The Trump administration has effectively halted most of the Agency for Healthcare Research and Quality’s activities, cutting off federal funding that officials estimate has saved thousands of lives and billions of dollars by improving medical practice over the past 27 years.
Shutting down the spigot
In a July 15 letter, the small Department of Health and Human Services agency told researchers it was stopping at least 104 grants, many of which were aimed at improving patient safety. Although Congress appropriated $345 million for AHRQ for this fiscal year, the agency has spent less than $15 million on grants and hasn’t issued a new one in over a year, according to a review of federal records. About 75% of agency staffers have been fired or quit since President Donald Trump took office last year, according to HHS.
Trump and HHS Secretary Robert F. Kennedy Jr. have sought to slash the federal government’s investment in biomedical research, terminating grants and forcing scientists out of agencies across the health department. The gutting of AHRQ strikes some of the administration’s critics as particularly shortsighted, though, because of the agency’s noncontroversial focus on patient safety and its overall alignment with Trump and Kennedy’s “Make American Healthy Again” campaign against chronic illness.
When you think about everything Americans hate about our healthcare system — that it costs too much, that you can’t get in to see a physician, that the treatment isn’t right, that the records contain wrong information — all that is what AHRQ studies, said Aaron Carroll, chief executive of AcademyHealth, a health services research group that supports AHRQ’s work.
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Removing the oversight
The Trump and Kennedy changes to AHRQ appear intended to be permanent. All of AHRQ’s grant managers have been fired, so there would be no way for the agency to directly oversee future grants, said Brent Sandmeyer, a former AHRQ program officer. “You wonder about this administration’s commitment to fighting fraud,” he said.
HHS spokesperson Emily Hilliard said AHRQ intended to establish a new “framework” for grants. She did not reply to requests for further details. Researchers who received the letter from AHRQ Director Roger Klein expressed bewilderment because much of their work has the same objectives that Klein highlighted as the agency’s current priorities.
AHRQ is the only federal agency that’s focused on safety and quality, said Hardeep Singh, director of the Houston Methodist Safety, Quality and Well-Being Institute. His research, funded until recently by AHRQ, has aimed to reduce medical errors introduced by inadequate software design. Klein stated that AHRQ’s research interests include patient safety, preventing antibiotic resistance, countering overmedication of children, promotion of digital health tools, and research “focused on scientifically valid, measurable health outcomes and solution-oriented approaches in health disparities research.”
Of the July 15 letter, Hilliard said: “Under statute, the AHRQ director must determine whether continuation funding is in the best interest of the federal government. AHRQ determined that certain non-competing continuation grants and jointly funded grants would not receive continuation awards.” Hilliard said the grants were not terminated but rather were “not awarded continued funding.” This subtlety may have legal relevance for grantees planning to sue the administration, said Lauren Adams, a spokesperson for AcademyHealth.
The Society for General Internal Medicine sued Klein and health secretary Kennedy last August over AHRQ’s failure to issue new grants. The lawsuit, which is pending, argues that failure to use most of AHRQ’s $369 million fiscal 2025 appropriation is illegal under a 1974 law intended to protect Congress’ power of the purse. “None of it makes any sense,” said Nora Becker, a pediatrician at Michigan Medicine who lost the last two years of a five-year training and research grant on the relationship between financial difficulty and health outcomes.
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In March 2025, Kennedy announced plans to fold AHRQ and parts of other HHS agencies into a new Office of Strategy. But Congress has shown no interest in the reorganization plan. Klein hasn’t publicly commented about AHRQ’s overall objectives or plans since attacking previous AHRQ activities in a Newsweek opinion piece he co-wrote with an assistant that was published in January. The article argued that under previous administrations, “scientific neutrality” had given way to “moral signaling” on diversity and equity. But now, Klein wrote, the Trump administration had righted AHRQ’s focus to “generate evidence that improves how health care is delivered.”
Staff members currently number 74, Hilliard said, down from about 300 in early 2025. The agency has halted about $100 million in this year’s commitments to grantees, a substantial chunk of its congressionally approved budget, according to a tabulation by AcademyHealth. “These claims about Dr. Klein are pointedly false,” Hilliard said. “AHRQ is strengthening its grants process, reviewing agency work for quality, aligning with its statutory mission, and focusing on research to improve patient outcomes.”
She did not respond to a request for specific information on grant funding.
AHRQ continues to conduct some data collection and has kept up its Medical Expenditure Panel Survey, which measures how Americans use and pay for medical care, insurance, and out-of-pocket costs. However, publication has slowed to a trickle because Klein reviews every piece of data or report issued by the agency, said Elisabeth Kato, who worked at AHRQ for 16 years before resigning from a senior position in April.
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Lost opportunities for research
AHRQ also runs the U.S. Preventive Services Task Force, a panel whose assessments on the value of drugs and procedures determine whether insurers are required to cover them. The task force hasn’t met since March 2025. Trump fired two of the group’s senior leaders and currently has only six of the 16 members it had when he took office. “The longer they don’t meet, the longer we’re losing connection between evidence and coverage,” said Sandmeyer, one of the former AHRQ officials.
A meeting of the task force is set for the end of August, Hilliard said. Pediatrician Courtney Mangus lost her grant in the middle of a five-year project aimed at reducing cancers by using a software tool to help reduce the number of CT scans done on children who come to emergency rooms with abdominal pain. In rural and community emergency rooms, children are much more likely to be scanned for appendicitis than they are in better-equipped children’s pediatric hospitals. Each scan contributes to cancer risk.
Mangus wonders how AHRQ’s disappearance as a funding source will affect her career. “I need some funding to finish what I’ve started,” she said, “so then I could apply for bigger awards that can move the needle on this issue.” She has applied to smaller foundations and may seek support from the National Institutes of Health, but her work was “really best suited for AHRQ.”
As the NIH, AHRQ, and other federal funders have cut grants over the past two years, new applications have flooded private biomedical foundations. “It’s baffling to me why AHRQ refuses to fund research that has legally been appropriated by Congress and signed by the president,” Carroll said. “I don’t understand why everyone else in government isn’t going out of their mind about this.”
