As Trump wrapped up his first term in 2020, he signed legislation to protect Americans from surprise medical bills. “This must end,” Trump said. “We’re going to hold insurance companies and hospitals totally accountable.”

But Trump’s wide-ranging push to slash government spending, led by billionaire Elon Musk, is weakening the federal office charged with implementing the No Surprises Act.

Some 15% of those working at the federal Center for Consumer Information and Insurance Oversight, or CCIIO, were fired two weeks ago, according to the agency’s former deputy director in charge of operations, Jeff Grant.