The HHS Secretary sits atop the Public Health Service under 42 U.S.C. 202 and holds the bulk of authority Congress vested in the agency under the Public Health Service Act of 1944. That includes appointing and supervising the Assistant Secretary for Health, designating the directors of CDC and most operating divisions, issuing regulations under the Food, Drug, and Cosmetic Act through delegations to FDA, and approving every Medicare and Medicaid rule.
The Secretary day-to-day power runs through delegations, budget control, and the ability to redirect personnel. The CDC director historically served at the Secretary pleasure until the Consolidated Appropriations Act of 2023 made the position Senate-confirmed starting January 20, 2025; the office remains removable by the Secretary, as Robert F. Kennedy Jr. demonstrated when he fired Senate-confirmed Director Susan Monarez 29 days after her swearing-in in August 2025.
Limits exist: Congress retains appropriations control, courts can vacate rules that exceed statutory authority, and Senate-confirmed positions create at least a confirmation choke point for the Secretary choice of successor.
Citizens often see HHS as a bureaucracy. In law, it is one Secretary holding most of the actionable health-policy authority Congress wrote between 1935 and 1944, with the rest delegated downward at the Secretary discretion.
People often think CDC and FDA are independent of HHS. They are not -- both report to the Secretary, who can hire, fire, redirect, and override their day-to-day decisions within statutory limits.
Citizens often see HHS as a bureaucracy. In law, it is one Secretary holding most of the actionable health-policy authority Congress wrote between 1935 and 1944, with the rest delegated downward at the Secretary discretion.
People often think CDC and FDA are independent of HHS. They are not -- both report to the Secretary, who can hire, fire, redirect, and override their day-to-day decisions within statutory limits.