How Trump warped HHS long before Covid-19

Emails to protect democracy, a monitoring group, divided with POLITICO provide a window into the real-time deliberations when officials rushed to meet the sudden political demands.

The acting communications director “is on board and ready to help,” wrote Mark Weber, a public affairs officer, in an email to three newly installed Trump officers on Jan. 25, 2017, to reset Obamacare ads. “I conveyed appreciation for what must be hard to do and for the work to be done.”

“We’ll never be in the room for the conversation, I guess,” one official wrote to another later that day while they waited to hear which initiatives would be cut.

Trump officials, troubled by the media coverage, were ultimately unable to withdraw some of the pre-purchased radio and television commercials – but they were able to cancel planned spending of more than $ 4 million despite Trump himself railing against the law and others took steps to weaken it. The new president had enacted an ordinance from day one instructing government agencies to repeal ACA regulations if they created burdens. The Internal Revenue Service then stopped enforcing the law’s individual insurance mandate.

Analysts have said that Trump’s anti-Obamacare volley has produced immediate results. Compared to the last two weeks of open registration in 2016, registrations ended for coverage on HealthCare.gov, the government’s flagship website Slump of around 30 percent compared to the previous year Researchers have warned that reduced access to health insurance is linked to poorer outcomes and financial difficulties.

Immediate efforts to weaken the Affordable Care Act also set a tone in the Health Department for the next four years in which Trump officials persecuted a Series of regulatory decisions intends to undermine the law’s health plans and other parts of the ACA – like his protection for LGBTQ patients – were also constantly attacked. Meanwhile, policymakers often turned to anecdotal stories to justify their decisions against a growing body of peer-reviewed studies that argued otherwise.

“Just take the Medicaid expansion,” said a former senior career officer who worked on safety netting health issues, referring to the ACA provision that allowed states to expand the health program for low-income Americans. “The total ignorance and rejection of the mountain of evidence of Medicaid’s expansion helps low-income or pregnant women other vulnerable patients … and yet this government is still saying no, it’s not working. “

Many career officials said they had prepared for the new administration to try to repeal the Affordable Care Act and replace it with another program aimed at offering lower cost options, as Trump promised on the campaign trail. However, using the bureaucracy to undermine the ACA without repealing it or offering an alternative, portrayed it as a violation of HHS ‘entire public health mission.

“The ideology has surpassed anything it wanted to do,” added the former official.

A spokesman for the Centers for Medicare and Medicaid Services, asked to respond to allegations that political officials meddled in promoting the Affordable Care Act and attempted to undermine the program, said, “CMS executives have been involved worked to create an environment in which political considerations run through intense discussion and thoughtful collaboration with career officials, political representatives and various public and private interest groups and partners. “

But nearly four years later, much of the ACA-related content is being removed from the department’s website, from information announcing its benefits to basic promotional efforts that began under the Obama administration.

“It was hard because I heard the ACA help people,” said Judy Sarasohn, a now retired civil servant who worked in public affairs and spoke regularly to people who benefited from the law – from a skeptical Republican who did discovered it after developing cancer, he needed health insurance for new mothers of babies with congenital health problems – and wrote dozens of Profiles of their experience between 2014 and 2016. Trump quickly removed these profiles from the site, Sarasohn said.

“The ACA wasn’t perfect, but I could really see that it was good for people,” added Sarasohn. “It hurt to have a new administration and throw it away.”

Ideology before science

While Obamacare was an obvious early target for the Trump administration, the Department of Health’s impending war on its own teen pregnancy prevention program came as a surprise.

The program was hailed as a bipartisan priority when it was first funded by Congress in 2010 – a science-backed initiative to test models for preventing pregnancy in teenagers and to scale up those that have been shown to work.

However, the emphasis on teaching teenagers about sexual health has been rejected by social conservatives who instead demanded that teenagers be taught about abstinence. And in July 2017 the Trump administration abruptly eliminated More than $ 200 million in teen pregnancy prevention and research by the Department of Health to more than 80 organizations across the country that claimed the program had no evidence of success.

The decision worried researchers and watchdogs, who argued the opposite: the program showed promise in containing teenage pregnancy rates.

“The Trump administration has exploded one of our most promising evidence-based programs,” warned two former Obama and Bush officials in an op-ed in The Hill. “Unlike the Trump administration, many Republicans are now realizing that evidence-based politics is the wave of the future.”

A journalist and a gynecologist wrote in the Washington Post: “The TPP initiative has been a flagship for evidence-based policies – programs that have been scientifically proven to be effective while continuing to test and evaluate different approaches.”

And within the health department, Trump-appointed individuals quickly found themselves confronted with questions from Evelyn Kappeler – a career civil servant who had led the health department’s health department for seven years and effectively oversaw the at-risk teen pregnancy prevention grants.

Kappeler, who took on a role in the inconspicuous support service center of HHS in 2019 and is now working on federal occupational health issues, declined to comment to POLITICO. But their emails and internal notes receive From a watchdog named Democracy Forward, draw a vivid picture of career officials’ efforts to get information from Wright, the then-incumbent Deputy Health Secretary, and the Trump-appointed people trying to abruptly cut the program.

“He stated that we as civil servants are responsible for implementing the administration’s agenda, whether we like it or not, as long as it is legal,” Kappeler wrote in a note on July 17, 2017. “And if we can’t, we should consider other options. He was furious and explained that I was [sic.] had to stand in line. “

“Given Dr. Wright’s recent admonitions, which he viewed as a lack of appropriateness or motivation for my questions, I thought it advisable not to ask questions about the parties involved in the conversation,” wrote Kappeler in another note dated Jan. August 2017.

In other documents, Kappeler describes the frustration of her team, which is cut out of the considerations and blinded by the resulting decisions.

“Our previous call shook me so much that I cried while talking on the phone,” she wrote On a July 28, 2017 note, she added that she was directed, “If they tell me that the funds will be used in accordance with the legal authority, I shouldn’t ask questions.”

When researchers and reproductive rights groups publicly pounded HHS for their decision, the health department hit back, insisting that the claims defending the teen pregnancy prevention program were inflated.

“False claim: the TPP program is a good use of tax money,” a data sheet published in August 2017 claims. “The facts: Continuing the currently structured TPP program would be a waste of taxpayers’ money.”

But federal courts ultimately blocked Trump’s attempted cuts to the teen pregnancy prevention program. vocation the hasty decision “arbitrary and capricious”.

In the meantime, Wright – the career officer who oversaw the cuts to the teen pregnancy program and Novotny’s team – would become more prominent during the Trump administration.

After Tom Price was ousted as HHS secretary in September 2017, the White House appointed Wright as deputy head of department, and in 2019 Trump selected Wright as U.S. ambassador to Tanzania, where he currently serves. The State Department declined to comment on Wright’s work at HHS, and an HHS spokesman said the department would not discuss personnel matters.

A drug test for Medicaid?

While Kappeler struggled to understand cuts to the teen pregnancy prevention program, other health ministry officials – and his doctors and scientists in particular – felt increasingly alone on an island and their warnings were being ignored.

in April 2017, then-Wisconsin Governor Scott Walker introduced a plan Drug test applicants for his state’s Medicaid program – an idea conservatives believed promoted personal responsibility, and an initiative that is being closely watched by other GOP-led states. But the plan had to be federally approved, and the idea soon caught on among Medicaid’s top officials, said Ostrovsky, who was the program’s chief medical officer at the time, remembering the first time he was briefed on Walker’s pitch .

About a dozen senior officials crowded around the table and on the sides of the room – Conference Room B at Baltimore headquarters, Ostrovsky recalled – and there was “silence” as the drug test proposal was discussed.

“I look around the table … and I’ve been waiting to hear this is a joke,” Ostrovsky said. “It seemed so absurd to me that a governor would propose drug testing as a requirement for admission to Medicaid,” because it would exclude so many vulnerable people who needed the program.

Going through what he’d just heard, Ostrovsky said he pulled up some data, quickly calculated after the envelope, and calculated that Walker’s plan could exclude hundreds of thousands of people struggling with substance use disorders – and over 8,000 people in Wisconsin could die for over a decade if left untreated. But when he shared that quick math with the other officers in the room, Ostrovsky said, the response was muted; The senior Trump appointee was “polite” and “said they would consider”.

Months later, the health department officially determined that Walker’s drug testing plan was illegal, and in October 2018 passed a compromise policy that allowed Wisconsin to ask non-binding questions about drug use from Medicaid applicants. Other officials said Ostrovsky – who left in December 2017 – was banned from political talks in which professional officials expressed similar concerns about public health and the moral ramifications of the plan. Medicaid chief Seema Verma herself did not think Walker’s plan was a good idea, said an officer with knowledge of her thinking.

“The former employee was not able to assess the development of the policy, nor was he privy to the policy interviews held this year,” said Ninio Fetalvo, a spokesman for Verma. Fetalvo also fired Ostrovsky as a “former disgruntled CMS employee” who never raised concerns about the drug testing plan to Verma or any other executive, adding that Verma had personally worked with Wisconsin’s team to develop a more viable alternative.

But Ostrovsky says the proposal should never have come out of the conference room, where it should be immediately rejected by Medicaid officials.

“We clinicians shouldn’t play defense to clearly prevent gross ethical violations,” Ostrovsky said. “We should weigh one study against another … not a conservative ideology.”

“It’s really a metaphor for the decision-making process over the past four years.”

A new team

An ongoing challenge within the Department of Health: simply briefing a number of Trump officers, many of whom are brand new to the federal service or who are deeply skeptical of the government.

“There were presidential nomination papers that had the title wrong and they said, ‘Know it,’ like a bottle of wit-out,” said a former senior career official, citing a mistake in early 2017 that the White House had named a Bush administration veteran named Demetrios Kouzoukas as the top Medicare MP – but accidentally wrote out the wrong title. “You had to tell them it didn’t work that way.”

A CMS spokesperson did not respond to a question about the incident.

More career violations that HHS employees viewed as good government surfaced almost every week. Trump officials asked career workers to pray with them before meeting, two officials said. Another commissioner was rushing to compose an anti-Obamacare event on a personal credit card, a former official said. The government withheld thousands of public comments in December 2017 criticizing a proposal on religious freedom and the wrath of the public information watchdog.

Also, some political officials made no secret of their love for the president or their disdain for the government, repeating Trump’s own jibes and attacks made through his social media accounts. The political officer responsible for the department’s digital communication drove a car with a “FAKENWS” washbasin number, which was occasionally parked in front of the headquarters so that his employees could see it.

“They ran the entire HHS like it was a political campaign and not an executive agency,” said a former official, pointing to a visible change after the inauguration day in 2017: the default channel on public televisions throughout the building are stationed. “In the Obama administration, televisions switched between Fox News, MSNBC and CNN,” added the former official. “But under Trump, things changed very quickly, and Fox News was on all TVs. … It’s like they just want TVs to repeat the news they wanted to hear.”

Meanwhile, Republican advisors were in the building and Trump officials like Verma reached out to them to shape public affairs and communications strategy despite the army of federal staff available. Verma also drew on former GOP Medicaid directors who worked at Speire Healthcare Strategies to deliberate on a rule for the Medicaid managed care market, said four current and former officials – an unusual decision made from 2017 through last month Partially outsource the extensive rulemaking process when the rule was finalized.

“If they’d just asked people in the building we could have done it faster,” said a former career official.

A spokesman for Verma denied Speire’s role, saying the advisors had no role in rule formulation or policy making.

“Federal career employees have worked out the managed care rule with the support of the federally funded MITER Corporation,” said the spokesman. “Speire was hired as a subcontractor for MITER to provide specific expertise in developing certain elements of our policy.”

Speire did not respond to a request for comment.

However, the decision to rely on external consultants went well beyond Verma. Trump administration officials spent millions of dollars on expensive initiatives like ReImagine HHS, a project that hired external consultants from companies like Deloitte to redesign the department.

“They were far more resilient to the permanent administrative state than their predecessors,” said a former senior official who served in Democratic and Republican administrations for more than 20 years.

“The administrative state wanted to help them get things done,” the former official said. “These guys from day one to the end saw it as an inconvenience and a group actively working against them.”

“It was a war of attrition against [career officials]who went left and right because the administration bypassed them, “said another former official who worked on the department’s messaging strategy.” You weren’t appreciated. “

From 2017 to Covid-19

Looking at the government-wide response to the pandemic, professional health officials said they see similarities with how Trump and his deputies at HHS have often made decisions based on politics rather than public health.

Despite repeated warnings about the dangers of knocking down Obamacare – and the risk to the tens of millions of Americans who depend on the program and its protection – Trump and his team rushed to keep their promise to GOP voters The Supreme Court will again decide the fate of the law next year. It heralded how the president ignored warnings of the creeping pandemic this year and worried about the economic and political implications of recognizing the virus threat.

And when Trump got tired of dire predictions from government infectious disease experts like the director of the National Institute for Allergies and Infectious Diseases, Anthony Fauci, and the coronavirus coordinator, Deborah Birx, the White House imported an outside expert – the radiologist and conservative Political analyst Scott Atlas – who carried the Covid-19 news the president wanted to hear.

“It’s not surprising that we got into the trouble we made,” said Novotny. “A lot more ideology was brought into the department than we’ve seen before.”

Novotny, now 73, said he was hoping for another visit to government service – perhaps the California regional office of the Department of Health – and was “optimistic” that Biden could repair the “disaster” left by Trump.

“Many of us who were previously in government do not want to give up public service,” said Novotny. “We would enjoy the chance to make a contribution again.”

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