Department of Health and Human Services

The Department of Health and Human Services runs the huge and fast-growing Medicare and Medicaid. These programs fuel rising health costs, distort markets, and are plagued by waste and fraud. The department also runs other costly subsidy programs, including Head Start, TANF, and LIHEAP. Growth in HHS spending is creating a federal fiscal crisis, and the 2010 health care law made the situation worse.

The department will spend $1.23 trillion in 2019, or $9,640 for every U.S. household. After adjusting for inflation, spending has more than doubled since 2000. The department employs 72,000 workers and runs more than 520 subsidy programs.

Department of Health and Human Services Spending in Billions of Constant Dollars
Downsize This!
  • Medicare Reforms. Medicare should be transformed into a system based on vouchers, individual savings, and competitive insurance markets.
  • Medicaid Reforms. Federal spending on low-income health care should be converted to block grants for the states.
  • TANF and Welfare Spending. Welfare reforms in 1996 created Temporary Assistance for Needy Families, but such aid should be provided by private charities.
  • Head Start and Other Subsidies. HHS funds a vast array of other subsidy programs, many of which are wasteful and ineffective.
  • 2010 Health Care Legislation. The law expanded Medicaid, added new taxes and subsidies, created new bureaucracies, and did little to reduce cost growth in health care.
Timeline of Government Growth
Cato Experts
"The government of the United States is a definite government, confined to specified objects. It is not like the state governments, whose powers are more general. Charity is no part of the legislative duty of the government."

James Madison. A paraphrase from Elliot’s Debates regarding a proposed subsidy bill, House of Representatives, January 10, 1794.

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