AcademyHealth CEO Aaron Carroll, MD recently submitted testimony to the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies about the dire condition of the Agency for Healthcare Research and Quality (AHRQ), where I spent 4 years as a medical officer early in my career. Dr. Carroll points out the immense return on investment that AHRQ has provided over the years - for example, saving $7.7 billion in U.S. health care costs by reducing hospital-acquired infections from 2014 to 2017 on a budget of around $300 million per year - and its unique, irreplaceable function among federal health agencies:
NIH [National Institutes of Health] studies diseases. AHRQ studies how health care is delivered. These are different missions. NIH can tell us that a treatment works in a clinical trial. AHRQ tells us whether that treatment reaches patients in a rural hospital, whether it is implemented safely, what it costs, and whether a critical access hospital in a rural county can actually use it. No other federal agency performs this function. Eliminating AHRQ does not transfer these capabilities elsewhere. It simply ends them.
Notably, Congress rejected HHS Secretary Robert F. Kennedy Jr.'s 2025 proposal to eliminate AHRQ. But Dr. Carroll observes that the Trump administration has effectively carried out this plan anyway, by laying off most of the agency's staff and the entire grants management division, crippling its ability to function as a funder of health services research:
AHRQ has not awarded a single new grant since April 2025. An estimated $80 million in FY25 appropriated research funding was allowed to expire unused—a pattern consistent with the Government Accountability Office’s ongoing impoundment investigation. In FY26, the agency has not funded any of the noncompetitive continuing grants it is statutorily obligated to pay. The FY27 congressional justification now explicitly states a policy of “no new grants,” ending AHRQ’s four-decade role as the nation’s primary funder of health services research—a decision Congress never authorized.
Similarly, former New York City and Philadelphia Health Commissioner Thomas Farley, MD wrote today on his Substack that the U.S. Preventive Services Task Force is being "quietly strangl[ed]" by being deprived of AHRQ support staff, not being convened since March 2025, and not appointing replacements for 5 members whose terms expired on December 31. He cites the recent ACC/AHA dyslipidemia guidelines as an example of what fills the preventive care vacuum when the USPSTF (which wrote its own cholesterol guideline in 2022) is effectively silenced:
Are cholesterol tests for kids and coronary artery scans for adults now scientifically justified? Here’s the problem: I do not know. It takes more expertise and time than I have to sift through all the many complicated studies to figure that out. ... But I do know that (by my count) 12 of the 33 members of the writing committee and 17 of the 29 members of the review committee for the ACC/AHA guidelines have financial ties to biotech companies that are likely to make money from this testing and treatment. (None of the USPSTF members have these conflicts.) And I know this rule: if you’re wondering whether you need a new pair of shoes, don’t ask a shoe salesman.The muddle about cholesterol testing, statin treatment and coronary artery scans is just one example of what we are losing from the USPSTF’s paralysis. ... Thanks to Kennedy, dozens of other important questions on the USPTF consideration list are also languishing. Each month that the Task Force is in deep freeze our ignorance accumulates. ... Surely we can afford to have a group of experts who are not motivated by profit guiding us on which medical services actually keep us healthy. With the USPSTF dead in the water, the war on science begins to feel like a war on us.
