Rfk Jr.’s Health Department Empowers Political Appointees Like Never Before

Robert F. Kennedy Jr. promised in March 2025 a “dramatic overhaul” of the nation’s Health Department to rid it of industry interests he said had corrupted the agencies and allowed chronic disease to spread.

A year later, the Trump administration has stacked his agencies with political appointees while purging thousands of civil service jobs, a POLITICO review of staffing at his Health and Human Services Department found.

The surge in political appointments is a trend across Donald Trump’s second administration as the president consolidates power in the executive branch by assigning allies to positions that do not require Senate confirmation. Kennedy’s HHS now has more political appointees than any other department, including much larger ones such as Defense and Justice. It has hired 264 non-Senate confirmed political appointees as of June, up from 175 in the final year of the Biden administration and the highest since at least 1996, according to data from the White House’s personnel office and the Plum Book, a routinely published list of appointed administration jobs.

The influx of political appointees comes as Trump has struggled to get other health nominees through the Senate confirmation process. Political appointees at the Health Department have in the last year made decisions typically controlled by career staff, such as canceling research grants, blocking external communication and altering vaccine guidance. The shift is raising alarms for longtime Health Department employees and advocates of a merit-based civil service, which Congress created in the late 19th century to end a spoils system in which jobs went to political allies.

“I was so surprised by how easy it was for all our norms to be overturned,” said Jennifer Troyer, who resigned as a director at the National Human Genome Research Institute in December after almost a 25-year career at the National Institutes of Health. A senior career official, Troyer decided to leave when Trump signed an executive order giving political appointees power to approve grants, she told POLITICO.

“I had hoped that with time, the new NIH leadership would find their voice and stand up for the importance of NIH as a bastion of scientific progress free from political influence… This is not happening,” Troyer wrote in her resignation letter.

Emily Hilliard, senior press secretary at HHS, said the changes were part of the mandate voters gave.

“The American people voted for a change in direction, and HHS is delivering it,” Hilliard said in a statement, adding that years of expanded department budgets and staffing had “failed” to improve public health.

An official at HHS, granted anonymity to speak candidly, said that the number of political appointees represent less than 0.5 percent of the department’s nearly 73,000 workforce. Kush Desai, a White House spokesperson, attributed the administration’s health policy wins, including on changes to dietary guidelines and the removal of artificial ingredients in the food supply, to the “hands-on leadership and policy coordination by Trump HHS officials.”

The increase in political hires comes after Trump’s Department of Government Efficiency, led by Elon Musk, reduced government staffing last year by hundreds of thousands through layoffs and buyouts.

Most political appointees at HHS are in Kennedy’s immediate office, which had at least 147 non-Senate-confirmed political jobs in May 2026, its highest in at least a decade. Two of HHS’ most important agencies, the Food and Drug Administration and the Centers for Disease Control and Prevention, saw the biggest jump in political appointees.

Despite Kennedy repeatedly saying he wants to rid his agencies from the “cloud of corporate capture,” many of his appointees boast strong connections to the industries they regulate. At the Centers for Medicare and Medicaid Services, Rebekah Armstrong, who previously led federal affairs at AHIP, the trade group for insurers, is chief of staff, while Kimberly Brandt, who most recently lobbied for pharmaceutical companies at Tarplin, Downs, and Young, a top pharmaceutical lobbying firm, is deputy administrator.

Several appointees have already returned to industry, like Mitchell Hailstone, most recently director of public strategy in Kennedy’s direct office, who returned to health insurer Elevance in May after a year at HHS. Hailstone declined to comment on his departure from the department.

Some Kennedy appointees have close ties to or have supported his fringe health views. This includes Lyndelle Redwood, president of Kennedy’s anti-vaccine nonprofit, Children’s Health Defense, who is a senior advisor in the office of the assistant secretary for health, and Justin Mabie, a scientist who has accused federal researchers of manipulating climate science to promote geoengineering and is a senior advisor at NIH. Mabie’s book attacking climate change science was published by Skyhorse Publishing, a firm owned by Tony Lyons, the leader of the nonprofits behind Kennedy’s Make America Healthy Again movement.

There’s also Shana Weir, who helped Trump challenge the results of the 2020 election in Nevada; and Rebecca Hines, the sister of Cheryl Hines, an actor and Kennedy’s wife. Weir is the assistant secretary for administration, and Rebecca Hines is the commissioner of the Administration on Disabilities at the Administration for Community Living.

“It's an administration that is finding every drawer that they can stuff with political appointees that they possibly can, and they're creating new ones, new drawers,” said Max Stier, chief executive of the Partnership for Public Service, a nonprofit that promotes the civil service.

Armstrong, Brandt, Redwood, Mabie, Weir and Hines did not respond to requests to comment, but Hilliard defended their hirings, saying the department recruits the “best and brightest” and brushed off concerns of corporate influence. “Prior industry experience brings knowledge and perspective to public service and should not be mistaken for corporate influence,” she wrote, adding that political appointees share the goal of advancing the president’s health agenda for the American people.

On Mabie, Hilliard said he brings “two decades of scientific experience and a strong commitment to advancing NIH’s mission.” Mabie’s work includes improving atmospheric pollution data collection and supporting research into the health impact of small particles, Hilliard said.

The civil service, a career once prized for its stability and benefits, has taken a hit as dismay over mass firings, leadership vacuums and hostile rhetoric from the administration have pushed many to quit. Around 363 HHS employees quit per month in the first 16 months of the Trump administration, up from an average of 282 during the same timeframe under Biden.

The Partnership for Public Service’s annual survey of federal employees found that HHS employees had an engagement and satisfaction score of 20.4 percent, among the lowest for large agencies and the lowest for the department since at least 2010. Nearly three-quarters of the HHS workforce reported feeling less engaged compared to a year ago, and less than 10 percent believed they can report a legal or regulatory violation without retaliation, the survey found.

“It’s literally your own government against the government,” said a CDC staffer who decided to leave after the Trump administration converted them and thousands of other federal workers to at-will employees. The employee was granted anonymity to discuss internal dynamics at CDC.

“I can’t keep trying. I can’t keep hoping for this to get better because so far, it’s proven it’s not getting better,” said the employee, who also cited what they described as the CDC’s uncoordinated response to the Ebola outbreak in Central Africa as further reason to leave government.

Former and current HHS employees, as well as academics who study government management, have warned that Trump’s downsizing of HHS and what they see as the politicization of public health will undermine the government’s ability to compete with the higher-paying private sector.

“The message that we're…giving our students is to look elsewhere to do work in public health,” said Jeremy Sarnat, head of graduate studies at Emory University’s Rollins School of Public Health, one of the highest-ranking graduate programs for public health in the country.

While Sarnat believes opportunities will return, others reckon the impact will be more permanent.

"People went to the government for stability…Now that stability is gone, there is no reason to go to government,” said an executive at a large U.S. drugmaker who recently hired a senior FDA employee and was granted anonymity because they were not authorized to speak to the press. “You might as well go to industry and get paid more.”

The White House did not respond to questions about whether it was concerned about the government's ability to compete with the private sector for hires.

Zooming out

The Health and Human Services Department boasted around 93,400 employees in January 2025. Seventeen months later, that number is down 22 percent to below 73,000, the lowest since 2006, according to Office of Personnel Management data.

The department’s restructuring, which Kennedy announced in March 2025, turbocharged the wave of departures.

“HHS is a sprawling bureaucracy…This leads to tremendous waste and duplication, and worst of all, a loss of any unified sense of mission. The resulting pandemonium has injured American health and damaged department morale,” he said in a video announcing the restructuring.

Kennedy said he would layoff 10,000 workers in an effort to reduce the workforce by 20,000. The cuts followed earlier downsizing measures, including early retirement offers, resignation incentives and the firing of probationary employees.

Former and current HHS employees have said the layoffs have instilled fear across the department and left agencies understaffed and unable to complete basic functions like order equipment and disburse grants. More than 1,000 employees who received reduction-in-force notices were reinstated after challenging their layoffs.

OPM data as of May 2026 show layoffs impacted just under 4,500 HHS employees since Trump returned to office.

Retirements made up the largest share of departures, followed by voluntary exits. Nearly 8,000 employees retired, with a quarter choosing to retire early. That’s compared to less than 3,000 retirements in the same 16-month timeframe in the Biden administration.

“I would have loved to have stayed there for the rest of my career,” said a senior career employee at the Agency for Healthcare Research and Quality, who quit voluntarily in the past year. The employee, granted anonymity out of fear of retaliation, described the agency as “crippled” following the mass departures.

The AHRQ, which focuses on improving health care services, saw the biggest decline in staffing among agencies, losing more than 70 percent of its workers between January 2025 and May 2026, mostly from layoffs and retirements. Since Trump returned to office, the agency’s grantmaking has been largely inactive. At least 117 grants have been cancelled, and only 5 percent of the grant money appropriated by Congress to the agency this year has been distributed, according to an analysis of publicly available federal spending data by AcademyHealth, a health services research nonprofit.

An AHRQ spokesperson said the “much-needed reforms” marked the agency’s “return to its statutory mission.” They did not respond to POLITICO’s question about whether AHRQ would spend its appropriated money in the final weeks of the fiscal year.

Elliot Anderson, who up until April served as AHRQ’s confidential assistant before moving to the CDC, penned a Newsweek op-ed in January alongside AHRQ director Roger Klein, saying the agency changes were part of the “abandonment of ‘woke’ advocacy” in research.

The Administration for Community Living, which supports seniors and people with disabilities, lost more than 50 percent of its employees between January 2025 and May 2026. The Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration, and the Administration for Children and Families all lost a third or more of their workers during that period.

Hilliard, the HHS press secretary, maintained that SAMHSA has the “specialized expertise and highly skilled workforce needed.” The Administration for Community Living, the Health Resources and Services Administration and the Administration for Children and Families did not respond to requests for comment.

“[People] are scared for their jobs…There is just so much fear,” said a senior career employee at the Administration for Children and Families who quit in the past year with no other job secured. More than a dozen staffers the employee helped hire were fired last year, according to the employee, who was granted anonymity out of fear of retaliation.

“It came down to…at what point am I just helping dismantle something I care about by just being here?” the employee said.

The number of political appointees is growing while the number of top-tier career employees is on the decline. There were 315 career employees in the permanent Senior Executive Service, the federal government’s top leadership corps, at HHS as of May — down 21 percent from 2024 and the lowest level in at least a decade, according to OPM data.

Trump has taken aim at senior career employees, directing agencies to convert more career Senior Executive Service positions into political ones and stripping other high-level employees of their civil service protections. “Because SES officials wield significant governmental authority, they must serve at the pleasure of the President,” Trump wrote in a memorandum on his first day back in office last year, ordering agencies to reassign senior officials to ensure they are “optimally aligned” to implement his agenda.

HHS employees and watchdogs warned the drop in senior career officials threatens the functionality and impartiality of the department.

“The institutional knowledge and wealth of knowledge that’s been lost at FDA, CMS, NIH, CDC, etc from all these senior leaders is just really unimaginable,” said a Senior Executive Service official at HHS who was put on leave in April 2025 along with several other Senior Executive Service members. The official, granted anonymity out of fear of retaliation, was later threatened with termination if they did not accept a reassignment from the Washington area to a remote post in the West. HHS did not respond to POLITICO’s comment request on the relocation of senior career employees.

“The systems, structures that made our Health Department the envy of the world, they’re crumbling before our eyes,” the executive said.

Join our team

At POLITICO’s Health Care Summit in April, Centers for Medicare and Medicaid Services Administrator Mehmet Oz pleaded with the audience.

“We are in need of high quality individuals, talented folks who can come often from the private sector,” he declared.

“I'm not kidding around. If you have family, friends, if you're interested, this is a generational opportunity to come serve.”

Kennedy had once told employees at the FDA he wanted them to “pack your bags.” But at a House Appropriations Committee hearing shortly before the POLITICO summit, Kennedy told lawmakers the Health Department was working to replace those that were fired. The department started with 82,000 full-time workers and fell to 62,000 after staffing cuts, he’d previously said. It was now back up to 72,000 full-time employees, he told the committee, adding that he planned to bring on an additional 12,000.

“We will have made up for all the employees that we lost, but we have replaced them with a better group of people who are actually going to address chronic health,” Kennedy said.

Minutes later, he conceded that “many of them were recalled.”

OPM data paints a different portrait. Excluding part-time and seasonal hires, the department had 66,803 full-time employees as of May 2026, down from 85,236 in January 2025.

From January 2025 to May 2026, the agency has made 3,252 new hires, that’s down from 11,811 in the same period in the Biden administration.

Hiring is uneven across agencies. Most hires occurred at the Indian Health Service, which made up 35 percent of new hires, followed by the Centers for Medicare and Medicaid Services and the Office of the Secretary of Health and Human Services.

Some agencies have done little to no hiring. AHRQ made three hires since January 2025, while the Agency for Toxic Substances and Disease Registry made two. HHS did not respond to POLITICO’s questions about its plans for the two agencies.

The lower hiring numbers are partially a reflection of limited availability. The department made 2,343 job announcements this year, down from 12,278 in 2024, according to OPM data from the end of July. There are currently 287 active job postings at HHS, less than half of which are open to the public.

“[Hiring] is definitely not keeping up. We're not treading water,” said Michael Weahkee, who led IHS in the first Trump administration and retired from the agency in June. Weahkee said new requirements for political appointees to approve routine hires, like nurses, and tighter controls for job announcements have extended the already slow hiring process “by weeks.”

“We didn't actually see any loss of accreditation [of providers] or any near misses…but it feels it could happen at any time,” he added.

In January, the IHS, an agency Kennedy has promised to strengthen, announced its “largest hiring effort in agency history.” The agency has long struggled to find workers since it pays less than private health care providers and its jobs are often in remote areas.

Hilliard said IHS “continues to aggressively recruit and retain” workers as part of its “robust 2026 hiring plan” that focuses on health care professionals. “IHS has not been affected by federal workforce reductions, and there are no plans to consolidate any IHS facilities without tribal consultation,” she said in a statement.

Many of the department’s recent hires are filling roles similar to those eliminated last year. At NIH, four IT management employees in Grade 13 in the federal pay system, which has a pay range between $90,925 and $118,204, were fired in July 2025, when layoffs peaked across the department, only for the agency to hire back two individuals in IT management in Grade 13 this year.

Similar patterns appear in other roles. At FDA, all 25 of the human resources management staff hired by the agency this year had the same pay grade and occupation categories as those that were laid off last year.

At CMS, the agency laid off a grade 15 medical officer and grade 13 pharmacist in July 2025, only to hire a grade 15 medical officer and a grade 13 pharmacist in April 2026. Similarly, six CMS health insurance administration employees in Grade 9 were laid off last year, only for the agency to hire six individuals in the same grade and occupation this year.

Overall, at CMS, the new hires overlapped in pay grade and occupation with those the agency laid off in July nearly 50 percent of the time. HHS and its divisions did not respond to questions about its hiring and the overlap in pay grade and occupations of new hires and those who received layoff notices.

Apart from January 2025, hiring at HHS peaked at 345 in May, the most recent month for which data was available at the time of POLITICO’s analysis. Most hires occurred in the “miscellaneous administration and program” occupation category, a catchall term for organizational office work, followed by nursing and medical officers.

Despite the hiring uptick, HHS employees continue to report low morale and insufficient staffing to do their jobs. They warn last year’s layoffs and the politicization of their work will be a lasting deterrent to current and prospective employees from pursuing careers in public service.

“It’s really pushing the very small amount of staff we have right now to do more and more with less. It’s definitely hard to continue,” said a senior physician at an IHS hospital who plans on leaving. Several doctors have recently resigned at the hospital, and new rules requiring a political appointee to approve contracts have made it hard to secure night doctors and other clinicians.

At the FDA’s Center for Biologics Evaluation and Research and Center for Drug Evaluation and Research, two of its most important regulatory bodies, departures have surpassed hiring. CBER hired 39 people but lost 93 employees in the first three quarters of fiscal 2026, while CDER brought on 205 employees but lost 261, according to data from the agency. The FDA did not respond to POLITICO’s questions about hiring.

Across HHS, 1,233 individuals quit in the first five months of 2026, compared to 1,075 new hires, according to OPM data.

“Who from industry is going to come in, take a pay cut, be bad-mouthed, and be vilified as being lazy civil servants?” said Vid Desai, former chief information officer at FDA, who received a layoff notice but opted to retire when he became eligible while the notice was litigated.

Whether the civil service can reclaim its reputation as a stable, fulfilling career option will largely depend on the next president, said David Lewis, who studies public administration at Vanderbilt University.

“There’s going to be reckoning. Whoever the next president is, they’re going to have to decide what they want the structure of the government to be,” Lewis said.

Ellie Borst and Carmen Paun contributed to this story.