The conservative ideologues at the Department of HHS are working overtime to wrest away our bodily autonomy.
Eight years ago, when Barack Obama was president and Donald Trump was not, a young gay man sought guidance from The Rumpus’s then-anonymous advice columnist, “Sugar.” His parents were “fundamentalist Christians” who believed “being a homosexual is a ‘sin’ that someone struggles with similar to alcoholism or drug addiction and that gays should repent and see Jesus.” He signed off as “Suffocated.”
In the process of encouraging Suffocated to be himself—“The real you. The authentic you. The gay you”—Sugar explicitly denounced the “both sides” attitude that Trump, years later, would normalize with assistance from the mainstream media. “We are all entitled to our opinions and religious beliefs, but we are not entitled to make shit up and then use the shit we made up to oppress other people,” she wrote.
That very mindset is now being written into federal policy, courtesy of the Trump administration and especially the Trump-era U.S. Department of Health and Human Services (HHS). Under the guise of “religious freedom,” the far-right political appointees and hires who have overrun HHS have been making shit up and then using it to oppress other people.
They serve at the pleasure of the president, but really, they are cut from the same evangelical cloth as Vice-President Mike Pence, sharing his preoccupations with undercutting reproductive and LGBTQ rights, and in the process, they are hurting women, queer people, people of color, people with disabilities, people with low incomes, immigrants, and those at the intersections thereof who don’t fit their so-called Christian worldview.
Former HHS Secretary Tom Price’s attitude that “there’s not one” woman who can’t afford birth control still pervades the department. (Meanwhile, this is the man who couldn’t hack flying commercial.) Office of Civil Rights Director Roger Severino is convinced that LGBTQ people, particularly those who are transgender, don’t need civil-rights protections at the doctor’s office or the hospital at the same time he’s encouraging health-care providers to deny them care. Office of Refugee Resettlement Director Scott Lloyd has repeatedly attempted to block undocumented immigrant teenagers from their constitutional right to abortion care and coerce them into remaining pregnant against their will, even in cases of rape. For kicks, Lloyd made up some shit, specifically, the myth of “abortion reversal,” to oppress them further.
Lest it appear that men and only men are in charge, a parade of powerful Aunt Lydias have marched out of The Handmaid’s Tale and into the top ranks of HHS. “Counselor” Maggie Wynne is in Lloyd’s camp. Valerie Huber, the acting head of the Office of Population Affairs, promotes ineffective abstinence-only programs that she rebranded under the sexier name “sexual risk avoidance.” Former top spokesperson Charmaine Yoest, who has since moved to the Office of National Drug Policy, told the New York Times Magazine’s Emily Bazelon that abortion increases the risk of breast cancer (It doesn’t) and that IUDs, a highly effective form of long-acting reversible contraceptives, have “life-ending properties.” (They don’t.)
Far-right HHS officials are entitled to their opinions and religious beliefs—but that’s all they are, opinions and religious beliefs. Not everyone shares them, and certainly, they shouldn’t have a higher claim on public-health policy than science or evidence.
Take the HHS-driven rollback of the birth-control benefit, the popular Affordable Care Act (a.k.a. Obamacare) regulation that widely guaranteed contraception without a co-pay and resulted in at least $1.4 billion in savings for contraceptive users. HHS carved out a religious exemption and a new, nebulous moral exemption for any employer, university, or college that doesn’t want to cover birth control for their employees or students. The estimated 62.4 million cisgender women and untold number of transgender and non-binary people who rely on the benefit could be on the hook for co-pays or worse: the entire cost of the medication or device itself. Depending on your employer and your income, and most certainly not on your health-care needs, at least some—potentially all—contraceptives may become unaffordable. That’s a problem because contraceptives aren’t one size fits all.
An outsider might peer into the Trump-era HHS and expect officials who so virulently oppose legal abortion to support birth control. But these are the same people who have stated that life begins at conception while advocating for the so-called rhythm method. Based on their opinions and religious beliefs, they oppose contraception, too. The resulting shit they make up about it amounts to wielding alternative facts at the expense of vulnerable populations.
Huber, for example, is supposed to help people with low incomes access family-planning services, including contraception, cervical- and breast-cancer screenings, and STD and HIV services, under the Title X program. Instead, Huber appears to be prioritizing Title X grant money for providers who promote abstinence and “natural” family planning. Her office’s grant announcement didn’t even mention the words “contraception” or “contraceptives.” The reproductive health of 4 million Title X patients—described as “a vulnerable population, most of whom are female, low income, and young” and “a racially and ethnically diverse population” in the Obama-era 2016 annual report on the program—are in Huber’s hands entirely. She has nearly unprecedented sole discretion over the final grant decisions.
Huber was involved in ending the Obama-era, evidence-based Teen Pregnancy Prevention Program, too, at a time when teen pregnancies in the United States have plummeted across race and ethnicity. The Trump-era revamped program funding guidelines emphasize Huber’s “sexual risk avoidance” doctrine, calling teen sex a “risk behavior” on par with “drug use, lack of physical activity, and failing to use a seatbelt when riding in a car.” Huber’s machinations, including a shift away from evidence-based requirements for teen pregnancy prevention, have only earned her a promotion.
Then there’s Severino, who reflects HHS’s anti-LGBTQ strain and effort after effort to erase queer people. Severino cracked open the civil rights office with a new “Conscience and Religious Freedom Division” that amounts to a state-sanctioned license to discriminate against LGBTQ patients and people seeking reproductive health care. News outlets have included sympathetic quotes from Severino about the “actual discrimination and mistreatment” he faced as the child of Colombian immigrants. To be clear, Severino’s experiences as a child of color and of immigrants are valid. As are the experiences of trans patients turned away from bigoted health-care providers who won’t test them for breast cancer or treat them for the common cold, let alone provide life-saving gender-affirming care. As are those of pregnant people forced to hemorrhage in Catholic hospitals that refuse to perform miscarriage management in the form of medication or surgical abortion care. By conflating “religious freedom” with civil rights, more patients may be turned away, may even sicken and die.
Severino is hardly writing policy in a vacuum. He presumably collaborates with his chief of staff, March Bell, an alum of congressional Republicans’ Planned Parenthood witch hunt, on how to turn their opinions and beliefs into more made-up shit. HHS unveiled the health-care discrimination division at a ceremony bolstering dubious allegations that medical professionals are routinely coerced into abortion care and face retaliation for saying no. In fact, a robust web of federal and state “conscience and refusal” laws already protects providers. In fact, at least one prominent story sounds familiar because congressional Republicans have been recycling it for years.
Former Alliance Defending Freedom (ADF) counsel Matt Bowman represented the plaintiff in that story. ADF is a bonafide hate group. Bowman now works at HHS and was one of the architects of the birth control benefit’s destruction. Together, the health department and the hate group conspired to block Medicaid beneficiaries from the family planning provider of their choice, and in doing so, disproportionately targeted women of color and women in rural areas.
When Americans consider the greatest threat to their civil rights, their thoughts more likely than not coalesce around Attorney General Jeff Sessions, who used the U.S. Department of Justice to help HHS regain control of regulations enforcing key nondiscrimination protections collected under Section 1557 of Obamacare. Now, HHS is speeding toward a rule that could strike Section 1557’s trans and pregnancy protections or otherwise undermine them, perhaps through the kind of broad religious and moral exemptions found in the birth control benefit rollback.
A comprehensive accounting of all the far-right HHS officials and all the shit they’ve made up could go on and on. Theirs is a holier-than-thou agenda, not unlike the one Suffocated’s parents were wielding against him when he reached out to Sugar. What would Sugar—the author Cheryl Strayed—say now if she was advising this facet of our national nightmare? “Dear Sugar,” the letter would begin. “How can we stop HHS from bulldozing our health and humanity? Signed, The American Public.”
Sugar might tell the American Public to fight back, just as advocates have in lawsuit after lawsuit after lawsuit. To file comments, the federal agency counterpart of holding their members of Congress accountable. To keep calling their representatives and senators. Demand increased congressional oversight. Demand legislation that explicitly codifies the intersection of public health and civil rights into law that HHS can’t touch, as opposed to regulations that it can and does. Despite or perhaps because Republicans control Congress, it’s all the more important for Democrats to step up, advocating for measures that uplift Black lives, queer rights, and reproductive health, that uphold dignity across immigration status and income and ability.
“HHS officials are entitled to their opinions and religious beliefs,” Sugar might conclude. “But they are not entitled to make shit up and then use the shit they made up to oppress you.”
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