How The DOGE Purge Could Undermine Federal Health Agencies

Some worked on lowering the price of drugs for senior citizens, others on making sure states weren’t wasting federal insurance money.

There were the ones keeping dangerous chemicals out of the food supply, and those on a project to reduce America’s notoriously high maternal mortality rate.

Now, they are out of work.

They are among the thousands of career government employees working on health care who received dismissal notices over the long weekend. And they include several who told HuffPost about their experiences.

Their firings were part of a broader, ongoing purge of the federal workforce that President Donald Trump has unleashed — an effort whose purpose, according to a Department of Health and Human Services spokesperson, is “to restructure and streamline the federal government … to ensure that HHS better serves the American people at the highest and most efficient standard.”

The driving force behind the dismissals appears to be billionaire Trump adviser Elon Musk and his Department of Government Efficiency, or DOGE. In response to criticisms that DOGE is cutting indiscriminately, an anonymous Trump official told Politico on Friday that the administration was sparing certain health care workers in order to be “thoughtful about critical functions that the government needs to perform.”

The list of protected employees, the official said, included those working on disease response and the management of Medicare, the government insurance program for the elderly and people with disabilities.

But the claim about Medicare does not appear to be true. HuffPost has spoken to two HHS employees who worked on Medicare and got dismissal notices, and there are plenty more, according to sources inside the department. That includes employees who were part of the new, Biden-era program to bring down drug prices through direct negotiation with manufacturers.

Disease response doesn’t appear to have been spared either. Several hundred workers at the U.S. Centers for Disease Control and Prevention have lost their jobs, despite a bird flu epidemic that is ravaging livestock and roiling the market for eggs. The virus has also already spread to humans in several cases, resulting in one death.

Neither White House nor HHS officials have responded to more detailed questions about the firings from HuffPost. Nor has the administration provided comprehensive accounts of how many workers it is dismissing or from which agencies inside the government.

That makes it awfully difficult to assess what impact these layoffs are having.

But the idea that this effort is “thoughtful” seems pretty dubious, given the broad, chaotic way firings have taken place ― and the fact that, as employees told HuffPost, many of the people who lost jobs were working on projects to reduce costs, to guard against fraud or to promote better health outcomes.

For now, the dismissals appear to have affected probationary workers, meaning those who have been in their positions for less than one or two years ― and, as a result, do not yet have the full job protections of civil servants. But that is a massive category, and it includes some veteran public employees, because switching jobs within the federal government or taking a promotion can start a new probationary clock.

Officials on Friday told STAT News about 5,000 workers at HHS stood to lose their jobs in this round, representing about 6% of the department’s total workforce. The final number may be smaller, STAT reported later, although the department already lost some workers to buyouts, and more layoffs may be coming soon.

Whatever the actual numbers, a few things seem to be clear, according to workers who spoke to HuffPost.

One is that the cuts did not distinguish among probationary employees in any obvious way. Another is that the dismissed workers received versions of the same letter, stating that their “ability, knowledge and skills do not fit the Agency’s current needs, and your performance has not been adequate to justify further employment at the Agency.”

The workers who spoke to HuffPost were especially upset about that last line. All said they had only strong performance reviews in their files. Several recounted emotional calls they had received from managers late last week as word of the impending firings spread, in which the managers made clear they had little or no input into firing decisions.

“They knew as much as I knew, essentially throughout the process,” one employee said. “The week before, I had gotten a tearful call from a senior manager ― it was a very surreal experience, essentially saying, ‘I don’t think we have any control over what happens to you and we’re sorry.’”

Other employees said there were obvious errors in their dismissal letters, like incorrect details of employment. They took that as another sign that whoever was making the decisions hadn’t seriously tried to differentiate among workers.

It made them wonder how that was supposed to make agencies operate more effectively.

“It seems profoundly inefficient to just fire everyone without looking at what roles actually are extraneous and which one needs to be filled, and instead just defaulting to the people who are procedurally the easiest to fire,” one employee said. “It has nothing to do with how necessary they are, how productive each individual employee is.”

Some of the workers who spoke to HuffPost went out of their way to say they respected the administration’s right to change agency priorities. They added they supported efforts to make government operations more efficient and recognized that HHS, like any large organization, could benefit from significant reforms.

But they questioned the logic of summarily firing so many employees whose jobs literally included safeguarding federal money — like the one who works on Medicaid, the insurance program for low-income Americans, and checks to make sure that states with “waivers” that allow them to customize their programs were not forcing the federal government to pay more as a result.

“If you want to talk about saving money for taxpayers, we were the ones that were ensuring that it actually was budget neutral for the federal government,” that worker said.

Another dismissed employee, Arielle Kane, cited her project on maternal health as an example of the kind of work that holds out the promise of not just saving money but also improving lives. It’s an initiative to help states support greater use of doulas and midwives through Medicaid.

The project is an experiment of sorts, one of many the federal government has launched through the Center for Medicare and Medicaid Innovation, or CMMI. The goal of these initiatives is to improve the delivery of medical care while holding down costs, a problem that has long vexed policymakers and researchers — and has been tough for CMMI to crack as well.

Research suggests this maternal health effort may work where others have not, with benefits for at-risk mothers and newborns, as well as taxpayers. But the project just lost four full-time workers, Kane told HuffPost, dealing a significant blow to its capabilities. And the widespread assumption at HHS is that more layoffs are imminent.

“If they keep cutting folks like they did on Saturday they will inadvertently — or maybe purposefully — kill the model,” Kane said.

The employees who spoke to HuffPost also challenged the idea of a uniformly bloated workforce, saying many of their teams had been understaffed and were struggling to keep up with existing workloads. With even fewer employees, they said, progress would slow even more, sometimes leading to breakdowns in payment or guidance that left public and private sector partners unable to do their jobs.

“I think how you do it makes all the difference,” one employee said. “This ‘move fast/break things’ mentality that seems to accompany DOGE efforts is not how government should work.”

“If you do that in a startup, maybe you go belly up, your website disappears, and then you go find another angel investor ― or something like that ― and you’re up and running later,” the employee continued. “If you fundamentally mess with the functioning of government, you’re going to have some serious problems.”

Several employees also said they thought that targeting probationary employees was at odds with the supposed mandate to make the federal government more nimble.

“Culling probationary employees, who tend to skew younger and are probably more willing to be more innovative, will almost certainly impact the culture of efficiency and inventiveness in the federal government,” one worker said.

The sheer breadth of the Trump administration firings, the wording and errors in the dismissal letters, and the statements by managers that they had little input ― all of that mirrors what has happened in other federal agencies and could be essential for legal action because probationary employees still have some protections against arbitrary dismissal.

On Friday, the nonprofit group Democracy Forward filed a formal complaint with the Office of Special Counsel. Lawsuits in federal court seem likely to follow and may well succeed. Judges have already blocked other Trump personnel actions, in some cases ordering the administration to let furloughed workers back on the job.

But the administration has found other ways to make the day-to-day life of federal workers difficult ― for example, by effectively evicting the U.S. Agency for International Development from its Washington headquarters so that employees returning to the building had to go back home and work remotely.

Trump and Musk have made no secret that they aren’t simply out to downsize the government. They also want to eliminate what they see as a “deep state” of left-wing, “woke” bureaucrats they believe tried to thwart Trump’s agenda last time he was president ― and were preparing to do so once again.

The workers who spoke to HuffPost said that characterization was far off the mark.

“During my near decade-long career working with or for the federal government, I have never seen anything remotely resembling that,” one worker told HuffPost. “I served our country under the Biden administration, and I was prepared to do that under the Trump administration.”

“Everyone I’ve met in the office has only been incredibly smart, incredibly decent,” the worker continued. “They love their country, and they want these programs to work well and survive, and it’s hard to be vilified this way when it’s a group of such great people.”

Every worker who spoke to HuffPost spoke with similar bewilderment, contrasting the way Trump, Musk and their allies see them with how they see themselves.

“I enjoy being a person who does that work of diving in and understanding policy with the recognition that, at the end of the day, the work that we’re doing will affect whether somebody gets treatment that they need, that, you know, is essential for their livelihood,” one employee said.

“I only ever wanted to work in government, I never intended to work in the private sector,” another said.

Even if the courts do step in or the Trump administration decides to reverse some decisions, workers who spoke to HuffPost said they thought the animosity and turmoil were enough to scare away some federal workers for good.

One worker predicted a “massive brain drain” of scientists, lawyers and other policy experts to the private sector, where the market will reward their skills with higher pay, “but I don’t think it will be as impactful to the American public as being a civil servant would be.”

And with the prospect that government jobs now mean so much more instability and hostility from above, attracting replacements for those who leave will be even harder, workers warned.

“It’s not just the immediate impact of losing these experts, which is bad, but you’re going to have a chilling effect on your ability to attract and retain top-quality public servants in the future,” one employee said. “We’ve just created a decade-plus problem in three days.”