By Arielle Kane, MPP

On February 15, I was unceremoniously fired from my job as a civil servant.

I worked at the Centers for Medicare and Medicaid Innovation (CMMI), a small but forward-looking office within the larger agency that runs Medicare and Medicaid. Our mandate was to improve efficiency and outcomes in these programs, an objective that ostensibly aligns with the administration's stated goal of the Department of Government Efficiency (DOGE): to maximize governmental efficiency and productivity. Specifically, I was part of a team focused on improving maternal health outcomes at lower costs to Medicaid.

The U.S. is an outlier on maternal health among developed nations. In fact, our country has the highest maternal death rate of any high-income country. In 2022, the U.S. had 22 maternal deaths for every 100,000 live births, compared to zero deaths in Norway, for example. That's because the vast majority of maternal deaths are preventable with better care. Our project, launched in January, was intended to support states using proven strategies to improve maternal outcomes and reduce unnecessary cesareans, all with lower costs.

Our team is a part of the federal civil service, which provides professional, nonpartisan experts dedicated to executing government policies and programs, regardless of political changes. Civil servants provide continuity, expertise, and institutional knowledge that help maintain critical services, from healthcare and infrastructure to national security and public safety. Yet, so many of us are being decimated by the Trump administration.

Ironically, DOGE's leader, Elon Musk, has framed the mass firings of civil servants as necessary to eliminate wasteful government spending, while Musk's companies have been promised or awarded more than $38 billion from the government since 2008. Is the work of critical civil servants less essential than Musk's business endeavors? Furthermore, while civil servants follow ethics rules -- reporting any side income and following strict "cooling off" periods when switching between the private and public sectors -- Musk is actively choosing which government contracts and programs should stay and which should go while his companies actively contract with the federal government, offering him an opportunity to enrich himself while cutting benefits to everyday Americans.

Instead of respecting civil servants, the Trump administration and DOGE in particular seem unconcerned about cutting the people who provide vital healthcare programs. Our project had a clear mission: improve maternal health in Medicaid while lowering costs. And while not all the CMMI projects have resulted in net savings, the lessons learned have kept more expensive strategies from becoming more widely adopted and have steered the industry -- including the private sector -- toward more efficient approaches.

But of course, I don't expect all those working within the Trump administration who fired us to even know the difference between Medicare and Medicaid. The firings appear to have been a blatant attack primarily targeted at probationary employees, without regard for the important roles we play and our often extensive experience. More firings, soon to come, will likely be based on job descriptions reduced to 200-character summaries -- less than a tweet. I believe this all represents a larger trend of rejecting expertise.

I grew up in a family that valued public service: my dad was a teacher. I never saw the government as a path to personal enrichment, but rather as a way to serve my fellow Americans. I think of the John F. Kennedy quote, "Ask not what your country can do for you, but what you can do for your country."

And yet, we've lost that idea over the past 60 years, and now seem to revere money and internet fame more than the consistent, middle-class work of giving back to your country through civil service. I'm confident that the 6,700 people who run Medicare, Medicaid, CHIP, and the federal Affordable Care Act marketplace are motivated not by the promise of profits, but rather by the idea of serving their fellow Americans and making healthcare programs run better.

Beyond my personal disappointment and loss, I am deeply concerned about what this hollowing out of public servants means for the future of government programs like Medicare and Medicaid. Who will want to serve in these roles if they are continually vilified? Instead, the government will most likely shift more and more work to private contractors who will run programs like businesses -- serving those who can pay the most and neglecting rural areas, people with disabilities, low-income communities, and other vulnerable populations as they are not profitable markets.

I worry most about what will happen to maternal health initiatives like the one I was working on. Maternity wards tend to be net revenue losers in hospitals, and birth centers struggle to stay afloat in increasingly consolidated markets. The maternal health crisis in America is an international disgrace, and we need better policies and programs to address it. Now, with a third of our team gone, what happens to that mission? Who will carry this work forward?

As an immigrant who moved to the U.S. because of the opportunities for innovation and entrepreneurship, Musk should be lifting up the civil service workforce that quietly serves behind the scenes. Instead, it appears he is undermining the workers that keep our air clean, our water safe, and provide healthcare to seniors, people with disabilities, and pregnant women. At the end of all this, I don't believe any of us will be winners.

Arielle Kane, MPP, is a former health policy analyst at the Centers for Medicare and Medicaid Innovation (CMMI).