The Trump Administration’s Quiet Dismantling of the Health Security Agency

On July 15, AHRQ suspended at least 104 grants

This is because for 27 years, AHRQ has been the only federal agency focused on supporting work and research to improve the safety and quality of health care, hence the agency’s name. That’s a very important thing if you have a human head and body and therefore need medical care at some point in your life or at least care about someone who does. An analysis by the agency had estimated that in the period from 2014 to 2017 alone, AHRQ-funded studies had saved about 20,500 deaths and $7.7 billion in health care costs.

These studies have included research on the prevention and control of healthcare-associated infections, the reduction of medical errors, the safe dispensing of medications, the measurement of hospital quality, and the development of technology that can help improve patient safety and experience. An estimated 250,000 to 400,000 people in the United States die each year from preventable medical errors. And it is estimated that between 75,000 and 99,000 people die each year from healthcare-associated infections.

However, without AHRQ, those interested in researching such areas may have difficulty finding funding, especially with what the Trump administration along with Elon Musk’s so-called Department of Government Efficiency have done with funding for the National Institutes of Health and the Centers for Disease Control and Prevention. Therefore, a July 15 letter from AHRQ It must have made many healthcare quality and safety researchers across the country complain, telling them that AHRQ was stopping at least 104 of their grants.

AHRQ had gone a year without awarding new grants

That was after AHRQ went more than a year without awarding new grants and spending less than $15 million of the $345 million Congress appropriated to the agency for the current fiscal year. So unless AHRQ somehow ends up giving out, oh, $330 million in grants between now and September 30, the Trump administration will have basically ignored what Congress had wanted and indicated, which wouldn’t be the first time this has happened.

Last August, the Society of General Internal Medicine filed a lawsuit against AHRQ Director Roger Klein, MD, JD, and U.S. Secretary of Health and Human Services Robert F. Kennedy, Jr., JD, for failing to award new grants. The lawsuit alleges that such actions – or rather inaction – violate a 1974 law that emphasizes that Congress, and not the President of the United States and his executive branch, ultimately determines what federal agencies can spend and on what. Of note, AHRQ’s July 15 grant suspension letter did not mention the T-word, which stands for “termination,” and instead used the phrase “no continued funding awarded,” which may have ramifications when it comes to what happens with lawsuits like the one brought by SGIM.

HHS spokesperson Emily Hilliard has indicated that AHRQ aims to establish a new “framework” for grants. However, it has not been made clear what this framework could be and when it could be revealed. I will continue to reach out to my contacts at HHS for further clarification.

AHRQ has laid off and lost three-quarters of its staff

In the meantime, if you try to call or contact AHRQ to ask questions about what’s going on, good luck getting an answer. The agency has lost about three-quarters of its staff since Donald Trump ascended to the US presidency in January 2025. Those personnel losses have come through a variety of different layoffs, resignations and other so-called RIFs or reductions in force. Those who have been to AHRQ told me that by the end of 2025, the number of empty chairs already far exceeded the number of people at AHRQ meetings.

Trump had already wanted to eliminate AHRQ during his first presidential term

What is happening now with AHRQ should not be a surprise. In 2017, I wrote in Forbes about how the budget proposal presented by then-US President Donald Trump and his administration had already attempted to effectively eliminate AHRQ. However, at the time Congress essentially treated this budget proposal like a pair of parachute pants and ignored it, leaving AHRQ with a budget.

Trump-appointed AHRQ director hasn’t been spending funds allocated to him by Congress

However, during Trump’s second term, his administration appears to have more trump cards up its sleeve when it comes to ignoring Congress when Congress ignores the Trump administration’s budget proposals. In 2025, the second coming of the Trump administration once again kept AHRQ out of its budget proposal, as I mentioned in Forbes. Congress once again ignored such a proposal and budgeted money for AHRQ. This time, however, the Trump administration has apparently circumvented Congress by simply preventing AHRQ from spending funds appropriated by Congress.

It remains to be seen whether the Trump administration will keep AHRQ as a separate agency or dissolve it entirely. Kennedy in March 2025 announced plans to fold AHRQ and other HHS agencies into a new Office of Strategy. And Klein hasn’t really made any public statements to help everyone clearly understand AHRQ’s direction since the Trump administration named him in July 2025 as AHRQ’s new director. Klein’s bio on AHRQ’s website lists him as “an attorney and board-certified molecular pathologist who was previously medical director of OmniSeq, Inc., a tumor profiling company that was acquired by LabCorp,” but doesn’t mention much about his vision for health care quality and safety.

Historically, federal agencies have incorporated several advisory committees of outside scientific experts to help provide more transparency and oversight of their activities, especially funding activities. But actions like Trump’s executive orders and the new White House Office of Management and Budget rule that I’ve covered in Forbes have progressively diminished the role of scientific peer review and other types of external oversight in guiding federal agency operations, such as grant making. At the same time, that has increased the power of the president and his political appointees over what federal agencies do and where agency funding goes.

The problem is that healthcare quality and safety work may seem like something that can be cut without clear immediate ramifications, something like cutting the White House’s pandemic preparedness and response capacity in 2017 and foodborne illness prevention and control programs in 2025. But the ramifications of such cuts will eventually be seen, which is what happened in 2020 with the COVID-19 pandemic and this year with the 12 active disease outbreaks. transmitted by foods that are currently being produced. And it’s safe to say that cutting work on health care safety and quality will have its ramifications in the future.