The Agency for Healthcare Research and Quality, known as AHRQ, told researchers in a July 15 letter that it was stopping continuation funding on dozens of grants aimed at reducing medical errors, curbing hospital infections, and improving care for high-risk pregnancies. Congress appropriated $345 million for AHRQ this fiscal year, but the agency has spent less than $15 million on grants and has not issued a new award in over a year, according to federal records reviewed by KFF Health News.
Staffing Collapse and a New Grant Framework
Approximately 75% of AHRQ staff have been fired or resigned since President Donald Trump took office, according to the Department of Health and Human Services. All of the agency’s grant managers have been dismissed, leaving no internal capacity to directly oversee future awards, according to Brent Sandmeyer, a former AHRQ program officer. “You wonder about this administration’s commitment to fighting fraud,” Sandmeyer said.
HHS spokesperson Emily Hilliard said AHRQ intended to establish a new “framework” for grants but did not provide further details. She characterized the July 15 action not as termination but as a decision that certain grants “would not receive continuation awards,” a distinction that may carry legal weight for researchers weighing lawsuits.
Contradiction With Stated Priorities
Researchers who received the termination letter from AHRQ Director Roger Klein expressed bewilderment because much of their canceled work aligns directly with the priorities Klein himself outlined. Those priorities include patient safety, preventing antibiotic resistance, countering overmedication of children, and promoting digital health tools.
KFF Health News examined roughly 20 of the canceled grants and found that nearly all had objectives overlapping with Klein’s stated agenda. “If there’s an ideology, lay it out clearly. But there’s no clarity whatsoever,” said Goutham Rao, chairman of the Department of Family Medicine and Community Health at Case Western Reserve University, who lost three current grants after 16 years of AHRQ funding.
Aaron Carroll, chief executive of AcademyHealth, framed the cuts as a paradox for an administration campaigning on making American healthcare healthier. “When you think about everything Americans hate about our health care 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,” Carroll said.
A Legacy Built on Measurable Results
AHRQ is perhaps best known for its work curbing hospital infections. Practices developed through AHRQ-funded studies prevented an estimated 20,500 deaths and saved $7.7 billion in healthcare costs between 2014 and 2017 alone, according to an agency analysis. Teams at Harvard, Yale, and Rand built a national standardized patient survey that HHS and healthcare systems use to refine care around patient perspectives, and the Centers for Medicare & Medicaid Services ties some hospital payments to those surveys.
Andrea Shields, a University of Connecticut OB-GYN, lost an AHRQ grant that trained nonspecialist doctors, nurses, and emergency medical technicians to manage high-risk pregnancies — work with direct relevance to maternal mortality, given that women in rural areas are two to three times as likely to die during pregnancy than those elsewhere in the United States. “The priorities they lay out in that letter make me think they didn’t even look at what we were doing,” Shields said.
Hardeep Singh, director of the Houston Methodist Safety, Quality and Well-Being Institute, whose AHRQ-funded research targeted medical errors introduced by poor software design, noted that “AHRQ is the only federal agency that’s focused on safety and quality.”
Artificial Intelligence as Replacement
Klein, a molecular pathologist and Federalist Society-affiliated lawyer who took over AHRQ last July, has told staff that artificial intelligence can replace much of the evidence review and analytics performed by agency scientists, according to one current and one recently departed official. That posture tracks with a July 22 report from White House science adviser Michael Kratsios calling for the government to “refocus support on individual scientists rather than legacy institutions” and build the future with AI.
Susan Edgman-Levitan, who has worked on AHRQ-funded patient survey research since 1995, lost a $1 million annual grant to develop hospital surveys on childbirth and behavioral health services. Her team received no award confirmation last year, wrote to Klein, and heard nothing until the July 5 p.m. termination email arrived. “My salary is gone. The salaries of all my research assistants, survey scientists, all lost,” she said. “But I’m near the end of my career. The salary piece is not as devastating as the loss of what I view as really critical work.”
What Happens Next
The Society for General Internal Medicine sued Klein and HHS Secretary Robert F. Kennedy Jr. last August over AHRQ’s failure to issue new grants, arguing that leaving most of a $369 million appropriation unspent violates a 1974 law protecting Congress’s power of the purse. That case is pending, and the distinction between “terminated” and “not awarded continued funding” may shape future litigation. Watch for additional lawsuits from individual grantees, congressional pressure to enforce the appropriation, and whether AHRQ’s promised new grant framework ever materializes — or whether AI-driven evidence review becomes the de facto replacement for the patient safety infrastructure the agency once built.
— Aisha Mensah, health desk, AXO News