Feature / June 4, 2024

Project 2025 Has Bad Medicine for HHS

Under Trump, the Department of Health and Human Services would become the “Department of Life” once again—and worse.

Joan Walsh
Looking up at the sign outside the Department of Health and Human Services building, against a sunny sky.
(J. David Ake / Getty Images)

This article is part of “Project 2025: The Plot Against America,” a Nation special issue devoted to unpacking the right’s vast and chilling program for a second Trump term.

Roger Severino, a prominent attorney for the Christian right, led the Department of Health and Human Services’ Office of Civil Rights during the Trump administration. In 2017, The Atlantic called him “the man behind Trump’s religious-freedom agenda for health care.” The profile contrasted Severino’s sparsely decorated office—adorned with a crucifix and a Clarence Thomas bobblehead—with his elaborate domestic agenda.

During Severino’s time there, Trump’s Department of Health and Human Services weakened the Affordable Care Act; strengthened the ability of healthcare providers to claim religious exemptions from providing all kinds of medical care, from abortion to birth control to vasectomies to gender-affirming care; and created a Conscience and Religious Freedom Division in his office. Under Severino’s legal counsel, HHS cut teen-pregnancy prevention programs and prioritized abstinence in its Title X family-planning grants. Backing Severino’s crusade was his boss, HHS secretary and former Eli Lilly president Alex Azar, best known for helping Trump botch his Covid response and presiding over his border policy of separating migrant children from their parents. Azar came to call his department “the Department of Life.”

In his chapter of Project 2025’s Mandate for Leadership, Severino promises to make HHS the “Department of Life” again—and to go even farther than Azar did. The plan outlines how HHS would use its power as a federal agency to dramatically curtail access to reproductive health services. Severino pledges that HHS will restrict access to birth control, rescind the FDA’s approval of medication abortion, and abolish what he calls “mail-order abortion”—the latter by using the long-dormant Comstock Act to prosecute anyone who provides such medication by mail. HHS will also focus on weeding out programs geared to the rights of LGBT people, especially anyone who is transgender. It would direct subsidies for childcare facilities to parents themselves—all in a punitive, misguided effort to shore up the nuclear family. This isn’t a public health document; it’s a theocratic manifesto, an attempt at ensuring public health through ultra-orthodox Christianity.

So much for “religious freedom.” Under “the next administration” (read: a Trump administration), Severino recommends that nearly every HHS program or agency—with special emphasis on the Administration for Children and Families, the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, and the Office of the Surgeon General—be retooled with the goal of promoting heterosexual marriage and procreation. He argues that the next president should use his powers to “maintain a biblically based, social science–reinforced definition of marriage and family.” Of course, he believes that “families comprised of a married mother, father, and their children are the foundation of a well-ordered nation and healthy society.” He claims that “all other family forms” apart from “heterosexual, intact marriage…involve higher levels of instability.”

Severino attacks President Biden for “focusing on ‘LGBTQ+ equity,’ subsidizing single motherhood, disincentivizing work, and penalizing marriage”—while offering no examples of his policies that did any of the last three things. Severino calls on HHS to repeal antidiscrimination policy statements that identify sex with “gender identity or sexual orientation.” Here’s the crescendo: “Working fathers are essential to the well-being and development of their children, but the United States is experiencing a crisis of fatherlessness that is ruining our children’s futures.”

Thus, HHS policies would “prioritize married father engagement” and stress the importance of heterosexual marriage in all of its health, education, and welfare programs, and it would even enable child-abuse prevention funds to be applied to marriage promotion efforts. The CDC would be directed to “eliminate programs and projects that do not respect human life and conscience rights and that undermine family formation.”

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The anti-abortion crusade, too, would continue throughout each of the department’s agencies: “HHS should return to being known as the Department of Life by explicitly rejecting the notion that abortion is health care,” and the secretary should make sure that “all HHS programs and activities are rooted in a deep respect for innocent human life from day one until natural death.” He or she would see to it that no funding whatsoever goes to abortion—not via Hyde Amendment exceptions for rape, incest, or the life of the mother; not even via private insurance subsidized by the Affordable Care Act. Severino recommends eliminating the HHS Reproductive Healthcare Access Task Force and creating a “pro-life task force to ensure that all of the department’s divisions seek to use their authority to promote the life and health of women and their unborn children.”

Severino would force the FDA to “reverse its approval of chemical abortion drugs because the politicized approval process was illegal from the start. The FDA failed to abide by its legal obligations to protect the health, safety, and welfare of girls and women.” This argument is in front of the Supreme Court right now, and even some of the conservative justices don’t appear to be convinced by it.

Severino promises that no Medicaid funding will go to Planned Parenthood. He also proposes reversing a Biden administration regulation that groups receiving Title X funds must be willing to “refer” women to abortion providers even if they don’t provide abortion themselves, thereby allowing “otherwise qualified pro-life grantees” to receive funding.

Severino also aims to restrict access to birth control, which many of us said would be the right’s next priority after banning abortion wherever possible. He announces that HHS must promote “public messaging about the unsurpassed effectiveness [fact check: This is widely disputed] of modern fertility awareness–based methods (FABMs) of family planning…. CDC should fund studies exploring the evidence-based methods used in cutting-edge fertility awareness.” Severino calls for HHS to prohibit women’s health facilities that receive Title X funding from distributing condoms. And by declaring that life begins at conception, his manifesto appears to commit HHS to finding ways to outlaw IVF, which relies on generating multiple embryos, most of which are not implanted. It could also eliminate birth control methods like the IUD and even some forms of the pill.

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Severino reserves special vitriol for the CDC, which he derides as “perhaps the most incompetent and arrogant agency in the federal government.” He wants to strip the CDC of its capacity to issue any kind of public health advice, because issuing such guidance is “an inescapably political function…. For example, never again should CDC officials be allowed to say in their official capacity that school children ‘should be’ masked or vaccinated (through a schedule or otherwise) or prohibited from learning in a school building,” his edict declaims. Instead, “a separate agency should be responsible for public health with a severely confined ability to make policy recommendations.”

Severino’s critique of the CDC also shouts Christian fundamentalism, as he complains about the agency “shutting down churches on the holiest day of the Christian calendar and far beyond as happened in 2020.” Yes, that was Easter 2020. “What is the proper balance of lives saved versus souls saved?” he asks.

Severino wants to use the CDC’s data collection capacity to police abortion, especially those obtained by women forced to travel because of restrictions in their home state. “Because liberal states have now become sanctuaries for abortion tourism, HHS should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother’s state of residence, and by what method.”

So the CDC won’t deal with genuine public health crises, but it will use its data collection expertise to collect abortion data. Please remember: People may have religious objections, but abortion is safer than giving birth.

Severino would also leave Americans far more vulnerable to crass capitalism when they are seeking healthcare. He wants HHS to promote private-sector Medicare Advantage plans, which—take it from me, I did my homework—may give healthy “young” seniors decent benefits at lower costs, but which get more expensive, and more restrictive, as seniors age and need more care. He recommends making Medicare Advantage the “default option” once a person qualifies for the senior-citizen health program at age 65, which would be a boon to private insurance companies, since it essentially privatizes the wildly popular public program.

Severino would also repeal recent legislation allowing Medicare to negotiate better prices for commonly used drugs. And he doesn’t like Medicaid any better: He would weaken the ACA provisions that rely on Medicaid expansion and would impose work requirements on recipients.

HHS currently funds certain childcare and preschool programs for low-income parents, and Severino doesn’t like any of them, either. His plan would do away with the entire Head Start program for low-income preschoolers. (It’s “fraught with scandal and abuse,” he writes.) And he advises that federal childcare subsidies be directed from care providers to parents themselves, enabling them to stay home with their children or pay a family member to do it instead, a longtime priority of the Christian right.

Finally, Severino would cancel the “woke policies” of the NIH, abolishing its diversity, equity, and inclusion office and halting its efforts to understand gender diversity. “Instead, it should fund studies into the short-term and long-term negative effects of cross-sex interventions,” he huffs. In fact, in every agency and activity under HHS’s auspices, Severino and his allies would root out any support for LGBT people, including research on their health needs.

So that’s what HHS will do under Trump: Ban abortion. Police marriage. Force women to give birth, even if they don’t want to. Force women to marry men, and vice versa, even if they don’t want to. Privatize Medicare. Tighten restrictions on Medicaid. And if you feel like you’d rather not live this way? Severino wants to criminalize “euthanasia,” too.

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Editorial Director and Publisher, The Nation

Joan Walsh

Joan Walsh, a national affairs correspondent for The Nation, is a coproducer of The Sit-In: Harry Belafonte Hosts The Tonight Show and the author of What’s the Matter With White People? Finding Our Way in the Next America. Her new book (with Nick Hanauer and Donald Cohen) is Corporate Bullsh*t: Exposing the Lies and Half-Truths That Protect Profit, Power and Wealth In America.

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