Tag: Deartment of Health and Human Services

Trump order targets wide swath of public assistance programs

The Trump administration is seeking to completely revamp the country’s social safety net, targeting recipients of Medicaid, food stamps and housing assistance.

Trump is doing so through a sweeping executive order that was quietly issued earlier this week – and that largely flew under the radar.

It calls on the Departments of Health and Human Services, Housing and Urban Development, Agriculture and other agencies across the federal government to craft new rules requiring that beneficiaries of a host of programs work or lose their benefits.

Trump argued with the order, which has been in the works since last year, that the programs have grown too large while failing to move needy people out of government help.

“Since its inception, the welfare system has grown into a large bureaucracy that might be susceptible to measuring success by how many people are enrolled in a program rather than by how many have moved from poverty into financial independence,” it states.

The order is directed at “any program that provides means-tested assistance or other assistance that provides benefits to people, households or families that have low incomes.”

Democrats have blasted the effort, arguing the order blends the issues of welfare and broader public assistance programs in a deliberate way they say is intended to lower support for popular initiatives.

“Welfare” has historically been used to describe cash assistance programs like Temporary Assistance for Needy Families. Democrats and liberal activists say the Trump administration is seeking to expand the definition of welfare to mean food stamps, Medicaid and other programs as a way to demonize them.

“This executive order perpetuates false and racist stereotypes about certain groups supposedly taking advantage of government assistance,” House Democratic Whip Steny Hoyer (Md.) and Rep. Barbara Lee (D-Calif.) said in a joint statement reacting to the order.

President Trump “is trying to erect a smokescreen in the shape of Reagan’s ‘welfare queen’ so people don’t see he’s coming after the entire middle and working class,” said Rebecca Vallas, managing director of the Center for American Progress’s Poverty to Prosperity Program.

Welfare reform has long been a goal of GOP lawmakers, and there’s broad support in the Republican conference for changing the federal safety net to impose stricter work requirements and block grant state funding for programs like Medicaid and food stamps.

While noting that he hadn’t seen the specific text of the executive order, Rep. Tom Cole (R-Okla.) said he supports the concept.

“For able-bodied, single adults, I certainly favor work requirements,” Cole said.

With Republicans in total control of the government, conservatives have been hoping for a major legislative push to overhaul federal assistance programs.

Speaker Paul Ryan (R-Wis.) late last year said he wanted Republicans to work on entitlement reform, with a focus on promoting work and career-based education.

“We want to smooth the path from welfare to work, pull people out of poverty, pull people out of welfare,” Ryan said in December.

Robert Rector, a senior research fellow at the Heritage Institute, said the executive order is meant to signal support to congressional Republicans.

“[Administration officials] have been talking to Congress, and the executive order is designed to set the table for them,” Rector said. “Do what they can in the executive branch, and give support to similar efforts on the Hill.”

But a short legislative calendar and a slim Republican majority in the Senate mean the administration may be largely on its own.

Agencies are limited in what changes they can make to their programs, so comprehensive welfare reform may be off the table without major legislation.

Republicans have already acknowledged they won’t be able to cut spending on entitlement programs like Medicare, Medicaid and Social Security.

“I think it’s very tough to get this thing through the Senate when it requires 60 votes. I certainly don’t have any problem with the president taking initiative,” Cole said.

The executive order doesn’t set any new policy, but Center for American Progress’s Vallas said the order is important as a messaging document, and it shows that Trump is willing to act without Congress.

“This is more of President Trump not being content to wait for Congress to dismantle these programs. This is him wanting to take matters into his own hands,” Vallas said.

The order follows policy shifts already underway at various agencies.

Health and Human Services officials have encouraged states to pursue work requirements for Medicaid beneficiaries. Arkansas, Indiana and Kentucky have already been granted such waivers, and several other states have waivers pending with the administration.

Earlier this year, the Agriculture Department sought input on “innovative ideas to promote work and self-sufficiency among able-bodied adults” participating in the food stamp program.

In Congress, House Republicans unveiled a provision in the 2018 farm bill to expand mandatory work requirements in the food stamp program. The broader legislation will be marked up later this month, but it faces a long uphill battle.

The administration’s effort could also face legal challenges. Medicaid advocates in Kentucky have already sued over the work requirements, and additional safety net changes could provoke even more lawsuits.

[The Hill]

HHS official shared post saying ‘forefathers’ would have ‘hung’ Obama, Clinton for treason

A political appointee at the Department of Health and Human Services shared an image in 2017 that said “our forefathers would have hung” Barack Obama and Hillary Clinton for treason, a CNN KFile review has found.

Ximena Barreto is a far-right political pundit who in December 2017 joined the Trump administration as deputy director of communications at the department.

Barreto was placed on leave by the department on Monday after the liberal watchdog Media Matters reported that Barreto called Islam “a cult” and pushed the false Pizzagate conspiracy theory, which alleged that Clinton was part of a child-sex ring based in part at a Washington, DC, pizza restaurant.

A subsequent KFile review of her Twitter account “RepublicanChick” found that Barreto also repeatedly used the hashtag #BanIslam and twice shared conspiracy theories about the death of Democratic National Committee staffer Seth Rich. Barreto also shared a conspiracy theory that French President Emmanuel Macron was controlled by the Rothschild family and that Clinton and Obama were controlled by investor and Democratic mega-donor George Soros. Both the Rothschilds and Soros are frequent targets of anti-Semitic conspiracy theories.

A department spokesperson did not comment on tweets unearthed by KFile and reiterated to CNN that Barreto has been placed on administrative leave while they look into the matter.

Prior to joining HHS, Barreto was a far-right political pundit and Trump-supporting blogger.
She co-hosted a YouTube show called “The Right View by Deplorable Latinas.” A now-removed biography on her personal website said she “has worked as a political activist, and worked hundreds of hours with Republican candidates (sic) campaigns, including John McCain, Ted Cruz and President Donald Trump.”

Here’s what Barreto tweeted:

On Barack Obama

In May of 2017, Barreto retweeted an imagesaying the “our forefathers would have hung” Clinton and Obama for treason.
In August of 2017 Barreto retweeted an image of a statue of Obama labeling him “a Muslim terrorist.”
In January of 2017, Barreto wrote in a tweetthat Obama was a “pansy and a traitor.”

On Seth Rich

In October 2016, Barreto implied Rich was killed by either Clinton or the Democratic National Committee, using the hashtags #KilledByTheDNC #HillaryBodyCount #ClintonBodyBags
In May, 2017, Barreto retweeted a video about Rich, saying that “the media blackout and the silence from Washington on Seth Rich should scare the hell out of you.”

On Islam

On five separate occasions found by KFile’s review, Barreto tweeted the hashtag “#BanIslam” in asserting that those participating in the Women’s March had turned their back on “real oppression.”
She also tweeted “#DeportLSarsour,” referring to Women’s March organizer Linda Sarsour.
In other tweets, she called for a boycott of Amazon for an ad that showed a Christian priest and Muslim imam together, saying that “an Imam would never sit with a priest FYI”.

On Hillary Clinton, Democrats and Emmanuel Macron

In a tweet in August of 2016, Barreto falsely claimed that Clinton aide Huma Abedin’s family had terrorist ties.
In April of 2017, Barreto spread a conspiracy theory that Macron was controlled by the Rothschilds and that Clinton and Obama were controlled by Soros.
“Macron is just a political puppet of the Rothschilds, just like Obama and Hillary are Soros Puppets!” she wrote.

[CNN]

Notes, emails reveal Trump appointees’ war to end HHS teen pregnancy program

The Trump administration’s abrupt cancellation of a federal program to prevent teen pregnancy last year was directed by political appointees over the objections of career experts in the Department of Health and Human Services, which administers the program, according to internal notes and emails obtained by NBC News.

The trove shows three appointees with strict pro-abstinence beliefs — including Valerie Huber, the then-chief of staff for the department’s Office of the Assistant Secretary for Health — guided the process to end a program many medical professionals credit with helping to bring the nation’s teen pregnancy rate to an all-time low.

Prior to serving at HHS, Huber was the president of Ascend, an association that promotes abstinence until marriage as the best way to prevent teen pregnancy.

The $213 million Teen Pregnancy Prevention Program was aimed at helping teenagers understand how to avoid unwanted pregnancies. It had bipartisan support in Congress and trained more than 7,000 health professionals and supported 3,000 community-based organizations since its inception in 2010.

In the notes provided to NBC News, Evelyn Kappeler, who for eight years has led the Office of Adolescent Health, which administers the program, repeatedly expressed concerns about terminating the program, but appeared out of the decision-making loop and at one point was driven to tears.

In a July 17, 2017 note, she says she was admonished to “get in line” and told it was not her place to ask questions about the agency’s use of funds. In a July 28 note, Kappeler recalled she was “frustrated about the time this process is taking and the fact that (her staff) has not been part of the discussions.” She described being “so rattled” that “my reaction when I got on (sic) the phone was to cry.”

She and her staff “were not aware of the grant action until the last minute” — an apparent reference to the decision, it says.

Last month, Democracy Forward, a nonprofit law firm and advocacy group, sued the administration for unlawfully terminating the program after the agency took months to respond to its Freedom of Information Act request.

The group claims the newly obtained emails show that HHS violated the Administrative Procedure Act that bars arbitrary decision-making and that the political appointees thwarted the will of Congress.

“Now that we’ve seen these documents, there is no question to us why the Trump administration withheld” the emails, said Skye Perryman, the group’s lawyer. The decision to end the program “was made hastily, without a record of any reasoned decision making and under the influence of political appointees who have long opposed evidenced-based policy,” she said.

Parties suing over the action include the city of Baltimore and the Healthy Teen Network, which represents grantees across the country.

HHS has given different explanations about its decision to terminate the program, including claims that it was ineffective or that it did not conform to the president’s proposed budget. HHS did not respond to emails or answer questions about who was responsible for ending the program.

HHS spokesman Mark Vafiades directed NBC News to a fact sheet and announcement on the agency’s website. They state that 73 percent of the projects funded by the program “had no impact or had a negative impact on teen behavior, with some teens more likely to begin having sex, to engage in unprotected sex or to become pregnant.”

“The evidence stands in stark contrast to the promised results,” the statement says.

The story behind the program’s demise is one of a growing list of examples of the control Trump political appointees are exerting at federal agencies.

It is also part of a broader narrative about programs benefiting women and children becoming political targets under a president who insists he is an advocate for women’s rights and health. Under Trump, a mandate under the Affordable Care Act to cover contraceptive coverage has been rolled back, while Republicans in Congress have sought to defund Planned Parenthood and proposed budget cuts to Medicaid, which covers half of all births.

In July 2017, the Office of Adolescent Health notified 81 grantees including the University of New Mexico Health Sciences Center and Cuyahoga County, Ohio, that it would be discontinuing funding under the Obama-era program beginning this June, with some programs cut off immediately.

After the program’s 2010 inception, teen pregnancy and birth rates fell faster than ever. Health care experts say considerable research and money that has already been invested in the program will be wasted and the number of at-risk teens will increase.

The president of the American College of Obstetricians & Gynecologists and women’s health advocacy groups, such as Planned Parenthood, have expressed alarm.

Haywood L. Brown, president of ACOG, called the program “vital.” The administration’s decision, Brown said in a statement, is “highly unusual” and a “step backward for ensuring healthy moms and healthy babies.”

In an op-ed last year, Ron Haskins, previously a Republican co-chair of a bipartisan commission on evidence-based policy making established by House Speaker Paul Ryan, R-Wis., said that by ending the program, Trump has “exploded one of our most promising evidence-based programs.”

In a June 21 note by Kappeler, Steven Valentine, Huber’s deputy, is described as having “taken the lead” in reversing the program. Valentine directed Kappeler to halt the review process for the grants, the notes say.

Before coming to HHS, Valentine was a legislative assistant to Rep. Chris Smith, R-N.J., an outspoken abortion rights opponent. Valentine also worked for a short time at the Susan B. Anthony List, a political organization that supports candidates who oppose abortion rights.

Don Wright, a senior career official at HHS, stated in a July 28 email to Kappeler that he himself was only “tangentially” involved in the discussions about the program’s termination. But one set of notes documents him instructing skeptical career staff members on the appropriate behavior of civil servants. He later complained to Kappeler about “rolling of the eyes by some staff,” her notes say.

Weeks later, Wright was made acting secretary of the department.

Also according Kappeler’s notes, some staff “expressed concerns about being able to ask questions in this environment and the lack of engagement by policy staff directly with the program office.”

Kappeler’s memos “are quite revealing of the agency’s improper and unlawful decision making,” said Perryman, Democracy Forward’s lawyer.

“The documents also show HHS disregarded the views of experienced career employees including those of the director of the Office of Adolescent Health,” she said.

Another appointee involved in terminating the teen pregnancy program was Teresa Manning, an anti-abortion activist and Trump appointee who was in charge of the department’s family planning programs and who has publicly questioned the efficacy of several popular contraception methods. She was previously a lobbyist for the National Right to Life Committee and for the Family Research Council. In January, Manning abruptly resigned.

In November, HHS announced a $10 million research initiative to ensure “any sex education programs follow the science to improve youth health and well-being,” including “sexual risk avoidance.”

Despite their popularity in some conservative regions and school districts, abstinence-only programs have been shown not to work.

A June 2005 study conducted by Case Western Reserve University found that the sexual education programs that Huber ran in Ohio promoting abstinence-only education had “critical problems.” The study suggested the program conveyed “false and misleading information” about abortion, contraceptives and sexually transmitted infections and misrepresented “religious convictions as scientific fact.”

In King County, Washington — one of the parties in the suit challenging the program’s termination — grantees created a 15-lesson sex education curriculum known as Family Life and Sexual Health (FLASH).

The FLASH program educates students on options including abstinence, the use of birth control and the importance of consent before engaging in sexual activity. It is now used in 44 states and taught in every school district in King County, which has seen a 63 percent drop in teen pregnancies since 2008.

King County was granted $5 million to conduct the first scientific evaluation of the FLASH program, and now it is unable to complete the study. The $3 million already spent is now wasted taxpayer dollars, according to King County spokesman James Apa.

[NBC News]

Reality

Data shows clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S

Senior HHS official placed on leave for promoting unfounded claims and conspiracy theories on social media

A top official at the Department of Health and Human Services has been placed on administrative leave after a CNN KFile inquiry while the agency investigates social media postings in which he pushed unfounded smears on social media.

Jon Cordova serves as the principal deputy assistant secretary for administration at HHS. A KFile review of Cordova’s social media accounts found that he pushed stories filled with baseless claims and conspiracy theories, including stories that claimed Gold Star father Khizr Khan is a “Muslim Brotherhood agent” and made baseless claims about Sen. Ted Cruz’s personal life.

“Mr. Cordova is currently on administrative leave while we look into this issue further,” a HHS spokesperson said in a statement.

Cordova did not respond to a request for comment.

Cordova joined HHS in February of 2017, initially as part of the Office of the White House Liaison. In his current role, Cordova oversees day-to-day operations for the Office of Human Relations, Office of the Chief Information Officer, Office of Security and Strategic Information, Equal Employment Opportunity Compliance and Operations Office and the Program Support Center, according to his biography posted on the HHS website.

Prior to joining HHS, Cordova served as a Trump delegate from California to the Republican National Convention and worked in communications for Donald Trump’s campaign in California.

During the 2016 presidential campaign, Cordova routinely promoted stories on social media that pushed fringe claims about Trump’s opponents that have no basis in fact.

In July 2016, Cordova shared a story that asserted without evidence that Khan, who spoke out against Trump at the 2016 Democratic National Convention, was a “Muslim Brotherhood agent” and “a Muslim plant working with the Hillary Clinton campaign.” He also shared another story that falsely claimed the Clinton Foundation paid Khan.

Cordova also shared unfounded and false stories that claimed Cruz, a Texas Republican frequented prostitutes, was involved in a sex scandal and was hiding various public records related to his birth and education.

In a post in 2013, Cordova called Democrats “the real racists” and said that 95% of blacks would not have voted for President Barack Obama if he were white.

In a December 2016 comment on Facebook on an article about a nonprofit selling access to President Trump during the inauguration, Cordova called Clinton “a slimy trailer trash huckster.”

Cordova also repeatedly shared fake or conspiratorial stories, including one that claimed that Clinton was photoshopping her rallies to make them look bigger, one with a fake quote from Clinton about Democratic voters, one that claimed NBA star Dwyane Wade endorsed Trump and one with a photoshopped picture of a black man holding a sign that read, “No mother should have to fear for her son’s life every time he robs a store.”

Cordova also struck a conspiratorial tone on his since-scrubbed Twitter account, of which only a few tweets are archived on several websites.

In one tweet, Cordova called for a boycott of Budweiser because the company supported “jihadis” over white immigration.

In another tweet, Cordova speculated the reason the identity of the shooter at Umpqua Community College in 2015 hadn’t been made public was because he was a Muslim. The shooter was not a Muslim.

In another tweet, Cordova compared MoveOn.org and the Black Lives Matter movement to Nazis.

[CNN]

Trump administration dismantles LGBT-friendly policies

The nation’s health department is taking steps to dismantle LGBT health initiatives, as political appointees have halted or rolled back regulations intended to protect LGBT workers and patients, removed LGBT-friendly language from documents and reassigned the senior adviser dedicated to LGBT health.

The sharp reversal from Obama-era policies carries implications for a population that’s been historically vulnerable to discrimination in health care settings, say LGBT health advocates. A Health Affairs study last year found that many LGBT individuals have less access to care than heterosexuals; in a Harvard-Robert Wood Johnson-NPR survey one in six LGBT individuals reported experiencing discrimination from doctors or at a clinic.

The Trump administration soon after taking office also moved to change the agency’s LGBT-related health data collection, a window into health status and discrimination. Last month it established a new religious liberty division to defend health workers who have religious objections to treating LGBT patients.

The changes at the Department of Health and Human Services represent “rapid destruction of so much of the progress on LGBT health,” said Kellan Baker, a researcher at the Johns Hopkins School of Public Health who worked with HHS on LGBT issues for nearly a decade. “It’s only a matter of time before all the gains made under the Obama administration are reversed under the Trump administration, for purposes that have nothing to do with public health and have everything to do with politics.”

The policy reversals also come after President Donald Trump repeatedly pledged during his campaign that he would support LGBT causes. “Thank you to the LGBT community!” Trump tweeted in June 2016. “I will fight for you while Hillary brings in more people that will threaten your freedoms and beliefs.”

The Trump administration defended its approach to LGBT health as part of its broader health care strategy.

“The policies of the Trump administration are intended to improve the lives of all Americans, including the LGBTQ community,” White House principal deputy press secretary Raj Shah said in a statement. “Through actions aimed at making health care more affordable, rolling back burdensome regulations, and combating the opioid crisis, the administration is working to ensure a healthier America.”

The new leader of HHS — Alex Azar, who was sworn in as secretary last month — is thought to be more pragmatic than his predecessor Tom Price. Azar previously led U.S. operations for Eli Lilly, a pharmaceutical company that has been hailed by the Human Rights Campaign, among others, for its pro-LGBT policies. Lilly opposed Indiana’s religious liberty law, advanced by then-Gov. Mike Pence, that LGBT groups said was discriminatory.

However, staff inside the health department have raised concerns about several other Trump appointees now in senior roles who had a history of anti-LGBT comments before joining the agency, Among them is Roger Severino, a former Heritage Foundation official who has said that the Supreme Court’s 2015 decision on same-sex marriage was “wrong” and repeatedly warned of its consequences.

“[S]ame-sex marriage was merely the start, not end, of the left’s LGBT agenda,” Severino wrote in May 2016, about 10 months before he was tapped by Trump to be the health department’s top civil rights official. “The radical left is using government power to coerce everyone, including children, into pledging allegiance to a radical new gender ideology over and above their right to privacy, safety, and religious freedom.”

Asked in an interview this month if he stood by those comments, Severino pointed out that since joining the health department he had reached out to LGBT advocates. He also said his responsibility as civil rights chief is to uphold constitutional protections for all Americans.

“Statements I’ve made in the past are not binding on what I do in my role as a public servant,” Severino said. “What I’m guided by, and what I’m required to follow, is the law… I’m dedicated to treating everybody fairly and in accordance with the law.”

HHS officials also pointed to a listening session that Severino convened in April 2017 with more than a dozen LGBT advocates as well as several follow-up conversations with medical experts. “The outreach has been significant,” an agency spokesperson said.

But nearly all of those LGBT advocates said they’ve essentially been ignored since sitting down with Severino nearly a year ago.

“There’s been no communication since then through all the channels that he and his staff know how to reach us,” said Mara Youdelman of the National Health Law Program, who attended last year’s listening session and submitted subsequent requests for information that haven’t been returned. “It was a one-shot deal — and all of their actions speak much louder than words and one listening session.”

New direction under Trump

Though Barack Obama as a candidate for president opposed same-sex marriage, his administration immediately took steps to advance LGBT health issues, like loosening the rules on hospital visitation rights after some same-sex couples had been barred from seeing each other.

“[A]ll across America, patients are denied the kindnesses and caring of a loved one at their sides… [and] uniquely affected are gay and lesbian Americans,” Obama wrote in a 2010 memorandum, instructing HHS to expand visitation rights, a policy that still stands.

The Obama administration in 2016 also finalized a regulation, Section 1557 of the Affordable Care Act, that banned discrimination in health care based on sexual orientation and extended those protections to transgender individuals for the first time.

While some conservative groups said that the Obama administration moved too quickly on LGBT health priorities, its leaders argue their efforts were necessary, even overdue. “The purpose of the agency is to serve all Americans, not just straight people. Our job was helping everyone,” said Kathy Greenlee, who was appointed as an assistant HHS secretary in 2009 and is openly lesbian. “There was pent-up support for these issues.”

But upon taking office last year, the Trump administration swiftly froze a series of LGBT-friendly rules, including proposed new regulations to further ban discrimination in Medicare and Medicaid. A regulation that would have allowed transgender HHS staff more protections when using the department’s bathrooms and other facilities also was ignored.

“It was signed and technically finished on Jan. 19, 2017, but not posted online,” said one staffer. “And the new administration considered it unpublished and pulled it back.”

The Trump administration also reinterpreted the ACA’s Section 1557 anti-discrimination mandate, with the White House declining to fight a court battle to enforce it and signaling that it would roll back the rule. The health agency’s new Conscience and Religious Freedom Division, which POLITICO first reported last month, is expected to offer greater protections for health care workers who do not wish to treat LGBT patients.

Meanwhile, the agency’s senior adviser for LGBT health — a lawyer named Elliot Kennedy — was reassigned from the HHS secretary’s office to an HHS office in Rockville, Md., to work on disease prevention. Kennedy’s previous portfolio, including leading a committee to review and advance LGBT policy issues across HHS, also has lost influence, after openly LGBT leaders left the agency and current LGBT staffers say they’ve been dissuaded from attending. The committee’s annual report has not been publicly posted since 2016.

“Elliot Kennedy currently serves in the Office of Disease Prevention and Health Promotion as liaison for Healthy People 2020’s LGBT Health Topic and Objectives,” an HHS spokesperson said, in response to questions about the reassignment. “He continues to serve on the HHS LGBT Policy Coordinating Committee.”

Another quiet battle has been over a pair of HHS surveys, with the Trump administration moving to strike questions about sexual orientation that had been added by the Obama administration in order to understand health disparities and LGBT specific health issues. The two surveys are used to shape policy for older and disabled Americans, respectively. The Trump administration subsequently reinstated some of the questions after an outcry.

“A lot of people think data are really boring. But data are fundamental, especially to public health,” said Baker, the Johns Hopkins researcher. “The only way to have the evidence you need to prioritize and spend wisely to address disparities is to have data about those disparities.”

A listening session followed by silence

The Trump administration says that it’s worked hard to engage LGBT health advocates, pointing to the listening session convened by Severino in April 2017 and attended by 17 representatives from groups that specifically deal with LGBT health.

“We’ve done a lot of outreach to the LGBT community to hear people’s concerns to be open, to listen and to learn,” Severino said. “And we will continue to do that because it’s important. I see my role as serving everybody.”

But all of the LGBT advocacy organizations represented at the April 2017 listening session said that they had concerns about HHS’ approach to LGBT health. Nearly every attendee said they hadn’t had meaningful interactions with Severino or the civil rights division in 10 months and they were underwhelmed by last year’s meeting.

“There’s a difference between hearing and listening,” said Robin Maril of the Human Rights Campaign, one of the attendees. “For a listening session to actually be successful, we would’ve had to see actual, meaningful engagement. And we’ve seen nothing but disappointing and harmful policies come out of HHS and [the civil rights office] since the meeting.”

“A number of us struggled with whether we would participate in something that would be used for exactly this purpose … a charade to be used by folks to suggest they are open-minded,” added Sharon McGowan of Lambda Legal, who also attended. “That was the lost cause that we suspected that it was.”

The Human Rights Campaign and Lambda Legal were among more than a dozen advocacy organizations that sent follow-up letters to Severino in April 2017 and July 2017 that warned HHS to halt rolling back LGBT protections and better engage the patient community. The advocates say they were ignored.

Only one attendee of last year’s listening session who responded to POLITICO — Ezra Young, a lawyer who has since left the Transgender Legal Defense and Education Fund and is now in private practice — said that he’s been reassured by Severino and HHS’ actions.

“I’m trying to be fair to them. There was a lot of fear based on what Roger wrote in the past,” said Young, a transgender, Latino man. “I don’t know at this point if all that fear is rational based on what has and hasn’t been done.” Young added that he’s been in dialogue with Severino, saying that the two men discussed lunch plans as recently as December.

However, Young’s former employer holds a different view. “This administration continues taking actions that harm our community, which already faces immense bias,” the organization said in a statement to POLITICO.

Christian conservatives hail HHS

Since Trump took office, multiple agencies have pursued policy reversals related to LGBT priorities. Under Attorney General Jeff Sessions, the Justice Department suggested that federal law doesn’t ban sex discrimination in the workplace for transgender employees, a turnaround from the Obama administration. The Department of Education this month said that it would no longer investigate transgender students’ complaints about access to bathrooms.

But Christian conservatives are noticing, and specifically praising, the reversals at the health department. “Few departments have [historically] given Christians more grief than HHS,” Tony Perkins of the Family Research Council wrote last month. But “from about-faces on radical sex ed to abortion policy, the White House is turning the Health and Human Services into a virtual promise-keeping factory.”

The Trump administration also has put its mark on the language it has — and hasn’t — included in formal HHS documents.

One recent flashpoint was the department’s four-year strategic plan, a document that’s required by federal law, prepared by career staff and used as an agency roadmap. The latest draft plan, which was released in October, did not make a single reference to LGBT health issues — a notable break from the two previous strategic plans, dating back to 2010. The agency removed the draft plan, which also contained strong anti-abortion language, from its web site late last year.

However, the plan originally contained references to LGBT health, two HHS staffers told POLITICO, until political appointees ordered that the language be stripped from the document. The effort was spearheaded by Shannon Royce, the agency’s liaison with religious groups, who staff say also took steps to include other language favorable to Christian conservatives.

“In our strategic plan, we actually affirmed life from conception to natural death,” Royce said, touting the new language at the Evangelicals for Life conference last month.

HHS did not respond to a question about why references to LGBT health were removed.

Past comments cited by LGBT staff

Beyond policy, staff say there have been clear signals about the personnel chosen to steer the department. For instance, the Obama administration tapped multiple LGBT officials for senior roles, including Richard Sorian to run the agency’s public affairs.

In contrast, the current public affairs chief is Charmaine Yoest, a prominent anti-abortion leader who for years advocated against same-sex marriage and other LGBT issues. For instance, Yoest a decade ago said that same-sex couples shouldn’t be allowed to adopt children and that transgender individuals suffered from mental disorders; she declined to comment on whether she still holds those positions now. (POLITICO first reported on Friday that Yoest will soon be leaving HHS.) Royce, the head of the faith-based office, previously worked as a senior leader for organizations that fought same-sex marriage and promoted “conversion therapy,” a controversial practice to change the sexual orientation of LGBT individuals.

Several other top officials also criticized LGBT priorities just months before joining the administration. “Vote LGBT if you want to be forced to have your baby delivered at an abortion clinic by an abortionist,” Matthew Bowman tweeted in April 2016, about nine months before being tapped by Trump to join the health department, where he is currently deputy general counsel. After the Obama administration in June 2016 expanded protections for transgender military members, Severino wrote that the “decision has nothing to do with the Constitution and everything to do with politics and a gender ideology run amok.”

HHS did not respond to specific questions about Yoest, Bowman, Severino and Royce’s past public comments, and made only Severino available for comment. But a spokesperson said that LGBT staff should not be concerned.

“All the HHS staff you refer to in your story have sworn to uphold the law and believe that everyone deserves to be treated with respect because of their inherent human dignity,” HHS spokesperson Matt Lloyd said in a statement. “The belief that marriage is between one man and one woman is a mainstream view held by millions of Americans, a belief the Supreme Court has said is based on ‘decent and honorable premises.'”

Severino, the son of Colombian immigrants, added that he’s spent his life working to combat bigotry after experiencing it growing up in California.

“I faced actual discrimination and mistreatment,” Severino said, who said he heard slurs while learning to swim at a public pool and was wrongly steered to remedial classes in high school. “Those sort of inflection points drives me and my passion for civil rights,” he added, pointing to his education at Harvard Law School and subsequent work in the Department of Justice, where he served as an attorney for seven years under the George W. Bush and Obama administrations.

Career staff say that, regardless of what agency leaders believe or maintain now, their past comments on LGBT priorities have been widely passed around the 80,000-person department. “I photocopied them and left them in the cafeteria,” said one staffer. “It’s important for people to know these are the leaders they work for.”

It’s also fostered a climate where six staffers who are LGBT described removing their wedding rings before coming to work in the morning, taking down photos of their partners and families or ultimately finding new jobs further away from certain political appointees. They did not want to be identified; two said they feared being reassigned for being gay.

“When you have to hide a major part of who you are … it’s really debilitating,” said one staffer. “I wish I had more courage to be out with these people.”

Some LGBT staffers told POLITICO they hesitated to raise their concerns while the agency was run by then-Secretary Tom Price, who as a congressman voted against LGBT priorities and as secretary was backed by the Family Research Council, an anti-LGBT group that holds an official position that “homosexual conduct is harmful.”

Long-serving staff who worked with new HHS Secretary Azar, when he served as a senior agency leader in the George W. Bush administration, or observed his work in the private sector say they’re hoping he’ll take a different approach. Under Azar’s watch, Eli Lilly was hailed by the Human Rights Campaign as a company committed to inclusion and LGBT protections. The Indiana-based company also opposed a state law that critics feared could be discriminatory against LGBT people.

“Alex always struck me as a very pragmatic person. Not an ideologue. Very business-like. Very smart,” said one LGBT staffer. “I’m hoping he’ll put some brakes on the ideological stuff.”

Staff also suggested that HHS has bigger priorities than rolling back LGBT health gains. “To the vast majority of Americans, this isn’t that big a deal anymore,” said an employee. “It’s perplexing why they spend so much time on it.”

[Politico]

 

 

Trump Administration Rejects Study Showing Positive Impact of Refugees

Trump administration officials, under pressure from the White House to provide a rationale for reducing the number of refugees allowed into the United States next year, rejected a study by the Department of Health and Human Services that found that refugees brought in $63 billion more in government revenues over the past decade than they cost.

The draft report, which was obtained by The New York Times, contradicts a central argument made by advocates of deep cuts in refugee totals as President Trump faces an Oct. 1 deadline to decide on an allowable number. The issue has sparked intense debate within his administration as opponents of the program, led by Mr. Trump’s chief policy adviser, Stephen Miller, assert that continuing to welcome refugees is too costly and raises concerns about terrorism.

Advocates of the program inside and outside the administration say refugees are a major benefit to the United States, paying more in taxes than they consume in public benefits, and filling jobs in service industries that others will not. But research documenting their fiscal upside — prepared for a report mandated by Mr. Trump in a March presidential memorandum implementing his travel ban — never made its way to the White House. Some of those proponents believe the report was suppressed.

The internal study, which was completed in late July but never publicly released, found that refugees “contributed an estimated $269.1 billion in revenues to all levels of government” between 2005 and 2014 through the payment of federal, state and local taxes. “Overall, this report estimated that the net fiscal impact of refugees was positive over the 10-year period, at $63 billion.”

But White House officials said those conclusions were illegitimate and politically motivated, and were disproved by the final report issued by the agency, which asserts that the per-capita cost of a refugee is higher than that of an American.

“This leak was delivered by someone with an ideological agenda, not someone looking at hard data,” said Raj Shah, a White House spokesman. “The actual report pursuant to the presidential memorandum shows that refugees with few skills coming from war-torn countries take more government benefits from the Department of Health and Human Services than the average population, and are not a net benefit to the U.S. economy.”

John Graham, the acting assistant secretary for planning and evaluation at the health department, said: “We do not comment on allegedly leaked documents” and that no report had been finalized. He noted that Mr. Trump’s memorandum “seeks an analysis related to the cost of refugee programs. Therefore, the only analysis in the scope of H.H.S.’s response to the memo would be on refugee-related expenditures from data within H.H.S. programs.”

The three-page report the agency ultimately submitted, dated Sept. 5, does just that, using government data to compare the costs of refugees to Americans and making no mention of revenues contributed by refugees.

“In an average year over the 10-year period, per-capita refugee costs for major H.H.S. programs totaled $3,300,” it says. “Per-person costs for the U.S. population were lower, at $2,500, reflecting a greater participation of refugees in H.H.S. programs, especially during their first four years” in the United States.

It was not clear who in the administration decided to keep the information out of the final report. An internal email, dated Sept. 5 and sent among officials from government agencies involved in refugee issues, said that “senior leadership is questioning the assumptions used to produce the report.” A separate email said that Mr. Miller had requested a meeting to discuss the report. The Times was shown the emails on condition that the sender not be identified. Mr. Miller personally intervened in the discussions on the refugee cap to ensure that only the costs — not any fiscal benefit — of the program were considered, according to two people familiar with the talks.

He has also played a crucial role in the internal discussions over refugee admissions, which are capped by an annual presidential determination that is usually coordinated by the National Security Council and led in large part by the State Department.

This year, officials at the State Department as well as the Department of Defense have argued vociferously that the United States should admit no fewer than the 50,000-refugee cap that Mr. Trump imposed in January as part of the travel ban, but Mr. Miller has advocated for a much lower number — half or less, according to people familiar with the internal talks who described them on condition of anonymity because they were not authorized to detail them. The Department of Homeland Security last week proposed a cap of 40,000. The limits being debated would be the lowest in more than three decades.

“We see an administration that’s running a program that it’s intent on destroying,” said Mark Hetfield, the president of HIAS, one of nine refugee resettlement agencies opposing the cut in admissions. “We do have champions in the White House and in the administration, but they’re not being given a voice in this.”

The issue is coming to a head as Mr. Trump attends the United Nations General Assembly this week for the first time as president. The United Nations has repeatedly appealed to nations to resettle 1.2 million refugees fleeing war and persecution from all over the world, and former President Barack Obama used the gathering last year to tout his goal of admitting 110,000 refugees in the fiscal year that ends this month, and to pressure other countries to follow the lead of the United States in embracing more displaced people.

Mr. Trump, by contrast, has highlighted his goal of radically cutting refugee admissions. The president moved swiftly after taking office to crack down on refugees, issuing his original ban against travelers from seven predominantly Muslim countries only a week after taking office.

Facing legal challenges to that order, his administration released a second travel ban two months later against six countries, along with a presidential memorandum in which Mr. Trump called on the secretary of state to consult with the secretaries of Health and Human Services and Homeland Security and his White House budget director and submit within 180 days “a report detailing the estimated long-term costs of the United States Refugee Admissions Program at the federal, state, and local levels, along with recommendations about how to curtail those costs.”

The budget Mr. Trump released in May argued that refugees and other immigrants were a fiscal drain. “Under the refugee program, the federal government brings tens of thousands of entrants into the United States, on top of existing legal immigration flows, who are instantly eligible for time-limited cash benefits and numerous noncash federal benefits, including food assistance through SNAP, medical care and education, as well as a host of state and local benefits,” the document said.

It would be less costly, it argued, if there were fewer refugees, since “each refugee admitted into the United States comes at the expense of helping a potentially greater number out of country.” Inside the administration, those who espouse this view argue that any research purporting to illustrate fiscal benefits of refugees is flawed and reflects only wishful thinking.

As Mr. Trump deliberates privately about the issue, a coalition of human rights and religious groups as well as former national security officials in both parties has formed to encourage him not to allow the refugee cap to plummet.

“From a national security standpoint, while we can’t take an unlimited number of refugees, we need to show our friends and allies that we stand with them and this is a shared burden,” said Michael Chertoff, the secretary of homeland security under George W. Bush.

“They’ve generated a lot of economic value,” Mr. Chertoff added in an interview. “I don’t think refugees are coming to take American jobs.”

Trump has made the Department of Health and Human Services a center of false science on contraception

Contraception policy may not be the biggest target of the anti-science right wing — climate change and evolution probably rank higher — but it’s the field in which scientific disinformation has the most immediate consequences for public health.

So it’s especially disturbing that President Trump and Health and Human Services Secretary Tom Price have stocked the corridors of health policy with purveyors of conclusively debunked claptrap about contraception, abortion, pregnancy and women’s reproductive health generally.

That’s the conclusion of a new article in the New England Journal of Medicine identifying four Trump appointees as carriers of the disinformation virus. What makes them especially dangerous, says the author, bioethicist R. Alta Charo of the University of Wisconsin law school, is that the “alternative facts” they’re purveying could influence an entire generation’s attitude toward contraception, for the worse.

Among their themes is that condoms don’t protect against HIV or other sexually transmitted diseases and that abortions and contraceptives cause breast cancer, miscarriages and infertility. None of these assertions is true.

“The move toward misinformation at the level of sex education is dangerous,” Charo told me, “because you form instincts about what is safe very early in life.”

These appointments are all of a piece with Trump’s habit of staffing federal agencies with people actively in opposition to those agencies’ goals and statutory responsibilities — climate change deniers at the Environmental Protection Agency, corporate executives at the Department of Labor, and so on.

They’re also consonant with policies from the White House and Price’s office aimed at narrowing access to contraceptives by reducing government assistance to obtain them.

As Charo observes, the rate of unintended pregnancies has come down sharply, especially since the advent of the Affordable Care Act, which mandated that health plans make birth control available without co-pays or deductibles.

Price has defended reducing government assistance for contraception on the ground that “there’s not one” woman who can’t afford it on her own, but that’s plainly untrue; some long-lasting contraceptives such as Nexplanon or IUDs, can cost hundreds of dollars, a discouraging obstacle for many low-income patients.

Let’s take a look at the four horsewomen of disinformation on Charo’s list. What characterizes their approach to human reproduction, she says, is “rejection of the scientific method as the standard for generating and evaluating evidence.”

(We’ve asked both Charmaine Yoest, now the assistant secretary for public affairs at Health and Human Services, and the department for comment but have received no reply.)

Charmaine Yoest

Charmaine Yoest is now the assistant secretary for public affairs at HHS. Yoest is the former head of Americans United for Life, a prominent anti-abortion group. She and the organization promoted the claim that abortion increases a woman’s chance of breast cancer, a claim that was conclusively debunked by medical authorities years ago. The National Cancer Institute (a government body), declared in 2003 that thorough scientific studies “consistently showed no association between induced and spontaneous abortions and breast cancer risk.”

The same goes for the claim by Yoest’s group that abortion increases the risk of “serious mental health problems.” This notion is the basis for state laws requiring counseling before a patient is allowed to undergo an abortion. A study by UC San Francisco published last year found that the “greater risk” of “adverse psychological outcomes is faced by women denied an abortion. These findings do not support policies that restrict women’s access to abortion on the basis that abortion harms women’s mental health,” the study concluded.

Yoest was an architect of the strategy that led Texas to enact an anti-abortion law so extreme that it was slapped down by the Supreme Court last year on a 5-3 vote. The law placed heavy restrictions on abortion clinics, ostensibly to protect women’s health, that effectively shut many down. In his majority opinion, Justice Stephen Breyer essentially called that a subterfuge: “There was no significant health-related problem that the new law helped to cure,” he wrote.

Teresa Manning

Teresa Manning was appointed as HHS’ deputy assistant secretary for population affairs. Manning is a former lobbyist for the National Right to Life Committee and a legislative analyst for the Family Research Council. During a 2003 NPR interview, she said: “Of course, contraception doesn’t work. … Its efficacy is very low.” In fact, as Charo observes, hormonal methods are 91% effective, and IUDs are 99% effective.

In 2001, then as Teresa Wagner, Manning was quoted in a Family Research Council news release attacking prescriptions for the morning-after pill, which she characterized as an abortion method. She said doctors prescribing the pill were “accepting — and, in effect, — promoting promiscuity — the cause of the STD explosion, as well as the well known social problems of out of wedlock pregnancy and illegitimacy. We expect more from our doctors than collaboration with abortion advocates!”

Valerie Huber

Valerie Huber was appointed earlier this month as chief of staff to the assistant secretary for health at HHS. Huber is an abstinence advocate and the president of Ascend, a Washington group that advocates for abstinence-only sex education.

The problem there is that birth control experts have consistently found that abstinence education is ineffective at preventing teen pregnancies. In fact, just the opposite — a 2011 study at the University of Georgia reported that the “data show clearly that abstinence-only education as a state policy … may actually be contributing to the high teenage pregnancy rates in the U.S.”

Huber’s approach is moralistic. “As public health experts and policymakers, we must normalize sexual delay more than we normalize teen sex, even with contraception,” she told PBS last year. But studies consistently show that what reduces teen pregnancies is increased use of contraceptives.

Katy Talento

Katy Talento was named to Trump’s Domestic Policy Council. Talento has been the author of frequent anti-birth control screeds, including several that appeared on the Federalist, a right-wing website. Among them was an article whose headline called birth control “the mother of all medical malpractice,” and another asserting that women who took chemical forms of birth control risked “breaking your uterus for good,” ruining it “for baby-hosting altogether.”

Talento’s basis for this claim was what she called a “ground-breaking 2012 study” ostensibly showing that women who used birth control pills for several years had higher rates of infertility and miscarriage than those who did not. But as Jon Cohen of Science Magazine showed earlier this year, the study reported nothing of the kind — as its lead author confirmed. In fact, the researchers cited a study indicating that long-term use of the pill — five years — actually increased a woman’s subsequent fertility.

The lead author, Robert Casper, a Toronto fertility doctor, told Cohen that while his study found that using the pill sometimes led to thinner uterus linings, that wasn’t associated with more infertility or miscarriages — his study group was small and predisposed to fertility problems, he explained.

“The benefits of the birth control pill in preventing unwanted pregnancy or in treating painful menstrual periods far outweighs the rare possible case of thin endometrium,” Cohen wrote. “There is no evidence that the birth control pill is ‘seriously risky’ in terms of future reproductive health.”

As Charo observes, the “alternative science” underlying these appointees’ approach has infected public discussions of birth control and the courts. “Legislatures and even the Supreme court have tolerated individuals making up their own definitions for abortifacient [that is, abortion-producing] and pregnancy,” she writes, and then using them to justify refusing to fill prescriptions or offer insurance coverage for contraceptives.”

That was glaringly true in the Supreme Court’s egregious 2014 Hobby Lobby decision, which allowed owners of private companies to refuse to cover contraceptives under the Affordable Care Act. The Hobby Lobby plaintiffs specifically objected to four birth control methods — including IUDs and the morning-after pill because they produced abortions, which the plaintiffs found objectionable supposedly on religious grounds. But neither medical authorities nor the federal government classified those methods as abortifacients; the plaintiffs’ definition was accepted as gospel by Justice Samuel Alito, who wrote the opinion, which became the basis for allowing businesses to exclude all birth control methods from their health plans.

With adherents of similar viewpoints now ensconced in positions of responsibility in the Trump administration, their approach threatens to spread throughout government policy. But it’s no more based on legitimate science than it ever was.

[The Los Angeles Times]

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