With the current administratioin, some federal activities like PAC CARB (experts for antibiotic resistance) and USPSTF (for prevention) seemed to come to a halt. But others, like MEDPAC (advisory body on Medicare) percolate right along.
Why is this?
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Could We Have Predicted Which Federal Health Agencies Would Keep Running Under Trump?
Could an expert, looking ahead from December 2024, have predicted what would happen under the second Trump administration to three rather different federal health-policy institutions—MedPAC, PACCARB, and the U.S. Preventive Services Task Force (USPSTF)?
The answer is: to a surprising extent, yes—but not perfectly. The important clue was not necessarily the subject matter each organization dealt with. It was the way each institution was built and, especially, how dependent it was on the executive branch.
First, the three organizations are quite different.
MedPAC, the Medicare Payment Advisory Commission, advises Congress on Medicare payment and policy. Although its work concerns CMS and HHS constantly, MedPAC itself is an independent legislative-branch agency. Its commissioners are appointed by the Comptroller General, and it has statutory responsibilities to report regularly to Congress.
PACCARB, the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria, advises the federal government on antimicrobial resistance. It is much more conventionally an executive-branch advisory body: a presidential advisory council operating within the HHS structure and dependent on the department for meetings, staff support, appointments, and continuation of its work.
The USPSTF, meanwhile, occupies a fascinating middle position. It is an expert panel that evaluates evidence and recommends preventive services such as cancer screening. By statute, its scientific judgments are supposed to be independent. But its administrative home is AHRQ within HHS. HHS provides its support and appoints its members. Moreover, litigation over the Affordable Care Act had already raised the question of just how independent the Task Force was from the HHS Secretary.
What could one have predicted in December 2024?
MedPAC was the easy case.
An expert familiar with Washington machinery could have said with high confidence that MedPAC would keep going. A change of president does not put a new political appointee in charge of MedPAC. Donald Trump could replace the Secretary of HHS, reorganize executive agencies, or take a very different view of federal advisory committees without thereby gaining control of a congressional commission.
A reasonable December 2024 prediction would therefore have been: MedPAC will probably continue holding its meetings, producing its reports, and arguing about Medicare payment policy much as before.
PACCARB was more vulnerable.
Its subject—antibiotic resistance—was hardly an obvious partisan target. Indeed, in late 2024 PACCARB looked perfectly healthy. Its charter had recently been renewed, and a January 2025 meeting was already publicly scheduled.
Nevertheless, its institutional position created risk. A presidential advisory council inside HHS ultimately depends upon the executive branch deciding to convene it and support it. An incoming administration interested in reducing advisory committees, scrutinizing federal health agencies, or simply freezing activities while conducting reviews could interrupt PACCARB with relative ease.
Thus, in December 2024 an expert might reasonably have said: PACCARB bears watching. It could be delayed, reconstituted, or placed on ice during the transition.
Predicting that it would actually disappear from normal activity for well over a year, however, would have been a much bolder call.
USPSTF would have been the hardest prediction.
The Task Force looked considerably more secure than an ordinary advisory committee. Congress had given it statutory responsibilities, its recommendations played an important role under the Affordable Care Act, and it had a long tradition of scientific independence.
But a particularly alert health-policy lawyer could already have spotted the weakness.
USPSTF was scientifically independent without being administratively independent. AHRQ supplied its infrastructure. HHS appointed its members. And the Braidwood litigation had already highlighted the argument that USPSTF members remained subordinate federal officers whom the HHS Secretary could supervise and remove.
So a sophisticated December 2024 forecast might have said: USPSTF looks protected, but less protected than it appears. If the new HHS leadership decides to interfere with federal scientific advisory processes, the Task Force could prove surprisingly vulnerable.
Still, predicting that ordinary USPSTF meetings themselves would effectively grind to a halt would have seemed aggressive in December 2024.
Then reality supplied the experiment
What happened subsequently was striking.
MedPAC carried right along. Meetings continued. Its normal Medicare-policy deliberations continued. Its statutory reports to Congress continued. To someone looking only at MedPAC, the change of administration might have seemed almost irrelevant.
PACCARB did not. Its January 28–29, 2025 meeting was canceled shortly after the inauguration amid the new administration's broad review of federal health activities. The council then remained largely dormant for more than a year before finally reconvening in June 2026.
USPSTF eventually suffered a similar fate. Its activities continued for a while, but its meeting schedule was repeatedly interrupted. By 2026, multiple scheduled meetings had been postponed or canceled and the Task Force's ordinary operating rhythm had essentially stopped.
The sequence therefore produced something close to a natural experiment.
All three organizations dealt with important federal health policy. All relied on expert deliberation. All could casually be described as federal advisory institutions.
But their actual resilience differed enormously.
The best predictor was not whether their work was valuable, scientific, bipartisan, or obscure. It was much more mundane:
Who appoints the members? Who supplies the staff? Who schedules the meetings? Who can remove the officials? And who can simply decide that the meeting will not occur?
MedPAC had structural independence because Congress had placed it outside the executive chain of command. PACCARB had very little such insulation. USPSTF had substantial statutory and scientific prestige but considerably less operational independence than its public image suggested.
So, could an expert have predicted the outcome in December 2024?
The ranking, yes. The magnitude, probably not.
“MedPAC will be fine; PACCARB is vulnerable; USPSTF is more vulnerable than it looks” would have been an excellent pre-inauguration forecast.
“PACCARB will lose more than a year of normal activity and USPSTF will subsequently enter an extended period without ordinary meetings” would have been genuinely prescient.
The larger lesson is almost boring enough to be overlooked: in Washington, institutional architecture matters. An organization described as “independent” may be independent in its judgments yet completely dependent on an executive agency for the mundane machinery that allows it to function. Sometimes the most important form of political protection is simply having been put on a different branch of the organizational chart.