Pod Insights Civics 101 What can (and can't) the Secretary of Health and Human Services do? About this episode Former HHS Secretary Kathleen Sebelius talks about the powers - and limits - of the role in the wake of President-elect Donald Trump's pick of RFK Jr. for the role. This episode was brought to us by the podcast Tradeoffs, hosted by former NHPR health reporter Dan Gorenstein.
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Transcript Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.
0:00 Nick Capodice? This is Civics 101. I'm Nick Capodice. The HSS, that is the US Department of Health and Human Services, they oversee Medicare, Medicaid, and the Affordable Care Act. HHS regulates the medicines we take, funds groundbreaking research, and sets recommendations for the vaccines we give our kids. And two weeks ago-
0:22 Speaker 01 President-elect Donald Trump promised to shake up Washington, and he is doing just that as he staffs up his administration.
0:28 Nick Capodice? President-elect Donald Trump has announced he is nominating a controversial pick, a vaccine skeptic who has repeatedly pushed debunked science, to run the department.
0:37 Speaker 02 Robert F. Kennedy Jr. is Mr. Trump's pick for Secretary of the Health and Human Services Department.
0:43 Nick Capodice? Now, unless the new president can get around it, one way or another, Kennedy's nomination is headed to the Senate for a vote. It is that body who will decide whether or not to give RFK Jr. the position, and therefore the power, to influence the health of the country.
0:59 Speaker 03 The secretary is in a position to do a lot of good, but also potentially do a lot of harm.
1:06 Nick Capodice? Today, we're bringing you a conversation with former HHS Secretary Kathleen Sebelius about what the country's top health official can do, what they can't do, and what RFK Jr. would have to do to implement his agenda. The episode you're about to hear was brought our way by our friends at Tradeoffs. It is a podcast about healthcare and the systems behind it. The podcast is hosted by former NPR health reporter Dan Gorenstein, and we will hear his conversation with Kathleen Sebelius about the role of HHS secretary and the limitations they face on this edition of Civics 101. Haven't you out there ever Googled your own name, like, actually done it?
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4:12 Speaker 03 I'm Kathleen Sebelius. I served as Governor of Kansas from 2002 until 2009, when I was appointed by President Barack Obama to lead the Department of Health and Human Services and served in that position for five and a half years.
4:33 Speaker 04 And Secretary, you know, I was driving my teenage son to school. Actually, he was driving me this morning, and I was telling him that we're going to interview you today. And I realized that I didn't know exactly how to describe what the HHS Secretary does. Obviously, it's a hugely important job. From your perspective, what is the job? What is its purpose?
5:02 Speaker 03 Well, HHS is one of the biggest domestic agencies and really connects with people from birth to death. The HHS budget is about $1.7 trillion. We send more money to states than all the other domestic agencies combined. And there are about, you know, 85,000 employees, both in the United States and around the globe. And I'd say the Secretary really is making sure that each of the spokes of that wheel are operating well and also is the public spokesperson for health and wellness, not only in America, but around the world,
5:42 Speaker 03 because America has a huge role in global health and in partnering with other countries.
5:49 Speaker 04 And Secretary, do you remember a time when your management skills were the difference in how much power you were able to exert in this role?
5:59 Speaker 03 Well, I would say that the role of Secretary is winning hearts and minds because I can guarantee you, nothing gets done in a federal agency unless a lot of the workers in that agency believe that they're part of the mission. So I spent a good deal of time at the beginning of my tenure, literally physically visiting each and every agency. CDC is in Atlanta, so going to Atlanta, you know, being there for two days, wandering around, having lunch with people on the ground. I could never have done the job with any measure of Success without learning something from really talented people, having people come forward and say, you know, you may not have thought about this, but how about this?
6:43 Speaker 03 That kind of management, I think, in any big organization works well. Not that you arrive with the answers, but that you actually learn something about the organization that you're asked to lead.
6:56 Speaker 04 Secretary, I'm really curious about the contours of the power that comes with this position. It seems like I've heard sort of like conflicting descriptions of the power. Like, on the one hand, there's the quote from former Trump HHS Secretary Alex Azar, who said, "The secretary has a shocking amount of power by the stroke of a pen." And on the other hand, you've got these former federal health officials pointing out that the department is made up of 80,000 employees. One even joked it took the FDA 15 years to define peanut butter. You've had this job. How powerful is this position?
7:37 Speaker 03 It can be wildly powerful and un-powerful at the same time. Most of the power in the agency, most of the administrative authority, comes from laws that Congress has passed. And the agency is then asked to write rules and regs and implement those laws. What I found out is that there were a lot of areas where the agency had administrative power that they had never used. So, for instance, when President Obama no longer had a sympathetic Congress, we were all asked to look at our administrative authority and figure out where we could go on various issues. And one of the areas that frankly was identified within HHS was a lot of opportunity to make
8:21 Speaker 03 a difference with LGBTQ citizens in the United States. I mean, across the board, there were rules and regs in place that were very limiting. So we began to redefine what a family member was. This was well before the marriage decision in Supreme Court and others. But we had partners who had been longtime living together and were not allowed to visit each other in a critical care unit in a hospital because they weren't a member of a family. So things like that, that you could actually move policy, longstanding policy, you could rescind what a previous administration had done. You could redefine terms that had a huge impact on people.
9:06 Speaker 03 And that could be done all administratively, not by going back to Congress.
9:10 Speaker 04 You've got, as HHS secretary, a boss. It's the President of the United States. That's clearly one of the checks on the power of this position. What are other checks, secretary, that you discovered once you occupied this position?
9:29 Speaker 03 Well, certainly what the President wants and needs and wants to drive is one, as you say. I would say there is a congressional check where lots of committees in the House and the Senate have jurisdiction over pieces of the Department of Health and Human Services. In fact, to the point that the secretary has to go through two Senate confirmation hearings, one with the Finance Committee and one with the Help Committee. That's gobbledygook to a lot of people, but it just means that there are lots of congressional committees, there are three in the House and two in the Senate with big interest in what's going on at HHS. And so they can have hearings on a regular basis.
10:11 Speaker 03 They do what's called oversight, calling the secretary in, calling the department in, why are you doing this or that, challenging authority. And then there's a whole legal system that can sue the department. The FDA is very used to that. I mean, anytime they would issue, for instance, a tobacco regulation, tobacco companies would immediately file a lawsuit and slow that down or stop it. When there's any kind of cut suggested to the hospital system, the hospital association immediately goes to court. So I would say court, Congress, and the President operate as guardrails around the secretary's power.
10:51 Speaker 04 When we come back, Secretary Sebelius explains the barriers RFK could face to implementing his agenda and what could happen if he is confirmed by the Senate.
11:05 Nick Capodice? Civics 101 will be right back after a quick break. Have any of you out there ever Googled your own name, like actually done it? You'll find your address, your phone number, maybe even that police report from the time you went to see Rain Man in the movie theater, but you were underage? Maybe that one's just me. But here's the thing, there are companies called data brokers whose entire business model is collecting your personal information and selling it to advertisers, to strangers, sometimes to people running scams. And once your data's out there, it just keeps circulating. That is where incognito comes in. Incognito contacts data brokers on your behalf and sends them removal requests over and
11:49 Nick Capodice? over, so your info doesn't just pop right back up. You set it up once and they keep working in the background. You can even track the progress on a dashboard. And for our listeners, we have an exclusive 60% off an annual incognito plan. Just go to incognito.com/civics or use the code civics at checkout. There's a link in the episode description. Remember, they can't harm you if they can't find you.
12:17 Speaker 04 Welcome back. We're talking with former HHS Secretary Kathleen Sebelius about the power of the job she did for five years under President Obama, a job that President-elect Trump has now picked Robert Kennedy Jr. for. Kennedy has mentioned a lot of things that he would like to do at HHS. So Secretary Sebelius, I'd like to walk through a few of those ideas and get a sense from you of how easy it would be for him to accomplish some of these goals. For example, he said staffers at the FDA should be ready to, quote, "pack their bags"
12:57 Speaker 04 and that he wants to slash 600 jobs at the NIH, the National Institutes of Health. How much discretion does the secretary have to fire people?
13:08 Speaker 03 Well, at this point, I would say the discretion is limited by civil service protection. You really can't just fire people who are in a protected position.
13:21 Speaker 03 But I think just suggesting that you want to fire people before he knows anything about what those folks are doing, who they are, what the expertise is, the likelihood that you lose the best talent right away because they walk out the door. The FDA scientists are well sought out by industry across the board. So just the suggestion that a secretary comes in and says at the outset, you know, I'm going to get rid of this division. What that does is send a chilling effect throughout the department saying, you know, we have somebody coming in here who doesn't value us, doesn't like what we do.
14:03 Speaker 03 And I can tell you right now, there are likely to be lots of people already having conversations about their next job.
14:10 Speaker 04 So Bobby Kennedy has spread known falsehoods about the debunked idea that vaccines can cause autism. At the same time, as you know, the US has seen a dip in measles vaccination rates, for example, among kindergarteners, according to the CDC. As of the beginning of this month, we've seen 266 measles cases with 16 outbreaks in 2022. New York had its first case of polio in more than 30 years after vaccination in some communities have dropped. Now you've got Kennedy, who's vowed to tell NIH scientists, we're going to give infectious disease a break for about eight years.
14:53 Speaker 04 If you have a secretary who is hell bent on limbing vaccine take up, what can the secretary do?
15:00 Speaker 03 Well, those are two different issues. Okay, so NIH does the research and that research is done in research universities across the country. You know, Bobby Kennedy said, let's give infectious diseases a break and focus on obesity. What he clearly doesn't understand is that within the national institutes of health, those are going on simultaneously. You can't pick and choose when an infectious disease is going to break out. And in fact, he's clearly not reading the news because we are, I think, You know, a year or so away from a major outbreak of avian flu in humans.
15:42 Speaker 03 We've seen it, avian flu, jump from birds to farm animals and from farm animals to farm workers. That's just a step away from a major outbreak of avian flu, which right now has no vaccine. Vaccines are recommended for children going either to school or to daycare centers and come from recommendations of scientists at the Centers for Disease Control and Prevention. And then state governments adopt their own vaccine list based on CDC recommendations. Some have a more robust list, some have a narrow list. So in terms of vaccine take up, a secretary could do a couple of things.
16:27 Speaker 03 He could make very strong recommendations to states that they grant far more exemptions to parents. So greatly increase the number of children who could qualify to go to school without vaccines. He could encourage states to just make it optional. And to me, this is really personal. I have an 11-month-old grandson. He is too young to qualify for the full measles vaccination set. We live in a red state. He is susceptible to getting measles because he can't get vaccinated. And so this is real life consequences that, I mean, kids could die from this kind of
17:12 Speaker 03 policy change. And I think the secretary could have a lot of influence. He can't change the rules, but he could recommend very strongly that people who believe in Donald Trump should change the rules.
17:25 Speaker 04 Right. He's talked about how he's not actually anti-vaccine, but he is a proponent of sort of vaccine choice. And this is just making me think about what we talked about at the top of the conversation. You said a part of the job is to be a spokesperson. And I think what you're saying is that if Kennedy became secretary, he would be able to Put out information that is ultimately harmful to public health.
17:55 Speaker 03 He'd not only be able to put it out, but because this is coming from the Secretary of Health and Human Services, he'd be able to deliver it in a way that people would think it was legitimate. And I remember clearly when we were dealing with this early outbreak in the Obama administration of H1N1, which thank God turned out to be less virulent than people had feared.
18:21 Speaker 05 We are closely monitoring the emerging cases of swine flu in the United States.
18:26 Speaker 03 We had no vaccine. It was a strain of the flu that had never been seen before, and it was killing children and young adults.
18:35 Speaker 06 The government now believes roughly 8 million children have come down with the virus.
18:39 Speaker 03 A very different population than usually dies from the flu, and that was terrifying to folks. We had some news outlets who were at that point doing sort of a point counterpoint with scientists on one hand and with vaccine skeptics on the other, and presenting them as if it was a debate. And I remember very clearly going to talk to the heads of various news organizations in New York and elsewhere, saying, this is really dangerous stuff. If you give that information as a choice to the American public, you're putting them in a very precarious situation because they believe that somehow, you know, this is a legitimate debate. That's really dangerous in this situation where people can die.
19:25 Speaker 04 Kennedy's talked a lot about vaccines, raw milk, ultra-processed foods. What we haven't really heard him talk much about, though, is Medicare, Medicaid, the Affordable Care Act. And to put this into perspective for a minute, if he were to become secretary, he'd be overseeing, as you know, the Centers for Medicare and Medicaid Services, which makes up nearly 90% of the department's budget and serves more than half of the country's population, 170 million people.
19:57 Speaker 04 I'm curious, is it possible for someone to run HHS and effectively ignore that part of the job?
20:07 Speaker 03 Yeah, probably. And that could be the best thing that could happen because there's some really talented folks who know how to run those programs. I think the secretary is in a position to do a lot of good, but also potentially do a lot of harm to all sorts of care. Could we be more healthy in the United States? You bet. What I'd like Bobby Kennedy to tackle processed foods and food ingredients and, you know, go to battle with corporate interests who are promoting products that make us a lot less healthy. You bet. A lot of that jurisdiction is not within HHS. The school lunch programs, all within the Department of Ag.
20:50 Speaker 03 The food stamp program that he talks about SNAP, all within the Department of Ag. So I, I think unfortunately, he really doesn't even understand what's within the jurisdiction of the department or what kind of impact he could have. But ignoring CMS might be a really good idea.
21:12 Speaker 04 Just to be clear, you say Department of Ag. You're talking about the Department of Agriculture. So as the Senate sets up potentially to vote on RFK Jr.'s nomination, how should the senators think about the amount of power they're potentially handing over to RFK?
21:32 Speaker 03 Well, I think they should think long and hard about it. You know, think about Bobby Kennedy as secretary during COVID, when there's an opportunity to stand up Operation Warp Speed and a COVID vaccine, which clearly saved lives. My guess is he would not have participated in that robust effort. He would have tried to throw barriers and roadblocks and suggested people that they shouldn't get the vaccine. That's a real life example that we've just had. And I think you see, you know, what was a remarkable scientific breakthrough and accomplishment and then contrasted with this point of view, that's a really dangerous place to be when
22:14 Speaker 03 you're looking at the safety and security of US citizens and you're looking at health issues that can topple our economy. In, again, my experience, I worked for a president who had a pretty clear health agenda. And there were times that I would sit with our leadership team and say, I think we're going to do this initiative. And somebody would kindly remind me, maybe you should talk to the White House about doing that initiative. And I'd be like, oh, yeah. Oh, yeah, there's that guy down the street. I have no idea what Donald Trump's
22:51 Speaker 03 health policy is. So it's a little confusing for me to know what to tell the senators. If he is allowed to, as Donald Trump has said, quote, "go wild on health," what does that mean? And I would, if I were a senator, try to understand that because it's likely within HHS to have a huge impact on that senator's constituents.
23:19 Speaker 04 Secretary, thank you very much for taking the time to talk to us on trade offs.
23:23 Speaker 03 Sure. Good to be with you.
23:30 Nick Capodice? After Dan Gorenstein's interview with Secretary Sebelius was recorded, another major healthcare nomination was announced.
23:37 Speaker 07 President-elect Donald Trump has picked Dr. Mehmet Oz to serve as the administrator for the Centers for Medicare and Medicaid Services. In a statement-
23:46 Nick Capodice? We encourage you to follow the podcast Tradeoffs. They're going to have more coverage in the weeks to come on what could happen to Medicare, Medicaid, Obamacare, all of that, after Donald Trump takes office, where he will, of course, be working with a Republican-led Congress. As we've mentioned on this show before, members of the cabinet do not do their work in a vacuum. Robert F. Kennedy's ability to implement his agenda will be shaped, in a large part, by his relationship with the people leading top HHS agencies. Here's how Tom Scully put it when he spoke with Dan Gorenstein. The secretary on his own can't do anything unless he has the support of the White House and the rest of the- If you have not supported the other people running your agencies, you're going to do a lot of stuff.
24:31 Nick Capodice? Tom ran one of those agencies, the Centers for Medicaid and Medicare Services, during the George W. Bush administration. Tom told Dan he likes the Dr. Oz pick. Also, it's too soon to know how Kennedy and Oz are going to get along.
25:02 Nick Capodice? If you want to know more about cabinet picks and how the president is able to ensure they're appointed, even if, you know, the Congress doesn't want them to be, just check out our most recent episode on the cabinet, right here in the Civics 101 feed. A massive thanks again to the Tradeoffs Podcast for lending us their episode this week. Make sure to follow them, subscribe to them, wherever you get your podcasts, to follow their tremendous work. The Tradeoffs staff includes producer Ryan Levy, editor Deborah Franklin, executive director Jessica Silverman, marketing director Catherine Dougal, audience team Shannon Crane, Kate Sepey and Cedric Wilson, sound designer Andrew Perella, senior producer Leslie Walker, and executive producer and host Dan Gorenstein. Music in this episode by Ty Siderman, Blue Dot Sessions, and Epidemic Sound.
25:47 Nick Capodice? I am Nick Capodice, and from all of us here at Civics 101, thank you so much for listening. Civics 101 is a production of NHPR, New Hampshire Public Radio.
26:07 Nick Capodice? Did you know that if your spouse goes missing and you don't tell anyone, that's not necessarily a crime? That surprising fact is at the heart of the brand-new season of Bear Brook, the critically acclaimed true crime podcast from New Hampshire Public Radio. I'm your host, Jason Moon. In this season, Bear Brook investigates another New Hampshire mystery. A Christmas tree farmer with dementia vanishes. His wife never reports him missing. Can he still be found? Don't miss it. Follow Bear Brook wherever you get your podcasts.
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