing, put the widely acclaimed pediatrician who oversaw maternal and child health programs on leave, fired the transplant surgeon recruited to help reform the nation’s transplant system, and eliminated entire offices that are essential to any organization—like HR and communications.
The grantee impacts are growing rather than abating. Community-based groups with small margins have experienced delays and confusion accessing the HHS payment portal for funding that was already awarded. Grantees received a series of confusing and conflicting notices that were issued and then withdrawn about what the Trump administration deemed an allowable grant expense. Now there is uncertainty about whether the Trump administration will follow through with Congress’ intent to continue FY2024 funding into FY2025 for current grantees.
And, of course, there are the challenges that have resulted from skilled HRSA staff being fired and critical work being disrupted, including, for example, the firing of the staff that managed the National Maternal Mental Health Hotline, the firing of the technology experts who were implementing Congress’ vision of a modernized organ transplant network, and the firing of the entire team that has been working with health centers to revolutionize how health care quality data is reported and used. It appears that the remaining HRSA teams are doing the best they can and developing interim workarounds to keep key initiatives afloat, but these dedicated public servants can only do so much when the headwinds are against them.
Although there is no public plan detailing the proposal, the Trump administration has said that it intends to create an Administration for a Healthy America, which they say will salvage some HRSA functions. However, a few examples of the many HRSA programs set to be completely eliminated in the President’s FY 2026 budget proposal, are those that:
- Address health care workforce shortages. I was proud that during our tenure we grew programs to train new physicians including in Senator Baldwin’s home state where we funded our first rural obstetrics and gynecology residency program at the University of Wisconsin, as part of our comprehensive approach to helping to address maternity care deserts in rural areas. The Trump administration intends to eliminate this and many other health workforce programs.
- Tackle the maternal mortality crisis. HRSA launched the first of its kind, maternal health research collaborative of and by the communities most impacted by the maternal mortality crisis, led by Morgan State University in Senators Alsobrooks and Van Hollen’s home state and including Morehouse, Meharry, Tennessee State, and other MSIs. The Trump administration would shutter it.
- Keep rural hospitals open. In Senator Welch’s home state of Vermont, the HRSA funded State Office of Rural Health is the one-stop shop on all things rural, leveraging HRSA rural hospital programs to help the states’ critical access hospitals survive and build capacity to remain viable. The Trump administration would end all of these rural programs.
- Help new moms and babies thrive. HRSA provides high-touch supports to pregnant and new moms in high need communities. Moms from Maryland to Georgia and Illinois to Arizona talk about the transformational power of the Healthy Start program. The Trump administration intends to eliminate it.
The rest of the elimination list is long and includes work on autism, sickle cell, ending the HIV epidemic, training new nurses, mental health providers, geriatricians and much more. Of note, many of these initiatives were supported by the president in his first term.
If the Trump administration has its way, HRSA will cease to exist and the families and communities in your states that most need this help will lose it just as the majority looks to make it harder for them to get and keep Medicaid coverage. The safety net may never have been more fragile than it is at this moment.
Thank you for the opportunity to join this conversation with my colleagues today. I also would like to share my appreciation for the remaining HRSA team navigating the current uncertainty and trying their best to continue the mission. I look forward to your questions.
Tags: medicare, donald trump, Department of Health and Human Services, reconciliation, senate democrats forum
TCF Senior Fellows Chiquita Brooks-LaSure and Carole Johnson Testify at Senate Democrats’ Event Spotlighting Reckless HHS Cuts
On Tuesday, May 20, 2025, The Century Foundation senior fellows Chiquita Brooks-LaSure and Carole Johnson, former administrator for the Centers for Medicare and Medicaid (CMS) and former administrator for Health Resources and Services Administration (HRSA), respectively, testified at Senate Democrats’ forum on the far reaching consequences of the Trump administration’s reckless HHS cuts and the impact of the House Reconciliation BiIl. Since taking office, President Donald Trump and Secretary of Health and Human Services Robert F. Kennedy Jr. have tried to cut health care investments everywhere from Alzheimer’s and cancer treatment to the experts that track illnesses and pandemics.
Below are the testimonies as prepared for delivery for Chiquita Brooks-LaSure and Carole Johnson on how those cuts impact Americans across the country. Video from the event is available here.
Chiquita Brooks-LaSure’s remarks as prepared for delivery:
Thank you for inviting my fellow colleagues and me to speak today about the impact of the HHS workforce cuts on our respective agencies.
I could talk at length about the harm these cuts will have on the Centers for Medicare and Medicaid Services’s current operations. However, I believe it is my duty to instead discuss these cuts in the context of the House Reconciliation Bill that poses a greater threat to the functioning of both Medicaid and the Affordable Care Act Marketplaces, and by extension, the people these programs serve.
The Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) estimate that at least 14 million people will lose their health coverage as a result of the House Reconciliation Bill—a number that I suspect could be greater when we account for CMS staff reductions that could hinder oversight.
The current proposals drown both Medicaid and the Affordable Care Act (ACA) Marketplace in excessive red tape that will hurt everyone, including seniors, mothers, children and those with disabilities, and cause more uncertainty, more churn, and more people delaying lifesaving treatments.
We have already learned this lesson. After the pandemic, many children eligible for Medicaid and the Children’s Health Insurance Program (CHIP) lost their coverage from difficult renewal processes that required a coordinated effort from states, health plans, advocates and CMS to get them reenrolled. A Harvard study on Arkansas work requirements found that 95 percent of Medicaid enrollees met work requirements, were in school, or otherwise exempt, and yet, 30 percent lost coverage. And if these people lose their Medicaid, they will only face more red tape trying to enroll in Marketplace coverage.
In fact, the current provisions in the bill will drastically destabilize and lower the competition necessary for the Marketplace to provide adequate coverage to the over 24 million people enrolled. At the same time, if enhanced tax credits expire, premiums could increase by over 75 percent. Many of these proposals would take effect in a little over six months.
One of the proposals is ending Marketplace auto-reenrollment, which requires all Marketplace consumers to actively reverify eligibility for health care coverage every year.
This could destroy the market and make it unattractive for plans and providers to participate. No other insurance market does this—not employer sponsored, not auto insurance—none.
And as people try to navigate through this red tape, CMS has fired the very people who were hired to help consumers, like the over 100 staff members fired from CMS’s Office of Program Operations and Local Engagement, Marketplace navigators and Marketplace probationary staff.
The bill also includes a provision that eliminates the cap on the dollar amount the IRS can recapture for individuals who overestimate their income and are covered through the Advanced Payments of the Premium Tax Credit (APTC).
We design APTC coverage to be predictive rather than retroactive because if people only received these dollars at the end of the tax year, most would never be able to purchase health insurance to begin with. And we put these caps on what can be reconciled because it’s hard to predict your income if you’re self-employed or in a seasonal or hourly job.
For context, if a single woman opens her own bakery and predicts she will make an income of $25,000 a year but receives more business than expected that increases her income to $40,000, she will now owe almost $1,700 when she files her taxes, a 78 percent increase. For people starting a new business, this amount of money can be critical for their business’s success.
The proposals in the House Reconciliation bill that target both Medicaid and the Marketplace seek to undermine the very progress that the Affordable Care Act sought to achieve in making our health care system more affordable and accessible to everyone regardless of their income or health needs. The bill aims to increase friction in the health care system for enrollees and does so at the same time that many of the staff, who could help reduce this friction, were fired.
These changes will hurt not just the millions of people that rely on those programs, but our entire health care system.
Carole Johnson’s remarks as prepared for delivery:
Senators Welch, Baldwin, and members of the Caucus, thank you for convening today’s discussion to shine a light on the dramatic changes occurring at the Department of Health and Human Services and the implications for the health and well-being of all Americans.
I am Carole Johnson. From January of 2022 to February of 2025, I served as the administrator of the Health Resources and Services Administration.
The Trump administration has announced its intention to eliminate HRSA, and the president’s proposed budget for Fiscal Year 2026 zeroes it out.
To put that in perspective, HRSA is the HHS agency that:
Rather than strengthen this essential safety net, the Trump administration is prioritizing dismantling it. The Trump administration has already slashed health center program staffing, put the widely acclaimed pediatrician who oversaw maternal and child health programs on leave, fired the transplant surgeon recruited to help reform the nation’s transplant system, and eliminated entire offices that are essential to any organization—like HR and communications.
The grantee impacts are growing rather than abating. Community-based groups with small margins have experienced delays and confusion accessing the HHS payment portal for funding that was already awarded. Grantees received a series of confusing and conflicting notices that were issued and then withdrawn about what the Trump administration deemed an allowable grant expense. Now there is uncertainty about whether the Trump administration will follow through with Congress’ intent to continue FY2024 funding into FY2025 for current grantees.
And, of course, there are the challenges that have resulted from skilled HRSA staff being fired and critical work being disrupted, including, for example, the firing of the staff that managed the National Maternal Mental Health Hotline, the firing of the technology experts who were implementing Congress’ vision of a modernized organ transplant network, and the firing of the entire team that has been working with health centers to revolutionize how health care quality data is reported and used. It appears that the remaining HRSA teams are doing the best they can and developing interim workarounds to keep key initiatives afloat, but these dedicated public servants can only do so much when the headwinds are against them.
Although there is no public plan detailing the proposal, the Trump administration has said that it intends to create an Administration for a Healthy America, which they say will salvage some HRSA functions. However, a few examples of the many HRSA programs set to be completely eliminated in the President’s FY 2026 budget proposal, are those that:
The rest of the elimination list is long and includes work on autism, sickle cell, ending the HIV epidemic, training new nurses, mental health providers, geriatricians and much more. Of note, many of these initiatives were supported by the president in his first term.
If the Trump administration has its way, HRSA will cease to exist and the families and communities in your states that most need this help will lose it just as the majority looks to make it harder for them to get and keep Medicaid coverage. The safety net may never have been more fragile than it is at this moment.
Thank you for the opportunity to join this conversation with my colleagues today. I also would like to share my appreciation for the remaining HRSA team navigating the current uncertainty and trying their best to continue the mission. I look forward to your questions.
Tags: medicare, donald trump, Department of Health and Human Services, reconciliation, senate democrats forum