A small federal agency responsible for studying how health care works for patients is largely dormant despite receiving millions of dollars from Congress for research into antibiotic resistance, health care access and safety or quality of care.
The Agency for Healthcare Research and Quality has spent none of the $345 million appropriated by Congress for the current fiscal year, and $80 million of its fiscal 2025 funding was sent back to the Treasury.
AHRQ hasn’t funded any new research projects in almost a year, and it hasn’t issued grant funding for existing projects since before the end of the previous fiscal year in September, according to multiple people familiar with the matter.
That has left the agency, created in 1999 to fund research into how health care delivery can be safer and better for patients, in limbo as the Trump administration signals its desire to reduce its funding or transfer its functions elsewhere.
“In practice, the agency has stopped functioning,” said Aaron Carroll, president of AcademyHealth, a professional organization for researchers who study health services, including projects that had been funded by AHRQ.
Much of the staff left through reductions in force or layoffs last year, including all employees who process grants, the sources say. About 90 employees remain at the agency which once employed 300 people.
Researchers who were awarded grants have been unable to reach staff and at times have been given incorrect information or told they should withdraw their proposals and submit them somewhere else. Still, researchers haven’t received termination notices or received information about when or if they might get funding.
“Not only has that money not come, if you call them, nobody answers the phone. Nobody replies when you email them,” said Ronald Ackerman, the senior associate dean for public health and director of the Institute for Public Health and Medicine at Northwestern.
Grants are typically awarded for five years, with funding released annually as researchers report progress and demonstrate they are meeting milestones. Program officers usually review those reports and provide guidance between funding periods.
Researchers have essentially been abandoned by the agency in the middle of their projects.
Five grants in Ackerman’s institute haven’t received funding in a year. They include studies related to reducing unnecessary antibiotic use, which can be dangerous for patients; the role of telehealth in improving access to care for Medicaid patients; and better care for acute low-back pain.
‘Black hole’
AHRQ Director Roger Klein, who was appointed last summer, has not issued directives to staff about the work the agency should be funding and frequently denigrates existing projects as “worthless,” according to a former employee who spoke anonymously for fear of retribution.
Klein has insisted on reviewing every public facing communication, report and presentation, however most submissions seem to go into a “black hole,” the former employee said. They either aren’t released publicly or employee requests about them aren’t responded to, effectively muzzling the agency.
As a result, at the end of fiscal 2025, the agency had to give a significant portion of its congressionally approved funding back to the Treasury, the person said.
AHRQ has canceled funding notices — announcements asking researchers to apply for funding to study certain topics — including several related to antibiotic resistance and hospital-acquired infections.
And panels that are supposed to meet several times a year to determine which applications should be funded have not met in a year, according to the agency’s website.
“If you were willing to roll the dice and assume that AHRQ will at some point do something, you literally cannot submit to the agency. It is not possible to request funds from the agency,” said Dr. Leora Horwitz, a researcher who received AHRQ funding in the past.
Agency history
AHRQ is the only federal agency focused solely on studying how to improve health care delivery in the U.S.
It has supported research on infections acquired in health care settings, finding that central-line infections, which affect catheters inserted into the bloodstream, could be prevented using checklists and safety practices such as hand hygiene. The agency then helped scale those practices nationwide, contributing to a significant reduction in infections and reducing health care costs.
“This one study paid for AHRQ forever, basically,” Horwitz said.
While the National Institutes of Health funds research into cures, this agency focuses on how to get those treatments to people.
“There is no perfect health care system right now. AHRQ’s externally funded research program aims to fix that,” Horwitz said.
Officials at the Health and Human Services Department say the agency is reprioritizing its mission.
HHS spokesperson Andrew Nixon blamed the delay in issuing fiscal 2026 funds on the “Democratic-led shutdown along with the late passage of the minibus,” in reference to the votes to fund the department in late January and early February.
Asked why no new grants have been issued in one year, Nixon said in an email that “efforts have been focused on the reorientation toward Presidential and Secretarial priorities, and a return to AHRQ’s core statutory mission of improving health outcomes for the American people.”
He added that AHRQ will “hire staff as needed and award new grants in the future.”
HHS’ fiscal 2027 budget request, however, proposes eliminating one-third of the agency’s funding, stating that “much of AHRQ’s research on quality, safety, and affordability of healthcare delivery is wasteful or duplicative of research conducted at NIH” and that it has “pushed radical gender ideology onto children.”
As for the descriptions of Klein’s handling of operations, Nixon said the claims “are based on anonymous sources and don’t reflect the reality of what’s happening at AHRQ. Dr. Klein is focused on ensuring the agency’s work is aligned with its core mission and delivers meaningful value,” as well as strengthening oversight of projects.
The fiscal 2026 budget request proposed moving the agency’s functions into a newly created “Office of Strategy,” as part of a massive reorganization of the department.
Congress rejected such a reorganization and instead funded the agency at $345 million, a 6.4 percent decrease from the prior fiscal year.
“AHRQ has been explicitly tasked by Congress to generate trustworthy research on how to deliver the highest quality healthcare at the lowest cost,” Rep. Donald S. Beyer Jr., D-Va., who has been pushing for answers and funding, said in a statement. “It is unthinkable to deliberately undermine an agency that improves healthcare delivery for Americans and ensures that taxpayer dollars are spent on effective, affordable, and safe care. This Administration’s attacks on AHRQ are illegal and are in clear defiance of lawful appropriations from Congress.”
The fiscal 2026 funding law also included language for the first time that HHS needs to “support staffing levels necessary to fulfill its statutory responsibilities,” a direct shot at the administration’s reductions in force that crippled agencies like AHRQ and others.
Still, onlookers haven’t seen evidence the agency is hiring staff to comply with the directive.
Legal action
In a lawsuit seeking to compel the agency to release funding, medical research organizations say AHRQ had to enlist the help of Food and Drug Administration employees to push funding out the door for research that had already been approved.
The administration argues, though, that statute doesn’t actually require AHRQ to issue grants or review every application it receives, and that the appropriations are a “lump-sum that could be used for any purpose in furtherance of AHRQ’s mission.”
The government seeks to have the lawsuit thrown out on the grounds that the plaintiffs — the Society of General Internal Medicine and the North American Primary Care Research Group — don’t have standing to sue.
The Government Accountability Office separately is investigating whether AHRQ’s actions qualify as an impoundment of funds, the withholding or delaying of federal funds appropriated by Congress. A report on that is expected in the coming months.
“We are still hearing every week from folks who have had to shut down their labs and let go of support staff and are waiting on even an answer from the agency on whether or not their work can continue,” said Stephanie Garlock, an attorney at Public Citizen Litigation Group representing the medical societies in the lawsuit.
