La transformación del HHS para que Estados Unidos vuelva a ser saludable / Fact Sheet: HHS’ Transformation to Make America Healthy Again

Hoja informativa: La transformación del HHS para que Estados Unidos vuelva a ser saludable La reestructuración del HHS se está llevando a cabo de acuerdo con la Orden Ejecutiva del Presidente Trump, "Implementación de la Iniciativa de Optimización de la Fuerza Laboral del 'Departamento de Eficiencia del Gobierno' del Presidente". En los últimos cuatro años, durante la administración Biden, el presupuesto del HHS aumentó en un 38% y su dotación de personal aumentó en un 17%. El plan combina recortes de personal, centralización de funciones y consolidación de divisiones de HHS, incluyendo: Los 82.000 empleados actuales a tiempo completo se reducirán a 62.000 28 divisiones se consolidarán a 15 10 oficinas regionales se convertirán en 5 Los recursos humanos, la tecnología de la información, las adquisiciones, los asuntos externos y la política se centralizarán. Con respecto a la FDA, CDC, NIH y CMS: La FDA reducirá su fuerza laboral en aproximadamente 3.500 empleados a tiempo completo, con un enfoque en la racionalización de las operaciones y la centralización de las funciones administrativas. Esta reducción no afectará a los revisores de medicamentos, dispositivos médicos o alimentos, ni afectará a los inspectores. Los CDC reducirán su fuerza laboral en aproximadamente 2.400 empleados, con un enfoque en volver a su misión principal de prepararse y responder a epidemias y brotes. Esto incluye el traslado de ASPR bajo los CDC para mejorar la coordinación de los esfuerzos de respuesta. NOTA: La disminución de "CDC" solo sería de 1.400 si incluyera a las personas que vienen de ASPR (aproximadamente 1.000 personas). Los NIH disminuirán su fuerza laboral en aproximadamente 1.200 empleados al centralizar las adquisiciones, los recursos humanos y las comunicaciones en sus 27 institutos y centros. CMS reducirá su fuerza laboral en aproximadamente 300 empleados, con un enfoque en reducir la duplicación menor en toda la agencia. Esta reorganización no afectará a los servicios de Medicare y Medicaid. La consolidación y los recortes están diseñados no solo para ahorrar dinero, sino para hacer que la organización sea más eficiente y más receptiva a las necesidades de los estadounidenses, e implementar el objetivo de Make America Healthy Again de poner fin a la epidemia de enfermedades crónicas. Actualmente no se planean recortes adicionales, pero el Departamento continuará buscando más formas de agilizar sus operaciones y agencias. Una nueva Administración para una América Saludable (AHA) consolidará la OASH, HRSA, SAMHSA, ATSDR y NIOSH, con el fin de coordinar de manera más eficiente los programas de atención crónica y prevención de enfermedades y armonizar los recursos de salud para los estadounidenses de bajos ingresos. Las divisiones de AHA incluyen Atención Primaria, Salud Materna e Infantil, Salud Mental, Salud Ambiental, VIH/SIDA y Fuerza Laboral, con el apoyo del Equipo de Cirujano General y Políticas de los Estados Unidos. El HHS tendrá un nuevo Secretario Adjunto de Cumplimiento para supervisar la Junta Departamental de Apelaciones (DAB), la Oficina de Audiencias y Apelaciones de Medicare (OMHA) y la Oficina de Derechos Civiles (OCR) para combatir el desperdicio, el fraude y el abuso. El HHS combinará al Subsecretario de Planificación y Evaluación (ASPE) y a la Agencia de Investigación y Calidad de la Salud (AHRQ) en la Oficina de Estrategia para realizar investigaciones que informen las políticas del Secretario y evalúen la efectividad de los programas del Departamento para una América más saludable. Los programas críticos dentro de la Administración para la Vida Comunitaria (ACL) que apoyan a adultos mayores y personas de todas las edades con discapacidades se dividirán entre la Administración para Niños y Familias (ACF), el Secretario Adjunto de Planificación y Evaluación (ASPE) y los Centros de Servicios de Medicare y Medicaid (CMS). Contenido creado por el Subsecretario de Asuntos Públicos (ASPA) Contenido revisado por última vez el 27 de marzo de 2025 https://www.hhs.gov/about/news/hhs-restructuring-doge-fact-sheet.html ## Fact Sheet: HHS’ Transformation to Make America Healthy Again The restructuring of HHS is proceeding in accordance with President Trump's Executive Order, "Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.” Over the past four years, during the Biden administration, HHS’s budget increased by 38% and its staffing increased by 17%. The plan combines personnel cuts, centralization of functions, and consolidation of HHS divisions, including: The current 82,000 full-time employees will be reduced to 62,000 28 divisions will be consolidated to 15 10 regional offices will become 5 Human Resources, Information Technology, Procurement, External Affairs, and Policy will be centralized. Regarding FDA, CDC, NIH, and CMS: FDA will decrease its workforce by approximately 3,500 full-time employees, with a focus on streamlining operations and centralizing administrative functions. This reduction will not affect drug, medical device, or food reviewers, nor will it impact inspectors. The CDC will decrease its workforce by approximately 2,400 employees, with a focus on returning to its core mission of preparing for and responding to epidemics and outbreaks. This includes moving ASPR under CDC to enhance coordination of response efforts. NOTE: The “CDC” decrease would only be 1,400 if you included the individuals coming over from ASPR (approx. 1,000 individuals). The NIH will decrease its workforce by approximately 1,200 employees by centralizing procurement, human resources, and communications across its 27 institutes and centers. CMS will decrease its workforce by approximately 300 employees, with a focus on reducing minor duplication across the agency. This reorganization will not impact Medicare and Medicaid services. The consolidation and cuts are designed not only to save money, but to make the organization more efficient and more responsive to Americans’ needs, and to implement the Make America Healthy Again goal of ending the chronic disease epidemic. No additional cuts are currently planned, but the Department will continue to look for further ways to streamline its operations and agencies. A new Administration for a Healthy America (AHA) will consolidate the OASH, HRSA, SAMHSA, ATSDR, and NIOSH, so as to more efficiently coordinate chronic care and disease prevention programs and harmonize health resources to low-income Americans. Divisions of AHA include Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce, with support of the U.S. Surgeon General and Policy team. HHS will have a new Assistant Secretary for Enforcement to provide oversight of the Departmental Appeals Board (DAB), Office of Medicare Hearings and Appeal (OMHA), and the Office for Civil Rights (OCR) to combat waste, fraud, and abuse. HHS will combine the Assistant Secretary for Planning and Evaluation (ASPE) and Agency for Healthcare Research and Quality (AHRQ) into the Office of Strategy to conduct research that informs the Secretary’s policies and evaluates the effectiveness of the Department’s programs for a healthier America. The critical programs within the Administration for Community Living (ACL) that support older adults and people of all ages with disabilities will be split across the Administration for Children and Families (ACF), Assistant Secretary for Planning and Evaluation (ASPE), and Centers for Medicare and Medicaid Services (CMS). Content created by Assistant Secretary for Public Affairs (ASPA) Content last reviewed March 27, 2025

Miles de médicos abandonan Puerto Rico

El trato discriminatorio en contra de los galenos y los altos costos para operar provocan la emigración

Por Rebecca Banuchi / rebecca.banuchi@gfrmedia.com

Los altos costos de ejercer la medicina en Puerto Rico y el trato desigual que reciben los galenos locales al ser remunerados por planes de salud como Medicare se han combinado peligrosamente para provocar el éxodo de miles de médicos que han abandonado el país en busca de mejores condiciones económicas.

Eduardo Ibarra, presidente del Colegio de Médicos Cirujanos, destacó hoy que la fuga de galenos -principalmente hacia Estados Unidos- no solo empeora de inmediato el acceso a servicios de salud, sino que también amenaza con dejar a Puerto Rico sin especialistas de gran demanda como los médicos de familia, cardiólogos, anestesiólogos y cirujanos generales.

“La situación se ha convertido en una insostenible, y los médicos están considerando como única alternativa irse a Estados Unidos”, indicó Ibarra durante una conferencia de prensa.

El presidente del Colegio de Médicos Cirujanos presentó en compañía de otros profesionales de la salud un estudio encomendado por esa entidad a la firma Custom Research Center, que según dijo el doctor, constituiría el primer análisis con datos estadísticos que respaldan las quejas que por años han levantado los miembros del gremio.

Ibarra señaló el "trato discriminatorio" que reciben los médicos locales por parte del gobierno federal y la proliferación de intermediarios en el sistema de salud como los principales problemas que aquejan a estos profesionales.

Explicó que la remuneración a los médicos en Puerto Rico por parte de Medicare es la más baja en todas las jurisdicciones estadounidenses, pues las tarifas que pagan están calculadas a base del Índice de Costo Geográfico de una Práctica (GPCI, en inglés), que utiliza criterios que no se ajustan a la realidad.

El psiquiatra Héctor Rivera planteó que lo que paga Medicare a los médicos locales es casi 50% menos que lo que desembolsa a otros profesionales en los lugares de más baja remuneración en Estados Unidos.

El estudio, realizado el mes pasado por el matemático y estadístico Parimal Choudhury, examina cómo en la última década han aumentado los costos en renglones como la electricidad y el servicio de agua potable, los cánones de renta de oficina, el gasto en compra y acarreo de equipo médico y el seguro por impericia médica, algunas de las variables que toma en cuenta el GPCI para determinar los honorarios que se pagarán a los médicos.

"Este estudio demuestra que nuestros médicos se están yendo en contra de sus propios sentimientos y debido a la complacencia que por décadas las administraciones gubernamentales han permitido con la prevalencia de un sistema injusto, desequilibrado y extremadamente atropellante", manifestó.

Barbara Southard, una de las investigadoras, sostuvo que la entidad federal Center for Medicare and Medicaid Services, que es la que maneja el GPCI, está usando estadísticas viejas suplidas por el gobierno estatal que no reflejan el alza que han experimentado esos renglones en los últimos años.

“Están utilizando estadísticas del '96 y '98, hace más de 10 años, y ellos alegan que las agencias aquí no les están dando las estadísticas más recientes, eso puede ser verdad, pero están resultando en subestimar” las variables, sostuvo Southard.

Ibarra, por su parte, estimó en unos 2,500 el número de médicos que han abandonado Puerto Rico en la pasada década, aunque dijo que esa cifra está bajo revisión en un estudio adicional que esa entidad encomendó, y cuyos resultados espera tener en los próximos meses. Precisó, en cambio, a modo de ejemplo, que hace tres años había alrededor de 300 cardiólogos, y hoy esa cifra se redujo a la mitad.

Ibarra insistió en la necesidad de transformar el sistema de salud en Puerto Rico en uno universal con un pagador único.

Reiteró que el creciente número de intermediarios en la estructura actual, como las aseguradoras y los administradores de ciertos servicios de salud, encarecen las prestaciones y se han convertido en un escollo para la atención médica.

Ibarra índico que suplieron copia del estudio al comisionado residente Pedro Pierluisi, quien, según dijo, inició gestiones en el Congreso estadounidense para que se consideren los reclamos de los médicos de Puerto Rico.

Además, adelantó que el domingo se revelará la segunda parte del análisis ante los candidatos a la gobernación durante un foro que llevarán a cabo, a partir de las 10:00 a.m., en el Hotel Intercontinental de Isla Verde.
http://www.elnuevodia.com/milesdemedicosabandonanpuertorico-1338566.html

Researchers Repeatedly Find Cost Sharing Harms Medicaid Beneficiaries’ Access to Care and Health Status

 Cost-sharing is one of the most studied aspects of the Medicaid program.  Over three
decades of research overwhelmingly establish that heightened copayments make it harder
for beneficiaries to afford medical services, while premiums make it harder for eligible
individuals to enroll and maintain coverage.  The adverse consequences of cost sharing
include poorer health and increased use of high-cost services like emergency rooms.
Leighton Ku & Victoria Wachino, The Effect of Increased Cost Sharing in Medicaid: A Summary of Research Findings (2005), available at http://www.cbpp.org/cms/?fa=view&id=321.

 100,000 people lost Medicaid coverage in Missouri because of less generous eligibility
standards, higher premiums and the expansion of copayments to nearly all Medicaidcovered services and prescription drugs.  After Missouri cut Medicaid, the number of uninsured individuals increased, hospitals became burdened with more uncompensated care, and revenue shortfalls forced community health centers to charge patients more and obtain larger state grants.
Stephen Zuckerman et al., Missouri’s 2005 Medicaid Cuts: How Did They Effect Enrollees and Providers?
HEALTH AFF (online ed. Feb. 2009), available at
http://content.healthaffairs.org/content/early/2009/02/18/hlthaff.28.2.w335.full.pdf+html.

 Medicaid cost sharing adds to families’ financial hardship, forcing difficult choices between
necessary health care and other basic necessities.
Thomas M. Seldon et al., Cost sharing in Medicaid and CHIP: How Does It Affect Out-of-Pocket Spending? 28 HEALTH AFF. W607 (online ed. 2009), http://content.healthaffairs.org/content/28/4/w607.full.

 Nominal copayments are associated with significant reductions in the use of clinically
important drugs.  When the Oregon Medicaid program implemented copayments for
prescription drugs, set at $2 for generics and $3 for brand name drugs, utilization of
prescription drugs declined by 17%.  Reduction in prescription drug use was observed in
every therapeutic category studied with the greatest reductions occurring for drugs treating
depression and respiratory disease.
Daniel Hartung et al., Impact of a Medicaid Copayment Policy on Prescription Drug and Health Services
Utilization in a Fee-for-Service Medicaid Population, 46 MED. CARE 565, (2008) available at
http://www.ncbi.nlm.nih.gov/pubmed/18520310


A dramatic reduction in Medicaid enrollment occurred in Oregon after the state imposed
new copays, ranging from $5 for an outpatient physician visits and $250 for an inpatient
hospital admissions, and new premiums ranging from $6 to $20 a month. Those who left
the program because of the heightened cost sharing had inferior access to needed care,
were significantly less likely to visit a primary care physician, and used the emergency room
more often than those who left the program for other reasons.
Bill Wright, et al., The Impact of Increased Cost Sharing on Medicaid Enrollees, HEALTH AFF. (online ed.,
July/August 2005), available at http://www.healthaffairs.org/RWJ/Wright.pdf.

 The Oregon Medicaid program’s copayment policies did not provide the expected cost
savings because individuals skipped preventive care and used more costly hospital
emergency care. Neal T. Wallace et al., How Effective Are Copayments in Reducing Expenditures for Low-Income Adult Medicaid Beneficiaries? Experience from the Oregon Health Plan, 43 HEALTH SERV. RES. 515 (2008), available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442363/.

 Women living in areas with lower median incomes were disproportionately affected by cost
sharing and more likely to forgo breast cancer screening than women from more affluent
areas. An analysis of Medicare plans also found that breast-cancer screening rates, among
women who should be screened according to clinical guidelines, were 77.5% in full coverage
plans, compared to only 69.2% in cost sharing plans.
Amal Trivedi et al, Effect of Cost Sharing on Screening Mammography in Medicare Health Plans, 358 NEW
ENG. J. MED. 375 (2008), available at http://www.nejm.org/doi/full/10.1056/NEJMsa070929#t=article

 Patients in low-income areas are significantly more sensitive to increases in drug
copayments than patients from high- or middle-income areas. Increased drug copayments
make it more likely that low-income patients will be unable to adhere to medication
instructions, worsening health disparities. A 10% increase in copayment for certain drugs
(statins) decreased medication adherence by more than 12% for patients living in an area
with a median household incomes of less than $30,000 compared with a decrease of less
than 2% for patients living in areas with a median income of more than $62,000.
Michael Chernew et al, Effects of Increased Patient Cost Sharing on Socioeconomic Disparities in Health
Care, 23 J. GEN. INTERN MED. 1131, (2008), available at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517964/?tool=pubmed

 Because low-income families live on slim margins, even nominal copayments lead to unmet
medical needs. Families, outreach workers, and providers in Washington State all reported
that immigrant families had significant difficulty paying for prescription drugs when new
copayments were imposed.
Mark Gardner & Janet Varon, Moving Immigrants from a Medicaid Look-Alike Program to Basic Health in
Washington State: Early Observations (May 2004) available at www.nohla.org/pdf-downloads/Moving-
Immigrants-from-a-Medicaid-Look-Alike-Program-to-Basic-Health-in-Washington-State-Early-
Observations.pdf.


A Utah study found that instituting a Medicaid copayment of $2 per prescription led to 13%
of enrollees not filling their prescriptions because they couldn’t afford the co-pay. When
enrollees started getting charged $3 copayments for doctor visits, 11% of enrollees did not
to go to the doctor because they couldn’t afford it.
Office of the Executive Director, Utah Department of Health, Medicaid Benefits Change Impact Study,
UTAH PUBLIC HEALTH OUTCOME MEASURES REPORT, (December 2003), available at
http://health.utah.gov/hda/reports/MedicaidBenefitsChangeSummary.pdf.

 When a prescription coinsurance and deductible cost-sharing policy was introduced in
Quebec, Canada, the use of essential drugs decreased by 14% for welfare beneficiaries. This
caused emergency room visits to increase by 78% and serious adverse health events to
increase by 88%.
Robyn Tamblyn, et al., Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and
Elderly Persons, J. AM. MED. ASS’N (online ed. January 2001), available at http://content.healthaffairs.org/content/18/2/201.long

 Elderly and disabled Medicaid beneficiaries who reside in states that charge copayments
have lower rates of prescription drug use. The primary effect of copayments is to reduce
the likelihood that beneficiaries will fill their doctors’ prescriptions. This burden falls
disproportionately on beneficiaries in poor health.
Stuart B, Zacker C., Who Bears the Burden of Medicaid Drug Co-payment Policies? HEALTH AFF. (online ed., March/April 1999) available at http://content.healthaffairs.org/content/18/2/201.long.

 Caps placed on prescription drugs in the New Hampshire Medicaid program increased the
cost of mental health services by a factor of more than 17, compared to the savings in drug
expenditures, because beneficiaries were more likely to be admitted into hospitals or
nursing homes.
Steven B. Soumerai et al., Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing
Homes, 331 NEW ENG. J. MED. 1072 (1991), available at
http://www.nejm.org/doi/full/10.1056/NEJM199110103251505

 The imposition of $1.00 copayments for services in California in the 1970’s caused affected
Medicaid beneficiaries to reduce their use of necessary care, decreasing immunizations by
45%, Pap smears by 21.5%, and obstetrical care by 58%.
As described by Julie Hudman and Molly O’Malley, Health Insurance Premiums and Cost-Sharing: Findings
from the Research on Low-Income Populations, (March 2003), available at
http://www.kff.org/medicaid/upload/Health-Insurance-Premiums-and-Cost-Sharing-Findings-from-the-
Research-on-Low-Income-Populations-Policy-Brief.pdf.

Federal funds are endangered

http://www.prdailysun.com/news/Federal-funds-are-endangered

July 24, 2010 by Juan A. Hernandez jhernandez@prdailysun.net

If the bill to reorganize the several government advocate offices goes through, there would be “terrible consequences” to people over 60, Puerto Rico Advocate for the Elderly said Friday.
Rossana López León reiterated her opposition to the reorganization plan, calling it “an indisputable laceration to the rights of the elderly.”
According to López León, should the House Substitute bill to the 2010 Reorganization Plan No. 1 become law, there would be “terrible consequences” and “an indisputable laceration to the rights of the elderly.”
“Current state law delegates our office the authority to act as administrator and recipient of whatever federal funds and appropriations are allowed by this [Older American Act of 1965] and other federal laws and programs for the elderly,” said López León during the hearings of the Senate Government Committee
López León explained that the mandate is also contained in a contract between the Commonwealth and the federal government known as the “State Plan on Aging.”
“Any changes to this plan have to be submitted to the federal government for its approval before going into effect,” López León told the Committee.
The Advocate said she has consistently requested from the chairman of the Modernization Council –State Secretary Kenneth McClintock – any evidence of meetings with federal officials to discuss the proposed changes to this plan. Because no such evidence has been provided, the Advocate said she assumed the meetings have not taken place.
The proposed substitute bill, like the original one, calls for the merging of all advocacy offices into one umbrella-type agency under the authority of the Citizens’ Ombudsman.
López León noted that failure to comply with regulations in the past had led to the loss of several million dollars in federal funding that would have benefited Puerto Rico’s elderly.
“The severity in the breach of federal regulations by the Health Department and the Department of the Family led to the government’s classifying Puerto Rico being classified as a ‘high-risk agency’ by the federal government,” López León said.
Government Committee Chairman Sen. Carmelo Ríos admitted to having several doubts regarding the federal funds the agency now receives.
“We cannot lose federal funds. If anything, we should be looking for ways to get more,” Ríos said.
The Advocate also argued that the merging of the advocacy offices into the proposed suprastructure “eliminates the autonomy and independence of the advocates as specialists on different populations.”
“Also, there’s an insurmountable conflict because, while [the plan] states that the advocates will keep their power to protect the populations they serve, it also limits them to whatever the Citizens' Ombudsman decides.” The proposed substitute bill, like the original one, calls for the merging of all advocacy offices into one umbrella-type agency under the authority of the Citizens’ Ombudsman,” López León said.
Ríos said that his committee is in the process of hearing out every advocate to gather as much information as possible and then start a process to reconcile possible differences with the House and the governor, who may have different views on how the merger should take place.