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The little-known mastermind of DOGE’s HHS cuts

June 3, 2025
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Washington Correspondent, D.C. Diagnosis Writer

Please welcome STAT's newest Washington correspondent Chelsea Cirruzzo. Chelsea and I worked together years ago at Inside Health Policy, and it'll be fun to be back in the same newsroom. Tip jar: John.Wilkerson@statnews.com or over Signal at John_Wilkerson.07.

layoffs

The top DOGE at HHS

He was in charge of cutting $67 billion from HHS spending by firing large swaths of staff and eliminating U.S. government research and disease prevention efforts. 

For many, Tara Bannow's profile of Brad Smith is likely the first they've heard of him. 

A Tennessee native, Smith made his fortune launching health care startups that serve poor, sick, and dying patients who rely on taxpayer funded health insurance. He has a track record of ruthlessness in the private sector, and it appears Smith brought the same hard-driving attitude to government service. 

This line from Tara's article is the mark of an excellent profile: "His mom told STAT he's worked upwards of 18 hours a day his whole career and has only recently started to cut back."

Trust me, you want to read this one.


ai

Is Makary a Frozen fan?

Elsa, FDA's new AI tool, made its debut yesterday, weeks ahead of schedule, Brittany Trang scoops

Brittany got an early peek at a press release that provides the most detailed look yet at the technology and how it may be used. Commissioner Marty Makary aims to use AI to save employees time and speed up regulatory reviews. 

Conversely, FDA employees characterized Elsa's launch as "rushed." They worry that the agency is overstating its capabilities and failing to set guardrails, Brittany reports. Read more.



fda

Unclear clarification on Covid shots

Makary went on CBS News' "Face the Nation" on Sunday to clarify the federal government's position on Covid-19 vaccines. It didn't really work, Lizzy Lawrence reports.

Federal recommendations for whether pregnant people should get vaccinated are a key source of confusion. The FDA listed pregnancy as a risk factor that warrants a Covid shot, then health secretary Robert F. Kennedy Jr. ordered the CDC to pull Covid vaccine recommendations for that population a week later.

Read more for Makary's response when host Margaret Brennan pressed him on that contradiction.


vaccines

Sowing discord over mRNA vaccines

Lizzy and Isabella Cueto track mRNA from its rise to a Nobel-winning biomedical advance that saved the world from Covid-19 during Trump's first term to a distrusted technology that Trump 2.0 health officials are casting away.

Some of the attacks are about the technology itself, while others stem from general vaccine skepticism and frustrations with vaccine mandates during Covid. 

Either way, Kennedy is undermining investments in the technology, and public health experts worry the field will flounder, leaving Americans exposed to the next pandemic.


budet proposal

More details on proposed NIH cuts

Jonathan Wosen and Daniel Payne provide a rundown of how the NIH would be affected by the president's budget request for next fiscal year, which was released late Friday. 

The "budget in brief" calls for cutting $18 billion from NIH's discretionary budget, a 40% reduction. It also details plans to collapse the agency's 27 institutes and centers into eight. The broad strokes of that had previously been disclosed, and Friday's budget summary spells out more clearly where these cuts would come from and how deep they would be. 

Read more for the details.


congress

Tax bill update

As Senate Republicans return from recess, they'll be treated with official Congressional Budget Office projections of how many people could lose insurance from Medicaid cuts and Affordable Care Act reforms in the tax bill that House Republicans passed before break.

The One Big Beautiful Bill squeaked through the House, and Senate Republicans are as divided as their colleagues, with a similarly tight margin. Some want to reduce the deficit more than the House bill would, while others don't want to cut Medicaid, which would increase deficit spending unless they find other offsets. 

There's also the matter of ACA reforms, some of which the CBO will assess for the first time this week, that could cut enrollment in marketplace plans by one-third. Those reforms haven't received much attention, but that could change. Enrollment in Affordable Care Act marketplace health plans has more than doubled since 2020, and most of that growth has been in states won by President Trump.

The CBO "score" will lay the foundation for those fights.

Republicans want to pass the bill by July 4, which is a self-imposed deadline. The deadline of real consequence is probably whenever the government reaches its borrowing limit, known as the debt ceiling, because the House bill includes a debt limit increase. Treasury has asked Congress to raise the debt ceiling before August. 

A court ruling blocking most of President Trump's tariffs could further complicate that timeline. The administration appealed that ruling, but if it loses, the government will have to pay back those who paid tariffs, which would likely mean the government would hit the borrowing limit sooner.


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What we're reading

  • AstraZeneca's CEO balances cancer-fighting opportunities with political uncertainty, STAT
  • Plans, states warn of Obamacare chaos due to GOP megabill, Politico
  • UnitedHealth conducting 'comprehensive review' of Medicare practices that are facing federal scrutiny, new CEO says, STAT
  • Republicans are trying to repeal Obamacare again. Sort of, Washington Post

Thanks for reading! More next time,


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