Insurers Told to Justify Rate Increases Over 10 Percent
By ROBERT PEAR
Kathleen Sebelius, the secretary of health and human services, said insurers would have to defend rate increases in an environment in which they are doing well financially.
The United States Department of Health and Human Services (USDHHS) was officially created by President Jimmy Carter in 1980, when the Department of Education was fashioned out of the education component of the Department of Health, Education, and Welfare. It traces its beginning to the establishment of the Federal Security Agency by President Franklin Roosevelt in 1939. The Federal Security Agency became the Department of Health, Education, and Welfare (DHEW) in 1953 and then DHHS in 1980. In the 1990s, three major changes affected the DHHS: (1) on March 31, 1995, the Social Security Administration, with its more than 55,000 employees and $400 billion expenditures (in 1995) was established as an independent agency, with the commissioner of social security reporting to the president; (2) in 1995, the eight agencies of the U.S. Public Health Service were designated as operating divisions of DHHS, reporting to the secretary instead of reporting to the Assistant Secretary for Health (which they had done since 1968); and (3) in 1996, Congress terminated the federal Aid to Families With Dependent Children's Program (commonly called welfare) and replaced it with block grants to states that stressed work instead of a minimum guaranteed payment for poor mothers and their children, thus dramatically reducing the federal role in welfare policy. The result of these changes was to make DHHS a de facto department of health.
The USDHHS is led by the Secretary of Health and Human Services Staff Offices (e.g., general counsel, Assistant Secretaries for Health, for Legislation, for Planning and Evaluation, for Public Affairs, and for Management and Budget, Director of the Office of Civil Rights), an independent inspector general and twelve operating divisions:(1) Administration on Aging; (2) Administration for Children and Families; (3) Health Care Financing Administration (Medicare and Medicaid); (4) Program Support Center; and the eight divisions that together constitute the U.S. Public Health Service: (1) Agency for Health Care Quality and Research, (2) Agency for Toxic Substances and Disease Registry, (3) Centers for Disease Control and Prevention, (4) Food and Drug Administration, (5) Health Resources and Services Administration, (6) Indian Health Service, (7) National Institutes of Health, and (8) Substance Abuse and Mental Health Services Administration.
In the year 2001, the expenditures by DHHS will exceed $400 billion, second only to the Social Security Administration. The largest expenditures will be for Medicare ($260 billion) and Medicaid ($123 billion), followed by the NIH ($20 billion), the Administration for Children and Families ($17 billion), to the smallest grant-in-aid programs ($29 million) of the Agency for Healthcare Research and Quality. The DHHS employs more than 50,000 individuals, mainly in the Indian Health Service and NIH.
The DHHS administers over 300 grant-in-aid programs, primarily to state and local governments for a variety of public health and social service programs, to universities for research, and to a range of nonprofit organizations and institutions (e.g., hospitals and community health centers).
The secretary's responsibilities include overseeing the hundreds of public health and social service programs, as well as Medicare and Medicaid. The secretary also oversees the Food and Drug Administration (FDA), which is the federal government's primary public health regulatory agency. In addition, the secretary advises the president on a range of health and social services policies. When President Roosevelt initiated the Federal Security Act in 1939 it was his desire to unite all federal agencies "concerned with the promotion of social and economic security, educational opportunity and the health of the citizens of the nation." In the intervening years the DHEW included these functions and expanded rapidly in the 1960s, with the advent of President Johnson's great society programs. In the 1970s, environmental health programs were moved to the EPA; in the 1980s education and vocational rehabilitation programs moved to the newly created Department of Education; and in 1995 the Social Security Administration (the core of the Federal Security Agency) became an independent agency. Despite these changes, the DHHS remains the largest federal department and one of the most complex to lead and manage.
(SEE ALSO: Administration for Children and Families; Agency for Healthcare Research and Quality; Centers for Disease Control and Prevention; Food and Drug Administration; Health Care Financing Administration; Health Resources and Services Administration; National Institutes of Health; United States Public Health Service [USPHS])
Berkowitz, E. (1998). "Health and Human Services, Department of." In A Historical Guide to the U.S. Government, ed. G. T. Kurian. New York: Oxford University Press.