Tens of millions of vulnerable Americans could lose critical public health services if a devastating Trump administration proposal to eliminate the Health Resources and Services Administration comes to fruition.

HRSA is one of several agencies listed as being on the chopping block in a recently leaked plan to overhaul the U.S. Department of Health and Human Services, which has been ripped apart by Trump and his associates in recent weeks.

Hundreds of employees have already been laid off from the 43-year-old agency, which funds nearly 1,400 health centers that provide quality, affordable health care to low-income people. The health centers saw 31 million patients in 2023, which was a 2.7 million increase since 2020, according to HRSA.

But the health centers are just one part of many HRSA bureaus covering the health workforce, maternal and child health, HIV/AIDS care, and health systems that tackle issues such as organ transplants.

“HRSA is the backbone of service delivery to historically underserved and rural communities and has a vital role to play in public health, helping to directly support the work that states and local communities do on critical public health issues like maternal mortality, ending the HIV epidemic,” former HRSA Director Carole Johnson, MA, told The Nation’s Health. “So there are population challenges all across the country when an entity like HRSA isn’t there.”

Zeroing out HRSA would be another blow to the nation’s goal of ending the HIV epidemic after previous cuts to the Centers for Disease Control and Prevention’s Division of HIV Prevention. HRSA-funded clinics provide HIV treatment services through its Ryan White HIV/AIDS Program, which as of 2023 served over 576,000 people — over half of people in the U.S. with HIV, according to HRSA. Of those patients, nearly 71% were Black or Hispanic. Almost 90% of the program's participants lived at or below 250% of the federal poverty level.

Losing HRSA would also be a massive blow to maternal and child health care. HRSA funds Healthy Start programs across the country, which provide clinical care for new moms and moms-to-be, as well as help with housing and transportation to and from doctor’s appointments. Another program, the Maternal, Infant and Early Childhood Home Visiting Program, pairs health workers with families to promote healthy behaviors such as creating safe sleeping arrangements for infants and reading to their children. The program helps prevent child neglect while also helping parents find stable employment or continue their education.

Funding for HRSA’s home visiting program traditionally had bipartisan support in Congress, even at times when it seemed they could agree on nothing, Johnson said. But that’s due in part to research that supported the program’s success — research now under threat because of the ongoing cuts to HHS agencies.

“You don’t get that kind of evidence just by hoping for it,” said Johnson, now a senior fellow for the Century Foundation. “You actually have to have a public health infrastructure. You have to have good data collection from our maternal and child health colleagues at CDC, good research supported by our colleagues at NIH and our partnership with our colleagues at the Administration for Children and Families in helping us to evaluate the effectiveness of these programs.”

But the future of the public health workforce is even more in jeopardy if HRSA’s axed. Numerous loan repayment programs and scholarships for health professions, such as nursing, could end. This includes programs like the National Health Service Corps, which places emerging health professionals in rural and disadvantaged areas already facing medical and mental health care provider shortages.

“HRSA is just a place where people put their head down and do the work and commit to the communities that they’re supporting, and really think creatively about how to ensure someone can get into a health profession's training program," Johnson said. Someone interested in medical school, for example, may want to get "exposure and training in the communities where we struggle to recruit providers, so that maybe they will continue to practice in those communities."

Johnson does not know if states could fill the health gaps if HRSA goes away. While the HHS plan is to dissolve HRSA and other agencies into a proposed Administration for a Healthy America, she said there is no clarity about what programs would be completely eliminated and what work may move to other agencies.

Ironically, among recently laid-off HRSA employees were staff set to launch updated health IT in May that would analyze health center patient outcomes and see if federal dollars were being used efficiently, according to STAT News.

“It’s important for there to be a robust conversation about what the reorganization is going to look like so that the communities around the country — particularly our public health colleagues around the country who are funded by HRSA resources, rural communities that depend on HRSA resources — that they have some visibility into what this really is going to mean for them,” Johnson said.

Other HHS agencies facing the Trump administration guillotine include the Administration for Community Living, the Substance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality, and the Administration for Strategic Preparedness and Response.

Among services offered by HRSA in the U.S. are maternal and child health centers. (Photo by Kampus Production, courtesy Pexels)