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Earlier this week, news broke that the Trump administration is going to propose massive cuts in the non-Medicare, non-Medicaid portion of the Department of Health and Human Services budget while ginning up some cash for Robert F. Kennedy Jr.’s so-called MAHA efforts, a New Age–y offshoot of the MAGA movement.
But, as the Washington Post reports, the administration isn’t waiting around for congressional action to cripple HHS. Elon Musk’s Department of Government Efficiency has made the ideologically suspect agency a laboratory for its sinister plans to generate “savings” by simply refusing to meet the federal government’s obligations:
The U.S. DOGE service is putting new curbs on billions of dollars in federal health-care grants, requiring government officials to manually review and approve previously routine payments — and paralyzing grant awards to tens of thousands of organizations, according to 12 people familiar with the new arrangements.
The effort, which DOGE has dubbed “Defend the Spend,” has left thousands of payments backed up, including funding for doctors’ and nurses’ salaries at federal health centers for the poor. Some grantees are waiting on payments they expected last week.
In the guise of ensuring that every single dollar being expended is consistent with Trump policies, “Defend the Spend” is essentially a slow-motion riot in which “efficiency” is promoted by the agency not doing its work, most of which is carried out via grants and contracts that are now in perpetual limbo. It’s all extremely and perhaps proudly irregular:
Typically, an organization that has been awarded a grant does not receive the funding up front. The money is held in a secure account managed by the government, and an organization will request “drawdowns” — tranches of money periodically throughout the year — to cover expenses such as salaries or research costs.
Under Defend the Spend, organizations must now include a justification for each transaction. Federal officials then review the justification before deciding whether to approve the payment.
It’s actually worse than that: DOGE is imposing multiple review requirements of disbursements on grounds that civil servants cannot be trusted:
Some officials have been told that only Trump political appointees can sign requests to disburse funds, even if a career official has already approved it, adding an additional layer of review. The justification for each payment also must include an explanation of how the money will be used to advance Trump administration priorities, according to two employees in separate agencies who received high-level briefings on the process.
It’s a fine way to slow down or stop legally obligatory spending while unknown bureaucrats — either HHS staffers or DOGE employees or both — take their time reviewing “justifications,” then tout anything not spent as “savings.” It’s like appointing a sloth to serve as a political commissar: Delay in payments is as much the object as prevention of woke or wasteful spending. Defend the Spend also makes Uncle Sam a deadbeat, unwilling to pay his bills.
Similar “pauses” and freezes in spending are happening all over the federal government, though HHS may offer a prototype for a branded DOGE effort to disrupt disfavored agencies by introducing political reviews of spending that deny them the use of congressionally authorized and appropriated funds. If this approach demoralizes federal employees, contractors, or grantees, so much the better, given DOGE’s and the Trump administration’s overall goal of blowing up “the deep state” and making government a purely ideological instrument for the 47th president’s agenda.
Among other things, Defend the Spend ought to wake up those observers who believe Elon Musk has lost influence in the administration, or that DOGE is largely a thing of the past, now that the shock-and-awe stage of Trump 2.0 is over. It’s looking like the disruption may have really only begun.
