Why Price’s conservative imprint on HHS is likely to endure

Tom Price is pictured here. | AP Photo

Price’s yet-to-be-named successor would be free to change the agency’s road map and priorities, but many of a draft strategic plan’s priorities embody goals of the Trump administration. | Alex Brandon/AP

A draft plan’s emphasis on faith-based groups and use of anti-abortion language reflect Trump talking points.

Tom Price may be gone as Health and Human Services secretary, but his efforts to put a conservative stamp on the $1.1 trillion agency, from promoting faith groups to scrapping Obamacare implementation, are likely to move forward without him.

A “draft strategic plan” for HHS, published before Price resigned last week, references “faith” or “faith-based” organizations more than 40 times in its five-year statement of priorities. The Obama administration’s last strategic plan contained only three such references.

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The Price draft also repeatedly mentions protecting individuals from “conception to natural death” — language similar to that used by anti-abortion groups.

Conspicuously absent is virtually any mention of the agency’s responsibility to carry out provisions of the Affordable Act, which had dominated the Obama administration’s plan. Also gone are most references to the health needs of minority groups, from African-Americans who have some of the nation’s worst health outcomes, to lesbian, gay, bisexual and transgender individuals.

Price’s yet-to-be-named successor would be free to change the agency’s road map and priorities, of course, after he resigned Friday after POLITICO reported he took more than $1 million in taxpayer-funded flights on charter and military planes.

But many of the draft’s priorities embody goals of the Trump administration and are therefore expected to survive. The five-year road map is often the vehicle for an administration to elaborate on its ideological goals, whether around culture war issues like abortion, or the role of safety net programs.

The emphasis on faith-based groups, for instance, reflects President Donald Trump’s executive order promoting “religious liberty,” signed in May. “All executive departments and agencies shall, to the greatest extent practicable and to the extent permitted by law, respect and protect the freedom of persons and organizations to engage in religious and political speech,” reads the order, which is referenced twice in the draft strategic plan.

Trump also promoted an anti-abortion agenda during his campaign and has lost no opportunity to criticize the Affordable Care Act as an unaffordable disaster.

“The big change that jumped out to us was the tone — there was a lot of focus on the unborn child,” said Jennifer Popik, legislative director of the National Right to Life Committee, the nation’s largest anti-abortion group, who applauded the new emphasis.

Supporters of the federal health law, however, decry what they see as an effort to sidestep the agency’s obligation to carry out a law passed by Congress.

“Their priority is to get rid of [the Affordable Care Act] as soon as possible and to do whatever they can to sabotage it in the meantime,” said Tim Jost, a legal expert and supporter of the health law.

An HHS spokesman stressed the document is a draft and the agency will accept public comments on it until Oct. 27.

“The purpose for public comment is to obtain feedback that will assist in refining and strengthening the plan,” the spokesman said in an email.

The bulk of the draft document is uncontroversial. It talks about expanding access to affordable health care, bolstering medical research, using scientifically rigorous data and improving vaccination rates. It also puts a strong emphasis on combating the opioid epidemic, which the Trump administration has set as a top priority. The Obama administration’s plan contained no references to the painkiller addiction crisis.

“There’s a lot of good stuff in there,” acknowledged Carl Schmid, deputy executive director of the AIDS Institute.

But Schmid’s advocacy group is one of several expressing worries the changed emphasis could marginalize groups that already have poor health outcomes.

“It’s not that we’re against faith-based groups,” Schmid said. “We just want to make sure that these groups will not withhold condoms, withhold messages that are important to prevent HIV, particularly among gay men, among transgender people. That’s been the issue that we’ve seen in the past.”

For instance, language in the draft plan to “affirmatively accommodate” religious beliefs echoes that in several state laws — including one passed and then revised in Indiana when Vice President Mike Pence was governor — that might allow organizations and businesses to refuse to serve gays and lesbians, said Sean Cahill, health policy research director at Fenway Health, which serves the LGBT community.

“If it stays this way, it would certainly be a step backward” from the progress that gay rights groups made under Obama’s watch, Cahill said.

The Trump administration draft makes no mention of LGBT health, meanwhile, in contrast to the Obama administration plan, where it pops up in at least four different places.

LGBT people face higher rates of depression, suicide, drug use, HIV and certain forms of cancer. If HHS doesn’t address those disparities, they could increase, said Meghan Maury, policy director for the National LGBTQ Task Force.

“While HHS chooses to deprioritize, it points to the fact that they’re not concerned about our physical or mental health,” Maury said.

While Trump’s decision to ban transgender people from serving in the military received a great deal of attention, Maury says the administration has quietly erased mention of LGBT people from census and survey data and also removed non-discrimination protections.

Groups representing racial and ethnic minorities say they’re also concerned the Trump administration’s strategic plan doesn’t prioritize the need to address health care access for those groups.

“If enacted as drafted, there will be more sick Americans,” said Rep. Robin Kelly (D-Ill.), chair of the Congressional Black Caucus Health Braintrust, in a statement to POLITICO. “This plan, in contrast to previous plans from both Republican and Democratic administrations, de-emphasizes those communities experiencing the greatest health disparities — mostly notably, communities of color and rural communities.”

The Trump administration plan includes only one section that mentions racial and ethnic minorities. It focuses on empowering people to make informed choices and zeroes in on populations with poorer health outcomes. The Obama administration’s plan, by contrast, focused on racial and ethnic minorities at least five separate times, referencing access to care, research and HIV/AIDS prevention and treatment programs.

The Trump document does address health disparities a number of times, but it doesn’t mention race or ethnic populations in that context. In one section, it references “people with limited English proficiency.”

Elena Rios, president and CEO of the National Hispanic Medical Association, told POLITICO she found it concerning the draft plan uses the description “populations at high risk” instead of mentioning racial and ethnic populations when discussing access to care.

“We really do need to have an understanding at HHS that the demographic shift in our population warrants a need to acknowledge outreach and training … in a culturally competent manner in order to increase access to healthcare services in our communities of color,” Rios said.

Reproductive rights groups are also alarmed by the document. They fear that the language about protecting individuals “from conception” will be used to limit access to care, particularly abortion services.

“This is a license to discriminate,” said Susan Berke Fogel, director of reproductive health at the National Health Law Program. “All of that language brings back all of these things that we’ve seen in the past that are just incongruous with really protecting health care and really improving people’s lives.”

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