Every four years between Election Day and Inauguration Day, the rumor and gossip mills of Washington D.C. go into hyper overdrive.
The 75-day sprint for power and influence consume the city as outsiders jockey for insider status. An obscure publication affectionately known as The Plum Book will soon be a brief best seller as it identifies more than 9,000 jobs in the Executive and Legislative branches that will go to “political appointees.” [ 1 ] Change will spread throughout D.C. as law firms, consulting firms, lobbying firms, and businesses with government contracts will staff up with folks with bona fide Republican credentials to boost their opportunities for timely access to the Trump Administration.
While the White House staffing will take shape rather quickly, filling positions throughout the cabinet-level Departments and sub-cabinet agencies will take months. White House appointees do not require confirmation by the Senate while senior Departmental appointments do. Simply getting the necessary paperwork on financial disclosure can delay confirmation. Transition teams have two objectives—personnel and policy. And as the old D.C. saying goes, “personnel is policy” so there really is only one paramount assignment for the Transition—sorting out tens of thousands of job seekers to find the right fit for the job.
The U.S. Department of Health and Human Services (HHS) is the largest single Department with a budget of $1.8 trillion (twice that of the Department of Defense). If HHS were its own country, it would be tied with Australia as the 13rd largest economy in the world, just behind Mexico. Medicare and Medicaid will account for about 85% of the HHS spending. However, it is still a massive and diverse organization to run. The National Institutes of Health (NIH) have budget authority of more than $46 billion and the Administration for Children and Families (ACF) has budget authority of $34 billion. The Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Indian Health Service (IHS), and the Public Health Service (PHS, which can trace its roots back to 1798) all operate under the HHS umbrella.
History holds some important clues as to what might be expected in the HHS transition. HHS was created in 1980 after the Department of Education was split off. Since then, eight men and four women have been confirmed as Secretary. Of these, five had been governors and five had served in Congress. Two had served in senior federal positions in previous Administrations. Thus, the next Secretary will likely have significant political and managerial credentials. Governors have run the programs financed with federal dollars from HHS agencies including Medicaid, Temporary Assistance for Needy Families (TANF), the Health Resources and Services Administration (HRSA), etc. They also have experienced staff to bring with them so they can “hit the ground running.”
The mission of the HHS transition team is to help prepare the new Secretary to take office, whomever that turns out to be. It will identify major decision points that will need to be made over the first 12-month period with a heightened emphasis on the first 30-60-90-180 day periods. The Secretary-designate may not be announced until mid-December and will have to be confirmed by the U.S. Senate. The new 119th Congress will commence January 3, 2025. The White House Transition Team will deputize a “sherpa,” usually a well-known lobbyist, to escort the Secretary-designate to meet with as many Senators of both parties as possible and perhaps multiple times with members of the Committee on Finance who will have to approve the nomination and report to the full Senate. The Trump Administration has a distinct advantage in getting its nominees confirmed quickly because Republicans will control a majority of seats in the new Senate.
The transition team to go into HHS will be small, fewer than 10 people. They are unpaid volunteers who are subject to government background checks. Their job is to collect and report information, not to debate or develop policy. The Biden Administration will try to make as many “final decisions” as possible prior to January 20, 2025 on its key priorities. Any disputes about sharing information will go back to the White House Transition Team to resolve. The Biden Administration will designate senior careerists to who will meet with and prepare briefing material for the Trump transition team. The gears of government will slow, but not stop.
The transition team serves another important role by meeting with external groups as well. The HHS transition team will brief the Secretary-designate on a wide variety of subjects, the most important of which may be the “unclear” and “unknown.” It may make recommendations to the Secretary-designate on how to restructure or consolidate the 13 Operating Divisions (OP-DIVs) and 14 Staff Divisions (Staff-DIVs) within HHS. One of the most important developments that could impact HHS since the last transition is the June 28, 2024 Loper Bright decision by the Supreme Court, which effectively overturned the Chevron deference given to federal agencies. The new Secretary will need to develop a new Loper Bright strategy for HHS, especially for the Medicare and Medicaid programs.
On January 20, the HHS Transition Team will simply and unceremoniously dissolve and be replaced by the Secretary-designee’s own team. If all goes well with the Senate confirmation process, the Secretary will take the oath of office that day. Key positions to be filled immediately with political appointees are Chief of Staff and Assistant Secretaries for Public Affairs, the Office of Legislation, the Office of White House Liaison. A group of perhaps a dozen newly minted “special assistants to the Secretary” will parachute into HHS to continue the transition, many of whom will seek permanent positions. These individuals will serve as liaisons to the OPDIVs and STAFFDIVs which will be headed by careerists who are designated as “acting “administrators and directors. This is a time great opportunity for the new Secretary and team to make decisions quickly without the usual process of consulting with multiple layers of decision-making in a matrix-style organization.
The cycle will restart in November 2028.
