14

DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Roger Severino

OVERVIEW

HHS consists of 11 operating divisions that have varying degrees of practicalindependence from the Secretary of Health and Human Services and 15 staff
divisions that are directly under the Office of the Secretary. This chapter’s recommendations are limited to those divisions that most need reform and address,
wherever possible, five cross-cutting goals.

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﻿If the U.S. Department of Health and Human Services (HHS) were a separate country, its approximately $1.6 trillion budget would rank as the world’s fifth-largest
national budget. For good or ill, HHS activities personally impact the lives of more
Americans than do those of any other federal agency. Under President Trump, HHS
was dedicated to serving “all Americans from conception to natural death, including
those individuals and families who face…economic and social well-being challenges.”1
Under President Biden, the mission has shifted to “promoting equity in everything
we do” for the sake of “populations sharing a particular characteristic” including race,
sexuality, gender identification, ethnicity, and a host of other categories.2
As a result of HHS’s having lost its way, U.S. life expectancy, instead of returning to normal after the COVID-19 pandemic, continued to drop precipitously tolevels not seen since 1996 with white populations alone losing 7 percent of their
expected life span in just one year.3 Nothing less than America’s long-term survival
is at stake. Accordingly, HHS must return to serving the health and well-being of
all Americans at all stages of life instead of using social engineering that leaves us
sicker, poorer, and more divided.

﻿Mandate for Leadership: The Conservative Promise

Goal #1: Protecting Life, Conscience, and Bodily Integrity. The Secretaryshould pursue a robust agenda to protect the fundamental right to life, protect conscience rights, and uphold bodily integrity rooted in biological realities, not ideology.
From the moment of conception, every human being possesses inherent dignity
and worth, and our humanity does not depend on our age, stage of development,
race, or abilities. The Secretary must ensure that all HHS programs and activities
are rooted in a deep respect for innocent human life from day one until natural
death: Abortion and euthanasia are not health care.
A robust respect for the sacred rights of conscience, both at HHS and among governments and institutions funded by it, increases choices for patients and program
beneficiaries and furthers pluralism and tolerance. The Secretary must protect
Americans’ civil rights by ensuring that HHS programs and activities follow theletter and spirit of religious freedom and conscience-protection laws.
Radical actors inside and outside government are promoting harmful identity
politics that replaces biological sex with subjective notions of “gender identity” andbases a person’s worth on his or her race, sex, or other identities. This destructive
dogma, under the guise of “equity,” threatens American’s fundamental liberties aswell as the health and well-being of children and adults alike. The next Secretarymust ensure that HHS programs protect children’s minds and bodies and that
HHS programs respect parents’ basic right to direct the upbringing, education,and care of their children.
Goal #2: Empowering Patient Choices and Provider Autonomy. Basic economics holds that costs tend to decrease and quality and options tend to increase
when there is robust and free competition in the provision of goods and services.
Health care is no exception. Health care reform should be patient-centered andmarket-based and should empower individuals to control their health care–related
dollars and decisions.
Of course, providers who deliver health care also need the freedom to address
the unique needs of their patients. States should be the primary regulators of the
medical profession, and the federal government should not restrict providers’ ability to discharge their responsibilities or limit their ability to innovate throughgovernment pricing controls or irrational Medicare and Medicaid reimbursement schemes.
Finally, America’s broken insurance system, run largely through confusing provider networks and third-party payers (employers), induces overconsumption ofhealth care, limits consumer shopping, and hides true costs from patients.
The federal government should focus reform on reducing burdens of regulatorycompliance, unleashing innovation in health care delivery, ceasing interference inthe daily lives of patients and providers, allowing alternative insurance coverage
options, and returning control of health care dollars to patients making decisions
with their providers about their health care treatments and services.

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﻿

Goal #3: Promoting Stable and Flourishing Married Families. Families
comprised of a married mother, father, and their children are the foundation ofa well-ordered nation and healthy society. Unfortunately, family policies andprograms under President Biden’s HHS are fraught with agenda items focusing
on “LGBTQ+ equity,” subsidizing single-motherhood, disincentivizing work, andpenalizing marriage. These policies should be repealed and replaced by policies
that support the formation of stable, married, nuclear families.
Working fathers are essential to the well-being and development of theirchildren, but the United States is experiencing a crisis of fatherlessness that is
ruining our children’s futures. In the overwhelming number of cases, fathers
insulate children from physical and sexual abuse, financial difficulty or poverty,
incarceration, teen pregnancy, poor educational outcomes, high school failure,
and a host of behavioral and psychological problems. By contrast, homes with
non-related “boyfriends” present are among the most dangerous place for a childto be. HHS should prioritize married father engagement in its messaging, health,and welfare policies.
In the context of current and emerging reproductive technologies, HHS policies
should never place the desires of adults over the right of children to be raised by
the biological fathers and mothers who conceive them. In cases involving biological parents who are found by a court to be unfit because of abuse or neglect, theprocess of adoption should be speedy, certain, and supported generously by HHS.
Goal #4: Preparing for the Next Health Emergency. The COVID-19 pandemic demonstrated how catastrophic a micromanaging, misinformed, centralized,
and politicized federal government can be. Basic human rights, medical choice, andthe doctor–patient relationship were trampled without scientific justification andfor extended periods of time. Excess deaths, not due to COVID-19, skyrocketedbecause of forced lockdowns, isolation, vaccine-related mass firings, and colossal
disruptions of the economy and daily rhythms of life.
The federal government’s public health apparatus has lost the public’s trust.
Before the next national public health emergency, this apparatus must be fundamentally restructured to ensure a transparent, scientifically grounded, and more
nimble, efficient, transparent, and targeted response that respects the uniqueneeds and input of patient populations and providers.
Every one of the overreaching policies during the pandemic—from lockdowns
and school closures to mask and vaccine mandates or passports—received its
supposed legal justification from the state of emergency declared (and renewed)by the HHS Secretary. Tellingly, however, the threshold for what constitutes apublic health emergency—how many cases, hospitalizations, deaths, etc.—wasnever defined. For the sake of democratic accountability, we must know with clarity
what will trigger the next emergency declaration and, just as important, what will
trigger its end.

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Mandate for Leadership: The Conservative Promise

Unaccountable bureaucrats like Anthony Fauci should never again have suchbroad, unchecked power to issue health “guidelines” that will certainly be the basis
for federal and state mandates. Never again should public health bureaucrats beallowed to hide information, ignore information, or mislead the public concerning
the efficacy or dangers associated with any recommended health interventions
because they believe it may lead to hesitancy on the part of the public. The only
way to restore public trust in HHS as an institution capable of acting responsibly
during a health emergency is through the best of disinfectants—light.
Goal #5: Instituting Greater Transparency, Accountability, and Oversight. The next Administration should guard against the regulatory capture of ourpublic health agencies by pharmaceutical companies, insurers, hospital conglomerates, and related economic interests that these agencies are meant to regulate. We
must erect robust firewalls to mitigate these obvious financial conflicts of interest.
All National Institutes of Health, Centers for Disease Control and Prevention,
and Food and Drug Administration regulators should be entirely free from private biopharmaceutical funding. In this realm, “public–private partnerships” is aeuphemism for agency capture, a thin veneer for corporatism. Funding for agencies
and individual government researchers must come directly from the government
with robust congressional oversight.
We must shut and lock the revolving door between government and Big Pharma.
Regulators should have a long “cooling off period” on their contracts (15 years
would not be too long) that prevents them from working for companies they haveregulated. Similarly, pharmaceutical company executives should be restricted frommoving from industry into positions within regulatory agencies.
Finally, HHS should adopt metrics across the agency that can objectively determine the extent to which the agency’s policies and programs achieve desired healthand welfare outcomes (not agency outputs). What is not measured is not achieved.
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

COVID and Structural Reform. COVID-19 exposed the Centers for Disease
Control and Prevention (CDC) as perhaps the most incompetent and arrogant
agency in the federal government. CDC continually misjudged COVID-19, fromits lethality, transmissibility, and origins to treatments. We were told masks were
not needed; then they were made mandatory. CDC botched the development of
COVID tests when they were needed most. When it was too late, we were told to put
our lives on hold for “two weeks to flatten the curve;” that turned into two years ofinterference and restrictions on the smallest details of our lives. Congress should
ensure that CDC’s legal authorities are clearly defined and limited to prevent a
recurrence of any such arbitrary and vacillating exercise of power.
The CDC should be split into two separate entities housing its two distinct functions. On the one hand, the CDC is now responsible for collecting, synthesizing,— 452 —

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﻿and publishing epidemiological data from the individual states—a scientificdata-gathering function. This information is crucial for medical and public healthresearchers around the country. On the other hand, the CDC is also responsible
for making public health recommendations and policies—an inescapably political
function. At times, these two functions are in tension or clear conflict. In February2022, for example, it was reported that “[t]wo full years into the pandemic, theagency leading the country’s response to the public health emergency has published only a tiny fraction of the data it has collected,” much of which “could [havehelped] state and local health officials better target their efforts to bring the virus
under control.” A CDC spokesman said that one of the reasons was “fear that the
information might be misinterpreted.”4
These distinct functions should be separated into two entirely separate agencies with a firewall between them. We need a national epidemiological agency
responsible only for publishing data and required by law to publish all of the data
gathered from states and other sources. A separate agency should be responsible
for public health with a severely confined ability to make policy recommendations.
The CDC can and should make assessments as to the health costs and benefits ofhealth interventions, but it has limited to no capacity to measure the social costs
or benefits they may entail. For example, how much risk mitigation is worth theprice of shutting down churches on the holiest day of the Christian calendar andfar beyond as happened in 2020? What is the proper balance of lives saved versus
souls saved? The CDC has no business making such inherently political (and often
unconstitutional) assessments and should be required by law to stay in its lane.
The CDC’s initial COVID-19 testing failures were largely the result of that agency’s prioritizing its own development and production of tests using its internal
staff and facilities. The private sector is much better positioned to tackle the challenges inherent in developing and manufacturing novel products, as illustrated by
the relative success of the alternative approach to facilitating the development of
COVID-19 vaccines and therapeutics by private companies that was adopted by
the Food and Drug Administration (FDA).
When it comes to testing, the CDC’s role should similarly be to facilitate rather
than supplant the efforts of private test developers, academic laboratories, statepublic health laboratories, and clinical testing providers. When responding to anovel pathogen, the CDC should focus on gathering and disseminating information,
including specimens needed for development of positive controls and reference
panels, and ensuring that test developers can develop and validate diagnostic
tests. These changes will require a shift in priorities and culture at the CDC—andthroughout HHS more broadly.5
Most problematically, the CDC presented itself as a kind of “super-doctor” forthe entire nation. The CDC is a public health institution, not a medical institution.
According to its mission statement, the agency focuses on “disease prevention and﻿Mandate for Leadership: The Conservative Promise

control, environmental health, and health promotion and health education activities.”6 It is not qualified to offer (and usually does not purport to offer) professional
medical opinions applicable to specific patients.
From time to time, the CDC offers findings and recommendations that competent medical practitioners often will consider in arriving at a professional medical
judgment for a particular patient. In this respect, CDC guidelines are analogous
to guidelines from other public health associations or medical societies: They are
informative, not prescriptive.
By statute or regulation, CDC guidance must be prohibited from taking on aprescriptive character. For example, never again should CDC officials be allowed tosay 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.
Such decisions should be left to parents and medical providers. We have learned
that when CDC says what people “should” do, it readily becomes a “must” backed bysevere punishments, including criminal penalties. CDC should report on the risks
and effectiveness of all infectious disease-mitigation measures dispassionately
and leave the “should” and “must” policy calls to politically accountable parties.
Conflicts of Interest. There was a time when the CDC could not take moneyfrom the pharmaceutical industry, but in 1992, the agency discovered a loophole infederal law that allowed it to accept pharma contributions through the nonprofit
CDC Foundation. The money started flowing immediately: From 2014 through2018, the CDC Foundation received $79.6 million from pharmaceutical corporations like Pfizer, Biogen, and Merck.7 This practice presents a stark conflict ofinterest that should be banned.
Data Systems. The COVID-19 pandemic has revealed the disastrous publichealth consequences of the CDC’s failure to follow multiple congressional
mandates to modernize its data infrastructure. Current reporting methods areburdensome for frontline medical workers, yet they result only in fragmented datathat are not available in real time or usable across systems.
Congress should require HHS to prioritize the electronic collection and dissemination of robust, privacy-protected data that better leverages existing systems
while reducing burdens on clinicians. HHS should also enter into a public–private
partnership with a data-management expert to develop a system that makes critical information available to health care workers and policymakers in real time.8
The CDC operates several programs related to vaccine safety including the Vaccine Adverse Event Reporting System (VAERS); Vaccine Safety Datalink (VSD);
and Clinical Immunization Safety Assessment (CISA) Project. Those functions andtheir associated funding should be transferred to the FDA, which is responsible forpost-market surveillance and evaluation of all other drugs and biological products.
Respect for Life and Conscience. The CDC should eliminate programs andprojects that do not respect human life and conscience rights and that undermine— 454 —

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﻿family formation. It should ensure that it is not promoting abortion as health care.
It should fund studies into the risks and complications of abortion and ensure thatit corrects and does not promote misinformation regarding the comparative healthand psychological benefits of childbirth versus the health and psychological risks
of intentionally taking a human life through abortion.
The CDC oversaw and funded the development and testing of the COVID-19
vaccines with aborted fetal cell lines, insensitive to the consciences of tens of
thousands to hundreds of thousands of people who objected to taking a vaccine with such a link to abortion. As evidenced by litigation across the country,
it is likely that thousands were fired unjustly because of the exercise of theirconsciences or faith on this question, which could have been avoided with amodicum of concern for this issue from CDC. There is never any justification forending a child’s life as part of research, and the research benefits from splicing or
growing aborted fetal cells and aborted baby body parts can easily be provided
by alternative sources. All such research should be prohibited as a matter oflaw and policy.
CDC should update its public messaging about the unsurpassed effectiveness ofmodern fertility awareness–based methods (FABMs) of family planning and stop
publishing communications that conflate such methods with the long-eclipsed“rhythm” or “calendar” methods. CDC should fund studies exploring the evidence-based methods used in cutting-edge fertility awareness.
Data Collection. The CDC’s abortion surveillance and maternity mortality
reporting systems are woefully inadequate. CDC abortion data are reported bystates on a voluntary basis, and California, Maryland, and New Hampshire do not
submit abortion data at all. Accurate and reliable statistical data about abortion,abortion survivors, and abortion-related maternal deaths are essential to timely,
reliable public health and policy analysis.
Because liberal states have now become sanctuaries for abortion tourism, HHSshould 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 whatgestational age of the child, for what reason, the mother’s state of residence, andby what method. It should also ensure that statistics are separated by category:spontaneous miscarriage; treatments that incidentally result in the death of a child(such as chemotherapy); stillbirths; and induced abortion. In addition, CDC should
require monitoring and reporting for complications due to abortion and every
instance of children being born alive after an abortion. Moreover, abortion should
be clearly defined as only those procedures that intentionally end an unborn child’slife. Miscarriage management or standard ectopic pregnancy treatments should
never be conflated with abortion.
Comparisons between live births and abortion should be tracked across various demographic indicators to assess whether certain populations are targeted byMandate for Leadership: The Conservative Promiseabortion providers and whether better prenatal physical, mental, and social care
improves infant outcomes and decreases abortion rates, especially among those
who are most vulnerable.
The Ensuring Accurate and Complete Abortion Data Reporting Act of 20239
would amend title XIX of the Social Security Act and Public Health Service Act
to improve the CDC’s abortion reporting mechanisms by requiring states, as acondition of federal Medicaid payments for family planning services, to report
streamlined variables in a timely manner.
The CDC should immediately end its collection of data on gender identity, which
legitimizes the unscientific notion that men can become women (and vice versa)
and encourages the phenomenon of ever-multiplying subjective identities.

﻿

FOOD AND DRUG ADMINISTRATION (FDA)

The FDA’s mission includes ensuring the safety and efficacy of drugs, biologicalproducts, and medical devices.
Federal Laws That Shield Big Pharma from Competition. Because generics
generally cost far less than brand-name drugs, consumers begin to save money assoon as a generic product comes on the market. The vast majority are very affordable with 93 percent of generic products costing $20 or less.
Savings would be even higher under proposals that prevent brand-name manufacturers from slowing down or impeding the entrance of generic products into
the marketplace. Specifically, the FDA should prohibit pharmaceutical companies
from purposely sitting on their legally available right to be the first to sell genericversions of their drugs. Additionally, Congress should create legal remedies forgeneric companies to obtain samples of brand-name products for their genericdevelopment efforts and should prohibit meritless “citizen petitions” submitted
by manufacturers to delay approval of a generic competitor.10
Approval Process for Laboratory-Developed or Modified Medical Tests.
Learning from the failed early COVID-19 testing experience, Congress and the FDA
should focus on reforming laws and regulations governing medical tests, especiallywith respect to laboratory-developed tests.
Commercial tests are developed with the intention of being widely marketed,distributed, and used, while laboratory-developed tests are created with theintention of being used solely within one laboratory. A test developed by a lab inaccordance with the protocols developed by another lab (non-commercial sharing)
currently constitutes a “new” laboratory-developed test because the lab in which
it will be used is different from the initial developing lab. To encourage interlaboratory collaboration and discourage duplicative test creation (and associatedregulatory and logistical burdens), the FDA should introduce mechanisms throughwhich laboratory-developed tests can easily be shared with other laboratories without the current regulatory burdens.11— 456 —

Department of Health and Human Services— 457 —

﻿The “laboratory-developed tests” category currently encompasses a range ofpossible tests, many of which would be characterized more appropriately as “laboratory-modified tests” because they are not truly novel tests but rather modified
versions of existing tests. To avoid stifling innovation and access to medical care,
the applicable statutes and regulations should be revised to facilitate greater accessto such modified tests.12
Finally, the FDA has long held that it has regulatory authority over such tests,
while others have argued that they should be considered clinical services regulatedby the Centers for Medicare and Medicaid Services (CMS). The FDA currently
has regulatory authority over in vitro diagnostics, and under the Clinical Laboratory Improvement Amendments (CLIA),13 the CMS ensures that labs meet
analytical validity standards for test methods. Congress, the FDA, and the CMS
need to clarify and disentangle overlapping authorities over tests to eliminate
regulatory confusion.14
Drug Shortages. The very thin profit margins and the regulatory burdens
associated with generic drug manufacturing discourage inventory and capacity
investments by manufacturers and contribute to drug shortages. HHS and the FDA
should encourage more dependable generic drug manufacturing.
The FDA should expand its current pass/fail approach to drug facility inspections into a graded system that recognizes manufacturers that exceed minimum
standards by investing in improving production reliability. The FDA should also
add facility codes to drug packaging and construct a searchable database thatcross-references product codes and facility codes. That would enable wholesalers
and pharmacy benefit managers to identify and preference drugs manufactured atmore reliable facilities, thus encouraging generic drug manufacturers to compete
on reliability as well as on price.
For its part, HHS should exempt multi-source generic drugs from requirements
to pay rebates to Medicaid and other federally funded health programs, as those
provisions penalize new investments in expanding manufacturing capacity when
supply is unable to meet demand.15 Additionally, FDA and NIH should promote
efficacy trials of new applications for generic drugs, which might include NIH funding such trials or conducting its own.
Abortion Pills. Abortion pills pose the single greatest threat to unborn children in a post-Roe world. The rate of chemical abortion in the U.S. has increasedby more than 150 percent in the past decade; more than half of annual abortionsin the U.S. are chemical rather than surgical.
The abortion pill regimen is typically a two-part process. The first pill, mifepristone, causes the death of the unborn child by cutting off the hormone progesterone,
which is required to sustain a pregnancy. The second pill, misoprostol, causes contractions to induce a delivery of the dead child and uterine contents, usually into a
toilet at home. The abortion-pill regimen is currently approved for up to 70 days

Mandate for Leadership: The Conservative Promise(10 weeks) into pregnancy and before Biden was subject to a heightened safety
restriction called a Risk Evaluation and Mitigation Strategy (REMS) that requires
an in-person visit with a physician who can check for dangerous contraindications
such as ectopic pregnancies and can advise the mother seeking an abortion of therisks of chemical abortion, including hemorrhaging, and what to do in such circumstances. Chemical abortion has been found to have a complication rate fourtimes higher than that of surgical abortion.
Since its approval more than 20 years ago, mifepristone has been associated with
26 deaths of pregnant mothers, over a thousand hospitalizations, and thousands
more adverse events, but that number does not account for all complications. Of
course, this does not count the hundreds of thousands to millions of babies whose
lives have been unjustly taken through chemical abortion. FDA should therefore:﻿lReverse its approval of chemical abortion drugs because thepoliticized approval process was illegal from the start. The FDA
failed to abide by its legal obligations to protect the health, safety, andwelfare of girls and women. It never studied the safety of the drugs
under the labeled conditions of use, ignored the potential impacts of thehormone-blocking regimen on the developing bodies of adolescent girls,
disregarded the substantial evidence that chemical abortion drugs cause
more complications than surgical abortions, and eliminated necessary
safeguards for pregnant girls and women who undergo this dangerous drug
regimen. Furthermore, at no point in the past two decades has the FDA everacknowledged or addressed federal laws that prohibit the distribution ofabortion drugs by postal mail; to the contrary, the FDA has permitted andactively encouraged such activity.
Now that the Supreme Court has acknowledged that the Constitution
contains no right to an abortion, the FDA is ethically and legally obliged torevisit and withdraw its initial approval, which was premised on pregnancy
being an “illness” and abortion being “therapeutically” effective at treating
this “illness.” The FDA is statutorily charged with guaranteeing thesafety and efficacy of drugs and therefore should withdraw this drug thatis proven to be dangerous to women and by definition fatally unsafe forunborn children.

As an interim step, the FDA should immediately restore the REMS by removing
the in-person dispensing requirement to eliminate dangerous tele-abortion andabortion-by-mail distribution.
Mail-Order Abortions. Allowing mail-order abortions is a gift to the abortion
industry that allows it to expand far beyond brick-and-mortar clinics and into

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Department of Health and Human Services

pro-life states that are trying to protect women, girls, and unborn children fromabortion. The FDA should therefore:lllAddress weaknesses in the current FAERS (FDA Adverse Events
Reporting System). The Administration and policymakers should ensurethat health care workers, particularly those in hospitals and emergency rooms,
report abortion pill complications. Women who experience complications
from abortion pills typically go to an emergency room, not to the abortion pillprescriber, so putting the onus of reporting on the prescriber who typically has
no idea that a complication has occurred means that the FAERS is seriously
undercounting adverse events. Submitting an adverse event to the databaseshould be a quick and efficient process for busy health care practitioners.
Currently, providers report that the process is difficult and convoluted.
Implement a policy of transparency about inspections of the abortion
pill’s sponsors, Danco and GenBioPro, as well as facilities that
manufacture the pills. The FDA should respond to congressional requests
and Freedom of Information Act (FOIA) requests about inspections,compliance, and post-marketing safety in a timely manner.
Stop promoting or approving mail-order abortions in violation of
long-standing federal laws that prohibit the mailing and interstate
carriage of abortion drugs.16

Vaccine Importation. Thousands of Americans of faith and conscience wish
to receive various childhood vaccinations for themselves and their families but are
not allowed to receive vaccines that are derived through or tested on aborted fetal
cells. For example, the chickenpox, Hepatitis, and MMR vaccines in the U.S. are alllinked to abortion in this way. There are ethically derived alternatives abroad thathave been used safely there for decades, but the FDA makes it exceedingly difficultfor Americans to import them.
In January 2021, the HHS Office for Civil Rights (OCR) and the FDA jointly
announced that HHS was required by the Religious Freedom Restoration Act— 459 —

﻿lReinstate earlier safety protocols for Mifeprex that were mostly
eliminated in 2016 and apply these protocols to any generic versionof mifepristone. A bare-minimum policy of limiting abortion pills to thepre-2016 policy of 49 days gestation, returning to the pre-2021 in-person
dispensing requirement, and returning to requiring prescribers to report allserious adverse events, not just deaths, to the drug sponsor would increase
women’s health and safety.

﻿Mandate for Leadership: The Conservative Promise(RFRA)17 to allow bulk importation by doctors of certain Japanese-made vaccines
to accommodate religious needs of patients, but the Biden FDA unlawfully revoked
this waiver. The FDA should restore the waiver to comply with RFRA and for the
obvious public health benefits of increased childhood vaccination by families seeking ethically derived alternatives.
To avoid future moral coercion of the sort experienced with the COVID-19 vaccines, the FDA and NIH should require the development of drugs and biologics thatare free from moral taint and switch to cell lines that are not derived from aborted
fetal cell lines or aborted baby body parts.
Conflicts of Interest. A 2018 report in Science found that more than two-thirdsof FDA reviewers later ended up at the same companies whose products they had
been reviewing while they were working for the government.18 This revolving door
is one mechanism by which pharmaceutical companies capture the agencies that
regulate them. The FDA should impose a lengthy cooling off period for reviewers,
preventing them from working for companies they regulated.
In 1997, the FDA relaxed regulations to permit broadcast drug advertisements,
after which Big Pharma began routine direct-to-consumer advertising, making theUnited States and New Zealand the only countries where such practices are legal.
Following the 1997 changes, pharma became the largest advertiser for all major
media organizations. This buys considerable influence in the newsroom—whether
media companies acknowledge this or not—and distorts independent reporting on
public health issues. The FDA or Congress should regulate where and how paid
advertising is used by pharmaceutical companies more stringently, especially on
media outlets.
NATIONAL INSTITUTES OF HEALTH (NIH)

The National Institutes of Health (NIH) is the world’s largest biomedical
research agency and is made up of 27 different components called Institutes andCenters. Despite its popular image as a benign science agency, NIH was responsible for paying for research in aborted baby body parts, human animal chimera
experiments, and gain-of-function viral research that may have been responsible
for COVID-19.
Bioethics Reform. Research using fetal tissue obtained from elective abortions
is immoral and obsolete. Research using human embryonic stem cells also involves
the destruction of human life and should not be subsidized with taxpayer dollars.
Good science and life-affirming, ethical research are not mutually exclusive. In
fact, ethically derived sources such as discarded surgical tissue and adult stem cells(made pluripotent), not tissue obtained from elective abortions, have contributed
the most successful treatments for a variety of ailments.
Congress authorized HHS to choose not to fund extramural abortion-derived fetal tissue research that fails ethics advisory board review, and in 2019, the— 460 —

Department of Health and Human Services

Trump Administration’s HHS chose that course. Subsequently, however, the Biden
Administration restored unrestricted funding of abortion-derived fetal tissue
research. HHS should:lllPromptly restore the ethics advisory committee to oversee abortionderived fetal tissue research, and Congress should prohibit suchresearch altogether.
End intramural research projects using tissue from aborted children
within the NIH, which should end its human embryonic stem
cell registry.
Aggressively implement a plan to pursue and fund ethical alternative
methods of research in order to ensure that abortion and embryodestructive related research, cell lines, and other testing methods
become both fully obsolete and ethically unthinkable.

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﻿In addition, the Administration should reconvene a new National Council on
Bioethics (NCB) to discuss new and emerging areas of ethical concern, to assess
whether the ends justify the means when it comes to the promise of therapies
and cures, and to establish what limiting principles should guide research andhealth policy. Because the male–female dyad is essential to human nature andbecause every child has a right to a mother and father, three-parent embryo creation and human cloning research should be banned. A new NCB should convene
leading experts to examine these issues and provide policy recommendations forthe new frontier of bioethical questions that our country will have to address inthe coming years.
Finally, HHS should create and promote a research agenda that supports prolife policies and explores the harms, both mental and physical, that abortion has
wrought on women and girls.
Conflicts of Interest. NIH maintains inappropriate industry ties that create
serious conflicts of interest. In 2018, it was revealed that a $100 million NIH study
on the benefits of moderate drinking was funded by the beer and liquor industry.19
More recently, the National Institute of Allergy and Infectious Diseases (NIAID),
Anthony Fauci’s division of the NIH, owns half of the patent for the Moderna
COVID-19 vaccine, among thousands of other pharma patents.20 Rather than providing grants to university-based investigators to run the clinical trials on their own
Moderna vaccine, the NIH conducted this research internally—a clear conflict ofinterest. The NIAID will earn millions from this vaccine’s revenue with several
NIH employees (and their heirs) personally receiving up to $150,000 annuallyfrom Moderna vaccine sales.21

﻿Mandate for Leadership: The Conservative Promise

In May 2022, documents obtained pursuant to a FOIA request revealed thatNIH Director Francis Collins, NAIAD Director Anthony Fauci, and Fauci’s Deputy
Director, Clifford Lane, all received royalties from pharmaceutical companies
between 2009 and 2014.22 Nonprofit watchdog Open the Books estimates that from2010 to 2020, third parties paid more than $350 million in royalties to NIH andits scientists, who are credited as coinventors. Most problematically, in the years
when they received payments, Collins, Fauci, and Lane were NIH administrators,
not researchers, with no plausible claim to be scientific co-discoverers.
Most of the world’s other advanced science countries have stricter prohibitions
on such conflicts, which helps to explain why the most significant studies on COVID
treatments, on natural immunity, and on vaccine efficacy have come mostly fromoutside the U.S.
Funding for scientific research should not be controlled by a small group of
highly paid and unaccountable insiders at the NIH, many of whom stay in powerfor decades. The NIH monopoly on directing research should be broken. Term
limits should be imposed on top career leaders at the NIH, and Congress should
consider block granting NIH’s grants budget to states to fund their own scientificresearch. Nothing in this system would prevent several states from partnering to
co-fund large research projects that require greater resources or impact larger
regions. Likewise, the establishment of funding for scientific research at the statelevel does not preclude more modest federal funding through the National Institutes of Health: The two models are not mutually exclusive.
The CDC and NIH Foundations, whose boards are populated with pharmaceutical company executives, need to be decommissioned. Private donations tothese foundations—a majority of them from pharmaceutical companies—should
not be permitted to influence government decisions about research funding or
public health policy.
Woke Policies. Under Francis Collins, NIH became so focused on the #MeToomovement that it refused to sponsor scientific conferences unless there were a certain number of women panelists, which violates federal civil rights law against sex
discrimination. This quota practice should be ended, and the NIH Office of Equity,
Diversity, and Inclusion, which pushes such unlawful actions, should be abolished.
NIH has been at the forefront in pushing junk gender science. Instead, itshould fund studies into the short-term and long-term negative effects of crosssex interventions, including “affirmation,” puberty blockers, cross-sex hormonesand surgeries, and the likelihood of desistence if young people are given counselingthat does not include medical or social interventions.
CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS)

With the goal of being a societal safety net, Medicare and Medicaid touch more
American lives than does any other federal program. While they help many, they

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Department of Health and Human Services

operate as runaway entitlements that stifle medical innovation, encourage fraud,
and impede cost containment, in addition to which their fiscal future is in peril.
Both programs should be managed so that the individuals enrolled are empowered to make decisions for themselves and have quality options with affordable
prices driven by competition and innovation. Providers who participate should
retain (or have restored) the freedom to practice medicine and take care of theirpatients according to their patients’ unique needs.
Medicare. Medicare should be reformed according to four goals and principles:llIncrease Medicare beneficiaries’ control of their health care.
Patients are best positioned to determine the value of health careservices, working with their health care providers. They also benefit fromincreased choice of doctors, hospitals, and insurance plans. Access toreliable information with respect to physicians, hospitals, and insurers istherefore essential.
Reduce regulatory burdens on doctors. Doctors must be free to focus ontreating patients first, not entering codes on computers, and should not be
tempted to change their medical judgment based on arbitrary or illogicalreimbursement incentives.

﻿

l

l

Ensure sustainability and value for beneficiaries and taxpayers.
Prices are best for patients when determined by economic value rather
than political power and when they are known in advance of the receipt ofservices. Government’s use of non-market-based methods to determine
reimbursement leads to overspending on low-value services and products
and underpayment for high-value services and products, stifles beneficial
innovation, and because of Medicare’s size distorts payments throughout
the health care system. Intermediate entities that can manage financial risk
and ensure quality of care are important in transitioning to value-based carewithin the Medicare program.
Reduce waste, fraud, and abuse, including through the use of artificial
intelligence for their detection.

Regulatory Reforms. Medicare regulations restrict choice of coverage andcare. The next Administration should reintroduce and restore regulations anddemonstrations from the Trump Administration that were withdrawn, weakened,or never finalized by the Biden Administration, including:l

The Medicare Coverage of Innovative Technologies (MCIT) rule;— 463 —

Mandate for Leadership: The Conservative Promise

l

l

﻿

l

The Risk Adjustment Data Validation (RADV) rule;
The Medicare Advantage Qualifying Payment Arrangement Incentive(MAQI) demonstration; andThe Global and Professional Direct Contracting (GPDC, rebranded as the
Accountable Care Organization Realizing Equity, Access, and Community
Health or ACO REACH) model.

Additionally, regulations should advance site neutrality by eliminating the inpatient-only list and expanding the ambulatory surgical center covered procedures
list. Medicare generally pays more for inpatient hospital procedures and less forthe same procedures performed in an outpatient setting. Whether a medical service is delivered in a physician’s office, a clinic, or a hospital setting, the Medicare
payment for that service should be the same. CMS should expand the applicationof site-neutral payment options to more settings. Such a policy would level theplaying field among providers and remove the financial disabilities for medical
professionals who would compete with hospital systems.23
Finally, HHS needs to restore and enhance conscience protection regulations
that allow medical practitioners to participate in federal health care programs
without being compelled to provide sex changes or similar services.
LEGISLATIVE PROPOSALSllRemove restrictions on physician-owned hospitals. The Affordable
Care Act (ACA)24 imposed restrictions prohibiting Medicare fromreimbursing physician-owned and specialty hospitals. The current
restrictions do little more than serve the special interests of large hospitalsystems and undercut consumer choice of high-quality, specialty care.
These restrictions should be removed so that physician-owned hospitals cancompete with other hospitals in serving Medicare patients.25

Encourage more direct competition between Medicare Advantage
and private plans. Medicare Advantage (MA), a system of competing
private health plans, is the major alternative to traditional Medicare for
America’s large and growing cohort of seniors. The program provides
beneficiaries with a wide range of competitive health plan choices—a richer
set of benefits than traditional Medicare provides and at a reasonable cost.
Equally as important, the MA program has been registering consistently
high marks for superior performance in delivering high-quality care.
Critical reforms are still needed to strengthen and improve the program forthe future. Specifically:— 464 —

Department of Health and Human Services

1.

Make Medicare Advantage the default enrollment option.

2. Give beneficiaries direct control of how they spend Medicare dollars.
3. Remove burdensome policies that micromanage MA plans.
4. Replace the complex formula-based payment model with a competitive
bidding model.
5. Reconfigure the current risk adjustment model.
6. Remove restrictions on key benefits and services, including those related
to prescription drugs, hospice care, and medical savings account plans.26
Legacy Medicare Reform. Legislation reforming legacy (non-MA)
Medicare should:
l

l

l

l

Replace the bureaucrat-driven fee-for-service system with valuebased payments to empower patients to find the care that best serves
their needs.
Codify price transparency regulations.
Restructure 340B drug subsidies27 toward beneficiaries rather
than hospitals.
Repeal harmful health policies enacted under the Obama and Biden
Administrations such as the Medicare Shared Savings Program28 andInflation Reduction Act.29

Medicare Part D Reform. The Inflation Reduction Act (IRA) created a drug
price negotiation program in Medicare that replaced the existing private-sector
negotiations in Part D with government price controls for prescription drugs.
These government price controls will limit access to medications and reduce
patient access to new medication.
This “negotiation” program should be repealed, and reforms in Part D thatwill have meaningful impact for seniors should be pursued. Other reforms should
include eliminating the coverage gap in Part D, reducing the government share in— 465 —

﻿lBase payments on the health status of the patient or intensity of theservice rather than where the patient happens to receive that service.

﻿

Mandate for Leadership: The Conservative Promise

the catastrophic tier, and requiring manufacturers to bear a larger share. Until the
IRA is repealed, an Administration that is required to implement it must do so in a
way that is prudent with its authority, minimizing the harmful effects of the law’s
policies and avoiding even worse unintended consequences.30
Medicaid. Over the past 45 years, Medicaid and the health safety net have
evolved into a cumbersome, complicated, and unaffordable burden on nearly every
state. The program is failing some of the most vulnerable patients; is a prime target
for waste, fraud, and abuse; and is consuming more of state and federal budgets.
The dramatic increase in Medicaid expenditures is due in large part to the ACA(Obamacare), which mandates that states must expand their Medicaid eligibility
standards to include all individuals at or below 138 percent of the federal poverty
level (FPL), and the public health emergency, which has prohibited states fromperforming basic eligibility reviews.
The overlap of available benefits among the various health agencies has led
to a complex, confusing system that is nearly impossible to navigate—even forrecipients. Recipients are often faced with a “welfare cliff” of benefit losses as theyearn above a certain amount, which is contrary to the fundamental purpose of
empowering individuals to achieve economic independence. Benefits increasingly
involve nonmedical services such as air conditioning and housing, many of which
are already handled by departments other than HHS.
Improper payments within Medicaid are higher than those of any other federal
program. These payments are evidence of the inappropriateness of Medicaid’s
expansion, which, stemming largely from public health emergency maintenanceof effort (MOE) requirements and the Affordable Care Act, has crowded out the
primary targets of these programs: those who are most in need.
True health care reform cannot be accomplished in a bureaucratic silo or only
through Medicaid and health safety net programs. Reform of the tax code is alsoessential to genuine, effective reform of our health care system. All componentsof the health care system should be part of the reform efforts, and it is imperativethat the system be modified to assist states with their current programs. Therefore,
the next Administration should:l

Reform financing. Allow states to have a more flexible, accountable,
predictable, transparent, and efficient financing mechanism to deliver
medical services. This system should include a more balanced or blended
match rate, block grants, aggregate caps, or per capita caps. Any financial
system should be designed to encourage and incentivize innovation andthe efficient delivery of health care services. Federal and state financial
participation in the Medicaid program should be rational, predictable, andreasonable. It should also incentivize states to save money and improve thequality of health care.

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Department of Health and Human ServiceslDirect dollars to beneficiaries more effectively and responsibly. The
current funding structure for the Medicaid program rewards expansions,lacks transparency, and promotes financing gimmicks. CMS should:
1.

End state financing loopholes.

2. Reform payments to hospitals for uncompensated care.
3. Replace the enhanced match rate with a fairer and morerational match rate.
4. Restructure basic financing and put the program on a more fiscally
predictable budget (which should include reform of Disproportionate
Share Hospital payments to hospitals).31
lStrengthen program integrity. Make program integrity a top priority andthe responsibility of the states. To protect the taxpayers’ investment:
1.

2. Improve Medicaid eligibility standards to protect those in need.
As Medicaid enrollment continues to climb, it is imperative that there
are appropriate and accurate eligibility standards to ensure that the
program remains focused on serving those who are in need. To thisend, CMS should:a. Hold states accountable for improper eligibility determinations.
b. Require more robust eligibility determinations.
c. Strengthen asset test determinations within Medicaid.32
3. Conduct oversight and reform of managed care.33lIncentivize personal responsibility. CMS should allow states to ensurethat Medicaid recipients have a stake in their personal health care and asay in decisions related to the Medicaid program. Personal responsibility— 467 —

﻿

Incentivize states. An enhanced contingency fee should be paid tostates that successfully increase their efforts to decrease waste, fraud,
and abuse. The current system’s IT development 90/10 matching rateshould be allowed for improvements in states’ current fraud and abuseand eligibility systems. Innovative programs that show a positive returnon investment for both the state and federal governments should beallowed without the onerous waiver process.

Mandate for Leadership: The Conservative Promiseand consumer choice for Medicaid recipients must go together as standard
components of the safety net, especially for able-bodied recipients.
Medicaid recipients, like the rest of Americans, should be given both thefreedom to choose their health plans and the responsibility to contribute totheir health care costs at a level that is appropriate to protect the taxpayer.
l

Add work requirements and match Medicaid benefits to beneficiaryneeds. Because Medicaid serves a broad and diverse group of individuals, it
should be flexible enough to accommodate different designs for different
groups. For example, CMS should launch a robust “personal option” to allow
families to use Medicaid dollars to secure coverage outside of the Medicaid
program. CMS should also:1.

Clarify that states have the ability to adopt work incentives for ablebodied individuals (similar to what is required in other welfare
programs) and the ability to broaden the application of targetedpremiums and cost sharing to higher-income enrollees.

﻿

2. Add targeted time limits or lifetime caps on benefits to disincentivize
permanent dependence.34lll

Allow private health insurance. Congress should allow states the optionof contributing to a private insurance benefit for all members of the family
in a flexible account that rewards healthy behaviors. This reform should also
allow catastrophic coverage combined with an account similar to a healthsavings account (HSA) for the direct purchase of health care and payment ofcost sharing for most of the population.
Increase flexible benefit redesign without waivers. CMS should
add flexibility to eliminate obsolete mandatory and optional benefit
requirements and, for able-bodied recipients, eliminate benefit mandates
that exceed those in the private market. This should include flexibility toredesign eligibility, financing, and service delivery of long-term care to serve
the most vulnerable and truly needy and eliminate middle-income to upperincome Medicaid recipients.
Eliminate current waiver and state plan processes. CMS should
allow providers to make payment reforms without cumbersome waivers
or state plan amendment processes where possible. More broadly, thefederal government’s role should be oversight on broad indicators like costeffectiveness and health measures like quality, health improvement, and— 468 —

Department of Health and Human Services

wellness and should give the balance of responsibility for Medicaid program
management to states. This reform would include adding Section 111535
waiver requirements in some cases (such as imposing work requirements
for able-bodied adults) while rescinding requirements in others (such as
non–health care benefits and services related to climate change).
AFFORDABLE CARE ACT AND PRIVATE HEALTH INSURANCElll

Revisit the No Surprises Act on surprise medical billing. The No
Surprises Act37 protected consumers against balance bills, but it alsoestablished a deeply flawed system for resolving payment disputes between
insurers and providers. This government-mandated dispute resolution
process has sown confusion among arbiters and regulators as judges havesought to ascertain its meaning. The No Surprises Act should scrap the
dispute resolution process in favor of a truth-in-advertising approachthat will protect consumers and free doctors, insurers, and arbiters from
confused and conflicting standards for resolving disputes that the disputing
parties can best resolve themselves.38
Facilitate the development of shared savings and reference pricing
plan options. Under traditional insurance, patients who choose lowercost care do not benefit financially from that choice. Barriers to rewarding
patients for cost-saving decisions should be removed. CMS should ensurethat shared savings and reference pricing models that reward consumers
are permitted.
Separate the subsidized ACA exchange market from the nonsubsidized insurance market. The Affordable Care Act has madeinsurance more expensive and less competitive, and the ACA subsidy
scheme simply masks these impacts. To make health insurance coverage
more affordable for those who are without government subsidies, CMS
should develop a plan to separate the non-subsidized insurance market— 469 —

﻿lRemove barriers to direct primary care. Direct primary care (DPC)
is an innovative health care delivery model in which doctors contract
directly with patients for their care on a subscription basis regardless of
how or where the care is provided. The DPC model is improving patient
access, driving higher quality and lower cost, and strengthening the doctor–
patient relationship. DPC has faced many challenges from government
policymakers, including overly exuberant attempts at regulation andmisclassification. Changes should clarify that DPC’s fixed fee for care does
not constitute insurance in the context of health savings accounts.36

Mandate for Leadership: The Conservative Promise

from the subsidized market, giving the non-subsidized market regulatory
relief from the costly ACA regulatory mandates.39﻿lStrengthen hospital price transparency. In 2020, CMS completed its
rule to require hospitals to post the prices of common hospital procedures.40
Future updates of these rules should focus on including quality measures.
Combined with the shared savings models and other consumer tools, these
efforts could deliver considerable savings for consumers.41

Center for Consumer Information and Insurance Oversight (CCIIO).
CMS also plays an outsized role in overseeing the Obamacare exchanges, including managing Healthcare.gov, through the Center for Consumer Information andInsurance Oversight (CCIIO). While Obamacare limits plan options, CCIIO has
been overly prescriptive in dictating what benefits and types of health plans may
participate in the exchanges, thereby actually stifling market innovation and driving up costs.
Congress should build on the Trump Administration’s efforts to expand choices
for small businesses and workers, both in and out of the exchanges, by codifying an
expansion of association health plans, short-term health plans, and health reimbursement arrangements (including individual coverage HRAs). CCIIO should also
work with the Treasury Department and the Office of Management and Budget(OMB) to give consumers more flexibility with their health care dollars throughexpanded access to health savings accounts.
EMERGENCY PREPAREDNESSllExpand the scope of practice of low-complexity and moderatecomplexity clinical laboratories. During the COVID-19 pandemic,
allowing laboratories greater regulatory flexibility regarding CLIA
requirements increased access to testing. However, the need for regulatory
flexibility is not limited to emergency situations. Ongoing innovations
in medical care will continue to drive demand for clinical testing andnew tests. One way that increasing demand for other medical services
has been accommodated is by revising restrictions on scope of practiceto enable providers to practice at the so-called top of their license. CMS
should similarly revise CLIA rules regarding scope of practice for clinicallaboratories and testing personnel.42

Create CLIA-certification-equivalent pathways for non-clinicallaboratories and researchers. The COVID-19 pandemic revealed that
the U.S. needs to leverage the expertise of non-clinical laboratories andresearchers in order to bolster clinical testing capacity. To accomplish this,— 470 —

Department of Health and Human Services

CMS should create pathways for granting non-clinical laboratories and their
testing personnel CLIA certification equivalency. Non-clinical researchers
already demonstrate their technical expertise through online training andcertification programs. CMS should build on that existing framework so thatthose laboratories and personnel can similarly demonstrate their clinicaltesting capabilities.43
LIFE, CONSCIENCE, AND BODILY INTEGRITYl

Two of the first actions of a pro-life Administration should be for HHS
to withdraw the Medicaid guidance (and any Section 1115 waivers issued
thereunder) and for DOJ OLC to withdraw and disavow its interpretation of
the Hyde Amendment.
lProhibit Planned Parenthood from receiving Medicaid funds. During
the 2020–2021 reporting period, Planned Parenthood performed more than383,000 abortions.46 The national organization reported more than $133
million in excess revenue47 and more than $2.1 billion in net assets.48 During
this same year, Planned Parenthood reports that its affiliates received morethan $633 million in government funding and more than $579 million in
private contributions.49 Planned Parenthood affiliates face accusations ofwaste, abuse and potential fraud with taxpayer dollars, failure to report
the sexual abuse of minor girls, and allegations of profiting from the sale oforgans from aborted babies.
Policymakers should end taxpayer funding of Planned Parenthood andall other abortion providers and redirect funding to health centers thatprovide real health care for women. The bulk of federal funding for Planned— 471 —

﻿

Prohibit abortion travel funding. Providing funding for abortions
increases the number of abortions and violates the conscience and religious
freedom rights of Americans who object to subsidizing the taking of life. The
Hyde Amendment44 has long prohibited the use of HHS funds for elective
abortions, but an August 2022 Biden executive order45 pressed the HHS
Secretary to use his authority under Section 1115 demonstrations to waive
certain provisions of the law in order to use taxpayer funds to achieve theAdministration’s goal of helping women to travel out of state to obtainabortions. Moreover, the Department of Justice Office of Legal Counsel(DOJ OLC) issued a politicized legal opinion declaring, for the first time in
the history of Hyde, that this action did not violate the Hyde Amendment
and that Hyde applies only to the performance of the abortion itself inviolation of the plainly broad language that Congress used.

Mandate for Leadership: The Conservative Promise

Parenthood comes through the Medicaid program. HHS should take two
actions to limit this funding:1.

Issue guidance reemphasizing that states are free to defund Planned
Parenthood in their state Medicaid plans.

2. Propose rulemaking to interpret the Medicaid statute to disqualify
providers of elective abortion from the Medicaid program.
Congress should pass the Protecting Life and Taxpayers Act,50 which
would accomplish the goal of defunding abortion providers such as
Planned Parenthood.

﻿

CMS should resolve pending Section 1115 waivers from Idaho, South Carolina,
and Tennessee, which, like Texas in January 2022, are seeking both to prohibit
abortion providers from participating in state-run Medicaid programs and towork with other states to do the same. Abortion is not health care, and statesshould be free to devise and implement programs that prioritize qualified
providers that are not entangled with the abortion industry.
lWithdraw Medicaid funds for states that require abortion insurance
or that discriminate in violation of the Weldon Amendment. The
Weldon Amendment51 declares that no HHS funding may go to a stateor local government that discriminates against pro-life health entities
or insurers. In blatant violation of this law, seven states require abortion
coverage in private health insurance plans, and HHS continues to fundthose states. HHS under President Trump disallowed $200 million in
Medicaid funding from California because of the state’s flouting of the law,
but the Biden Administration restored it.
HHS/CMS should withdraw appropriated funding, up to and including 10
percent of Medicaid funds, from states that require abortion insurance
coverage. DOJ should commit to litigating the defense of those funding
decisions promptly to the Supreme Court in order to maximize HHS’s
ability to withdraw funds from entities that violate the Weldon Amendment.
Additionally, California has announced that it will discriminate against
pharmacies that do not carry chemical abortion drugs outside of California.
California’s discrimination takes the form of cutting state contracts withsuch pharmacies and clearly violates the Weldon Amendment. The violation
should likewise face the penalties discussed above.

— 472 —

Department of Health and Human ServiceslRewrite the ACA abortion separate payment regulation. Section 1303
of Obamacare requires that insurers collect a separate payment for certain
abortion coverage in qualified health plans that are approved to be sold on
exchanges and that they keep those separate payments in separate accounts
that are used only to pay for elective abortion services. Neither the letter
nor the spirit of the law was enforced under President Obama, and a Trumpera regulation sought to correct this problem. The Biden HHS rescinded
this regulation to allow insurance companies once again—contrary to
the law—to collect combined payments for what are clearly required to
be separate payments for elective abortion coverage. “Separate” does notmean “together.”
HHS should reinstate a Trump Administration regulation and enforce what
the plain text of Section 1303 requires. That regulation should be further
improved by requiring CMS to ensure that consumers pay truly separate
charges for abortion coverage.

l

Reverse distorted pro-abortion “interpretations” added to theEmergency Medical Treatment and Active Labor Act. The Emergency
Medical Treatment and Active Labor Act (EMTALA)52 prohibits hospitals
that receive Medicare funds from “dumping” emergency patients who
cannot pay by sending them to other hospitals. It also mandates that
hospitals stabilize pregnant women and explicitly protects unborn children.
Hospitals or physicians found to be in violation of the statute could lose
all of their federal health funding—Medicare, Medicaid, CHIP, and otherfunds—and face civil penalties of up to nearly $120,000.
In July 2022, HHS/CMS released guidance mandating that EMTALAcovered hospitals and the physicians who work there must perform
abortions, to include completing chemical abortions even when the childmight still be alive. The guidance also declared that EMTALA would
protect physicians and hospitals that perform abortions in violation ofstate law if they deem those abortions necessary to stabilize the women’s
health. This novel interpretation of EMTALA is baseless. EMTALA requires— 473 —

﻿l

Audit Hyde Amendment compliance. HHS should undertake a full audit
to determine compliance or noncompliance with the Hyde amendment andsimilar funding restrictions in HHS programs. This audit should include afull review of the Biden Administration’s post-Dobbs executive actions topromote abortion. It should also encompass a review of Medicaid managed
care plans in pro-abortion states.

Mandate for Leadership: The Conservative Promiseno abortions, preempts no pro-life state laws, and explicitly requires
stabilization of the unborn child.
HHS should rescind the guidance and end CMS and state agency
investigations into cases of alleged refusals to perform abortions. DOJ
should agree to eliminate existing injunctions against pro-life states,
withdraw its enforcement lawsuits, and in lawsuits against CMS on theguidance agree to injunctions against CMS and withdraw appeals of
injunctions.
l﻿lReissue a stronger transgender national coverage determination.
CMS should repromulgate its 2016 decision that CMS could not issue a
National Coverage Determination (NCD) regarding “gender reassignment
surgery” for Medicare beneficiaries. In doing so, CMS should acknowledge
the growing body of evidence that such interventions are dangerous andacknowledge that there is insufficient scientific evidence to support suchcoverage in state plans.
Enforce EMTALA. The undeniable reality of abortion is that it does do
not always result in a dead baby, and these born-alive babies are left todie. HHS should use EMTALA and Section 504 of the Rehabilitation Act,53
which prohibits disability discrimination, to investigate instances of infants
born alive and left untreated in covered hospitals. CMS, OCR, and OIG
should be required to follow through on these investigations with specific
enforcement actions.
HHS should revive a Trump Administration proposed regulation,“Special Responsibilities of Medicare Hospitals in Emergency Cases andDiscrimination on the Basis of Disability in Critical Health and Human
Service Programs or Activities,”54 to achieve this end. In addition, Congressshould pass the Born-Alive Abortion Survivors Protection Act55 to requirethat proper medical care be given to infants who survive an abortionand to establish criminal consequences for practitioners who fail toprovide such care.

lPermanently codify both the Hyde family of amendments and theprotections provided by the Weldon Amendment. Congress canaccomplish this through legislation such as the No Taxpayer Funding for
Abortion and Abortion Insurance Full Disclosure Act56 (Hyde) and theConscience Protection Act57 (Weldon).

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Department of Health and Human Services

l

l

l

Announce nonenforcement of the Biden Administration’s COVID-19
vaccination mandate on Medicaid and Medicare hospitals.
Revoke corresponding guidance and regulations.
Refrain from imposing general COVID-19 mask mandates on health carefacilities or personnel.

— 475 —﻿

Radical Redefinition of Sex. On August 4, 2022, HHS published a proposed
rule entitled “Nondiscrimination in Health Programs and Activities.”58 This rule
addresses nondiscrimination provisions of the Affordable Care Act, known as
Section 1557, which is enforced by the Office for Civil Rights and the Centers for
Medicare and Medicaid Services. Section 1557 prohibits discrimination on the basisof race, color, national origin, age, disability, and sex in covered health programsor activities.
Under the proposed rule, sex is redefined: “Discrimination on the basis of sex
includes, but is not limited to, discrimination on the basis of sex stereotypes; sex
characteristics, including intersex traits; pregnancy or related conditions; sexual
orientation; and gender identity.”59 In other words, the department proposes tointerpret Section 1557 as if it created special privileges for new classes of people,
defined in ways that are highly ideological and unscientific.
The redefinition of sex to cover gender identity and sexual orientation andpregnancy to cover abortion should be reversed in all HHS and CMS programs as
was done under the Trump Administration. This includes the Children’s Health
Insurance Program (CHIP). Low-income families who rely on CHIP should not be
coerced, pressured, or otherwise encouraged to embrace this ideologically motivated sexualization of their children.
However, while the Biden Administration’s Section 1557 regulation should bealtered and corrected, the lactation room requirements added in the regulation
should either be consistently included in any upcoming Section 1557 rulemaking
or be proposed in a new individual rule.
COVID-19 Vaccination and Mask Requirements. Health care workers werepraised for their self-sacrifice in caring for sick patients at the beginning of the
COVID-19 pandemic, but then they were fired if they objected to receiving COVID19 vaccines with or without complying with onerous masking requirements andregardless of whether they already had the virus and had gained natural immunity.
With the disease being endemic and constantly mutating, vaccines and universal masking in health care facilities do not have appreciable benefits in reducing
COVID-19 transmission throughout the community. Moreover, more recent
COVID strains pose fewer health risks than the earlier strains, and the pandemic
has been declared to be at an end. CMS should:

Mandate for Leadership: The Conservative PromiselPay damages to all medical professionals who were dismissed directly
because of the CMS vaccine mandate.

﻿

ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF)

TANF. The Temporary Assistance for Needy Families (TANF) program is afederal block grant that gives states significant flexibility to fund a broad array ofprograms aimed at helping low-income families break the cycle of poverty andachieve economic self-sufficiency. States use TANF to fund monthly cash assistance payments to low-income families with children as well as a wide range ofservices that include work activities, work supports and supportive services, childcare, administration and systems, tax credits, pre-K/Head Start, child welfare, andother services.
The TANF program serves 1.8 million individuals. Since 1996, when the program
was reformed, federal TANF outlays have been $16.5 billion. The state match is$14.9 billion, bringing the total state and federal TANF investment to $31.4 billion.
The TANF statute requires that states engage 50 percent of single-parent families in work for at least 30 hours a week (20 hours a week for single parents withchildren under age six, though states have the option to waive the requirement
for families with children under the age of six, and most do). States also have 90
percent work requirements for two-parent families to engage in work for 35 hours
per week. Because of the “Caseload Reduction Credit,” states’ work engagementtargets are reduced if their assistance caseloads have fallen since 2005. As a result,
21 states had a work engagement target of zero percent in 2017.
Generally, states apply their work requirement only to beneficiaries receiving basic assistance, who account for 22.3 percent of TANF outlays. The Trump
Administration proposed a Supplemental Nutrition Assistance Program (SNAP)
rule to “increase program integrity and reduce fraud, waste, and abuse” that would
have prevented an individual from qualifying for SNAP simply because he or she
received a pamphlet from the TANF program.60 This rule defined non-cash benefits
as those that are worth at least $50 a month and received for at least six months.
The tenets of this rule should be applied to the TANF program as well. This definitional change would apply the TANF work requirements to any noncash benefit
worth $50 a month and received for six consecutive months.
To increase transparency, HHS should clarify how states, in their quarterly andannual reports, ought to track and audit the outcomes from how they spend TANF
funds to meet the TANF program’s four statutory purposes.
Additionally, TANF priorities are not implemented in an equally weighted
way. Marriage, healthy family formation, and delaying sex to prevent pregnancy
are virtually ignored in terms of priorities, yet these goals can reverse the cycleof poverty in meaningful ways. CMS should require explicit measurement ofthese goals.

— 476 —

Department of Health and Human Services— 477 —

﻿

Teen Pregnancy Prevention (TPP) and Personal Responsibility Education Program (PREP). TPP is operated by the Office of Population Affairs in the
Office of the Assistant Secretary for Health; PREP is operated by the ACF Officeof Planning, Research, and Evaluation. Both programs should ensure that there
is better reporting of subgrantees and referral lists so that they do not promoteabortion or high-risk sexual behavior among adolescents. CMS should ensure that
Sexual Risk Avoidance (SRA) proponents receive these grants and are given every
opportunity to prove their effectiveness. SRA programs, both at ACF and at OASH
and both discretionary and mandatory, should be equal in funding and emphasis.
Qualitative research should be conducted on both types of programs to ensure
continuous improvement.
In addition, certain provisions should be employed so that these programs do
not serve as advocacy tools to promote sex, promote prostitution, or provide afunnel effect for abortion facilities and school field trips to clinics, or for similar
purposes. Parent involvement and parent–child communication should be encouraged and be a part of any funded project. Risk avoidance should be prioritized, andany program that submits a proposal that promotes risk rather than health should
not be eligible for funding.
Site visits should be revamped to ensure adherence to these optimal health metrics, and a cost analysis of programming as compared to students served should bea metric in funding (taking into account that in certain cases, intensive programs
will serve fewer students and can have more positive results). These same parameters should apply to sex education programs at ACF. Any lists with “approved
curriculum” or so-called evidence-based lists should be abolished; HHS should
not create a monopoly of curriculum, adding to the profit of certain publishers.
Furthermore, lists created in the past have given priority to sex-promotion textbooks. HHS should create a list of criteria for evaluating the sort of curriculumthat should be selected for any sex education grant programs, both at OASH andat ACF, with the aim of promoting optimal health and adhering to the legislative
language of each program.
Adoption Reform. There are roughly 400,000 children across the nation on thewaiting list for foster care and 100,000 awaiting adoptive families, and the opioid/
fentanyl crisis is putting more at risk every day. Unfortunately, many of the faithbased adoption agencies that serve these children are under threat from lawsuits,
or else their licenses and contracts have been halted because they cannot in good
conscience place children in every household due to their religious belief that achild should have a married mother and father.
HHS, through ACF and the Assistant Secretary for Financial Resources (ASFR),
should repeal the unnecessary 2016 regulation61 that imposes nonstatutory sexual
orientation and gender identity nondiscrimination conditions on agency grants
and return to the policy of maximizing the options for placing vulnerable children﻿

Mandate for Leadership: The Conservative Promisein their forever homes. ACF and OCR should also survey their programs to consider
whether additional waivers of HHS grant conditions—waivers the Biden Administration revoked in 2021—are needed for faith-based agencies.
Additionally, Congress should pass the Child Welfare Provider Inclusion Act62 toensure that providers and organizations cannot be subjected to discrimination forproviding adoption and foster care services based on their beliefs about marriage.
Office of Refugee Resettlement (ORR). The Office of Refugee Resettlement
should be moved to the Department of Homeland Security. Having health andwelfare functions managed by HHS and border security functions managed by
DHS has created intolerable failures in both. HHS and ORR have forgotten their
original refugee-resettlement mission and instead have provided a panoply of freeprograms that incentivize people to come to the U.S. illegally. Even more troubling,
ORR has too often placed children into dangerous situations when releasing theminto the country.
Nearly all of HHS’s care, custody, and placement of children is done throughcooperative agreements with private agencies, many of which may have broken
federal law by inducing or being accomplices in illegal immigration. Thosearrangements could be handled far more effectively by DHS. Congress should
reform the Trafficking Victims Protection Reauthorization Act63 to transfer all
ORR duties for unaccompanied alien children to DHS and eliminate the Flores
settlement agreement.64
Regardless of where ORR’s functions reside, ORR staff and care providers should
never be allowed to facilitate abortions for unaccompanied children in its custody, including by transporting minors across state lines from pro-life states toabortion-friendly states. Pregnant, unaccompanied girls in ORR custody shouldbe treated with dignity, not trafficked across state lines to be victimized by theabortion industry. ORR should withdraw its policy of allowing elective abortions
for children in ORR care and issue a new policy of instructing care providers not
to allow girls to be transported for elective abortions. HHS OGC and the WhiteHouse should insist that DOJ fight to defend that policy up to the U.S. Supreme
Court in light of Dobbs.
Office of Child Support Enforcement (OCSE) Congress established Aid to
Families with Dependent Children in 1935 to assist single-parent families who
were suffering financially from the loss of a bread-winning husband and father.
Within two decades, however, the majority of families receiving aid were dependent because of paternal abandonment rather than death. Today, nearly a third ofAmerica’s children live without a father present in the home, and a fourth of them
are enrolled to receive child support.
The glaring issue in child support enforcement today is a non-resident father’sability to provide full or consistent child support payments. The literature reflects
this divide as fathers have been categorized as “deadbeat” dads, then as “deadbroke”— 478 —

Department of Health and Human Services— 479 —

﻿

dads, and now as “disconnected” dads who do not commit to the mother and child.
Child support in the United States should strengthen marriage as the norm, restore
broken homes, and encourage unmarried couples to commit to marriage.
Child Support Tax Credit. National or state guidelines and tax law should be
updated to ensure that nonresident parents with child support orders can receivea nondependent, child support tax credit. Single filers of up to $41,756 and marriedor joint filers of up to $47,646 would be eligible for a child support tax credit similar
to the current earned income tax credit. Filers could receive a maximum of $538
in annual returns for one child and a maximum of $3,584 in annual returns for two
or more children (based on a credit rate of 34 percent). A child support tax credit
would use the low-income, nonresident parents’ own earned income and historyof employment to assist them further in the task of caring for their children.
The key to this policy is that it empowers fathers with their own resources andmoney rather than creating another government assistance program (or a fully
refundable credit) devoid of the father’s own monetary efforts. This way, the nonresident father’s role as financial provider and relational figure is affirmed, andmuch-needed financial resources are given to the children.
Visitation. Visitation is key to revitalizing child support and increasing payment frequency. The most effective way to lower a nonresident parent’s monthly
child support order is to spend more court-accounted-for time with the child. For
example, Texas combined its child support court with its visitation court to ensurethat resident and nonresident parents received state-mandated financial support
orders and enforceable visitation orders.
Child Support Payment and Interactive Smartphone Application. Eachstate should be induced to implement a high-tech, easy-to-use application to centralize child support payments. As with Venmo or Cash App, nonresident parents
would link their bank accounts and provide one-click monthly payments (or contribute incrementally throughout the month while tracking how much is due).
Additionally, the nonresident parents could track “informal” gifts from money,
groceries, clothes, sports gear, and more through the app.
This would address one of the main issues within current child support payment systems: nonresident parents claim that they are spending much of theirown money to provide for children outside of their monthly payments and resident
parents’ claim that they spend little and neglect their official child support orders.
Currently, only the latter claim can be tracked reliably. This process would enable
nonresident parents to track the amount of informal support they provide and thereason for it while ensuring that the resident parent acknowledges and accepts
the contribution.
Healthy Marriage and Relationship Education (HMRE) Program. The
HMRE program is part of the ACF Office of Family Assistance. The following policies should be implemented.

Mandate for Leadership: The Conservative PromisellUtilize HMRE funding or grants to provide state-level high school
education resources and curriculum on healthy marriages, sexual
risk avoidance, and healthy relationships. Early interventions andprevention are much more cost-effective than are efforts to reach people
already in broken relationships.
Allow child welfare funding to be used for marriage and relationshipeducation. Congress should adopt the following recommendation from areport issued by members of Congress’s Joint Economic Committee:
Children are far more likely to experience abuse when they are raisedoutside of their married-parent family. Title II of the Child Abuse Prevention and Treatment Act provides grants to communities for the purposeof preventing child abuse and neglect, and one of the stated purposes
for which the grants can be used is for efforts to increase family stability.
However, Congress could change the law to make it clear that Title IIfunding can be used for healthy marriage and relationship education.

﻿Funding provided under Title IV-B of the Social Security Act—which
provides grants to states for foster care and adoption services—can also
be used for promoting healthy marriage. States should consider using
some of their Title IV-B funding for providing healthy marriage andrelationship education for families at risk of having their children placedin foster care.65llProvide educational information on healthy marriage andrelationships at Title X family planning clinics. HHS should requireclinics it funds under Title X (family planning) to provide information
to customers about the importance of marriage to family and personal
well-being and refer them to available federal, state, and nonprofit
marriage resources.
Ensure proper assessments with enough time to assess HMRE
programs. Although some widely available assessments of HMRE
programs report poor outcomes, many of these assessments either utilized apoor methodology or tried to measure program success prematurely. Recent
assessments have shown increasing effectiveness and positive communitylevel marital outcomes.66
The HMRE program should receive a fair and realistic assessment.
Additionally, the positive role of faith-based programs should be protected— 480 —

Department of Health and Human Services

and prioritized so that these programs do not receive undue scrutiny orpressure to conform to nonreligious definitions of marriage and family as
put forward by the recently enacted Respect for Marriage Act.67
lProtect faith-based grant recipients from religious liberty violations
that maintain a biblically based, social science–reinforced definitionof marriage and family. Social science reports that assess the objective
outcomes for children raised in homes aside from a heterosexual, intact
marriage are clear: All other family forms involve higher levels of instability(the average length of same-sex marriages is half that of heterosexual
marriages); financial stress or poverty; or poorer behavioral, psychological,
or educational outcomes.
For the sake of child well-being, programs should affirm that children
require and deserve both the love and nurturing of a mother and the playand protection of a father. Despite recent congressional bills like theRespect for Marriage Act that redefine marriage to be the union between
any two individuals, HMRE program grants should be available to faithbased recipients who affirm that marriage is between not just any two adults,
but one man and one unrelated woman.

﻿
Healthy Marriage and Responsible Fatherhood (HMRF) Program. This
program is located within the ACF Office of Family Assistance. Its goal, like thatof the HMRE program, is to provide marriage and parenting guidance for low-income fathers. This includes fatherhood and marriage training, curriculum, andsubsequent research.
llImplement a pro-fatherhood messaging campaign. With nearly 41
percent of children born without a married father in the home (and nearly
69 percent among black Americans), the fatherhood problem is clear.
Similar to Florida Governor Ron DeSantis’s 2022 fatherhood bill, HMRF
funds should be used to support national messaging campaigns that affirm
the role fathers play in the lives of their children, that recognize the financial
hardships the fathers themselves face, and that seek to provide relationshipeducation to fathers who were raised without a father in the home.
Fund effective HMRF state programs. Grant allocations should protect
and prioritize faith-based programs that incorporate local churches andmentorship programs or increase social capital through multilayered
community support (including, for example, job training and social
events). Programs should affirm and teach fathers based on a biological and— 481 —

Mandate for Leadership: The Conservative Promisesociological understanding of what it means to be a father—not a genderneutral parent—from social science, psychology, personal testimonies, etc.
ADMINISTRATION ON CHILDREN, YOUTH, AND FAMILIES (ACYF)
l

Allocate funding to strategy programs promoting father involvement
or terminate parental rights quickly. ACYF is currently considering
different programs to encourage parents, especially fathers, to engage with
their children in foster care. While these program ideas and initiatives arestill in the early planning stages, promoting responsible parenthood toreintegrate children or at least keep a consistent male figure in the minor’slife is crucial. At the same time, in cases where the father or mother does
not make a sincere or serious effort to be involved in the child’s upbringing,termination of parental rights for children in foster care should be swift.

OFFICE OF HEAD START (OHS)﻿lEliminate the Head Start program. Head Start, originally establishedand funded to support low-income families, is fraught with scandal andabuse. With a budget of more than $11 billion, the program should function
to protect and educate minors. Sadly, it has done exactly the opposite. In
fact, “approximately 1 in 4 grant recipients had incidents in which children
were abused, left unsupervised, or released to an unauthorized person
between October 2015 and May 2020.”68 Research has demonstrated thatfederal Head Start centers, which provide preschool care to children from
low-income families, have little or no long-term academic value for children.
Given its unaddressed crisis of rampant abuse and lack of positive outcomes,
this program should be eliminated along with the entire OHS. At the very
least, the program’s COVID-19 vaccine and mask requirements should
be rescinded.

ADMINISTRATION FOR COMMUNITY LIVING (ACL)lSupport palliative care. Physician-assisted suicide (PAS) is legal in 10
states and the District of Columbia. Legalizing PAS is a grave mistake that
endangers the weak and vulnerable, corrupts the practice of medicine
and the doctor–patient relationship, compromises the family andintergenerational commitments, and betrays human dignity and equality
before the law. Instead of embracing PAS, policymakers should focus on
the benefits of palliative care, which works to improve a patient’s qualityof life by alleviating pain and other distressing symptoms of a serious
illness. HHS ACL should survey their programs to ensure that they aresupporting vulnerable persons of age or disability and are not facilitating or
encouraging participation in PAS.

— 482 —

Department of Health and Human ServiceslReaddress the National Strategy to Support Family Caregivers. Whilein theory the strategy aims to support family members with duties to carefor older family members, the plan is overly focused on racial and “LGBTQ+
equity.” The strategy should be examined to establish an efficient plan tosupport caregivers and their families. There should also be a review of its
COVID-19 policies.

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)ll

Congress should allow CMS to use the 340B data that HRSA collects
rather than having CMS conduct its own survey, especially in viewof the U.S. Supreme Court’s American Hospital Association v. Becerra
decision.69 The legislation should also create penalties for those who do notrespond to HRSA’s data collection.
Legally define the locus of service as where the provider is locatedduring the telehealth visit rather than where the patient is. With sucha definition, states could continue to reserve their powers to establish thestandards for licensure and scope of practice. The providers could ensure
continuity and consistency of care no matter where their patients might
move while maintaining the licenses that make the most sense for them.

﻿Americans are far more mobile and technologically advanced today thanthey were when most health care laws were written. Telehealth has become
increasingly important, particularly during the height of the COVID-19
pandemic. It also has great potential in rural and other areas where there
are shortages of health care providers. HRSA’s Office for the Advancementof Telehealth includes a program known as the Licensure Portability Grant
Program, which bolsters state efforts to reform licensing laws to maximize
telehealth flexibility. HRSA does not have the authority through this office
to dictate licensure laws; that power has typically been reserved to thestates. However, telehealth across state lines, when permitted, is interstate
commerce, which can be regulated by the federal government according to
the Constitution.
l

Restore Trump religious and moral exemptions to the contraceptive
mandate (also a CMS rule). HHS should rescind, if finalized, theregulation titled “Coverage of Certain Preventive Services Under the
Affordable Care Act,” proposed jointly by HHS, Treasury, and Labor.70 This
rule proposes to amend Trump-era final rules regarding religious andmoral exemptions and accommodations for coverage of certain preventive
services under the ACA. Preventive services include contraception, and— 483 —

Mandate for Leadership: The Conservative Promise

it appears the proposed rule would change the existing regulations forreligious and moral exemptions to the ACA’s contraception mandate.
There is no need for further rulemaking that curtails existing exemptions
and accommodations.
lRequire HRSA to use rulemaking to update the women’s preventive
services mandate. The contraceptive mandate issued under Obamacare
has been the source of years of egregious attacks on many Americans’religious and moral beliefs. The mandate was issued as part of the women’s
preventive services guidelines, which were issued without any rulemaking
that involved public notice and an opportunity to comment. Instead, HRSA
issued and changed the mandate by simply posting changes to its website.
HRSA also started off not requiring coverage of fertility awareness–based
methods of family planning, then requiring them, and then removing therequirement without notifying the public. A federal judge recently ruledthat this failure to undergo notice and comment in issuing the mandate
is unlawful. HRSA should be required to repromulgate any women’s
preventive services mandates through the notice and comment process thatis compliant with the Administrative Procedures Act.

﻿

Moreover, since the Obama Administration HRSA entered into longterm contracts with the pro-abortion American College of Obstetricians
and Gynecologists (ACOG) and related entities to serve as an exclusive
adviser with respect to the content of this mandate, HRSA has used
this arrangement to ignore comments that members of the public weresometimes able to submit in the process, and ACOG has abused its
position to attack HHS’s allowance of religious and moral exemptions
to the contraceptive mandate. HHS should rescind these contracts andestablish an advisory committee that is compliant with the Federal Advisory
Committee Act and has members that are committed to women’s preventive
services and are not pro-abortion ideologues.
lExpand inclusion of fertility awareness–based methods and supplies
to family planning in the women’s preventive services mandate. The
ACA requires coverage of and prevents insurance plans from imposing
any cost-sharing requirements on women who obtain preventive care andscreenings as defined by HRSA. In 2016, HHS included “instruction in
fertility awareness-based methods” as part of this requirement. However,in December 2021, HHS removed that language from its list without
using the notice-and-comment process or giving any rationale, both ofwhich are mandated by the Administrative Procedures Act. In August— 484 —

Department of Health and Human Services

2022, a federal court blocked this attempt to eliminate health insurance
coverage for fertility awareness–based methods of family planning fromrequirements that cover at least 58 million women, and the judge made hisruling permanent in December 2022. HRSA should promulgate regulations
consistent with this order.
HHS should more thoroughly ensure that fertility awareness–based
methods of family planning are part of women’s preventive services underthe ACA. FABMs often involve costs for materials and supplies, and HHSshould make clear that coverage of those items is also required. FABMs
are highly effective and allow women to make family planning choices in amanner that meets their needs and reflects their values.
lEliminate men’s preventive services from the women’s preventive
services mandate. In December 2021, HRSA updated its women’s
preventive services guidelines to include male condoms after claiming foryears that it had no authority to do so because Congress explicitly limited
the mandate to “women’s” preventive care and screenings. HRSA should notincorporate exclusively male contraceptive methods into guidelines thatspecify they encompass only women’s services.

﻿

l

l

l

Eliminate the week-after-pill from the contraceptive mandate as apotential abortifacient. One of the emergency contraceptives covered
under the HRSA preventive services guidelines is Ella (ulipristal acetate).
Like its close cousin, the abortion pill mifepristone, Ella is a progesterone
blocker and can prevent a recently fertilized embryo from implanting in awoman’s uterus. HRSA should eliminate this potential abortifacient fromthe contraceptive mandate.
Withdraw Ryan White guidance allowing funds to pay for cross-sex
transition support. HRSA should withdraw all guidance encouraging
Ryan White HIV/AIDS Program service providers to provide controversial“gender transition” procedures or “gender-affirming care,” which cause
irreversible physical and mental harm to those who receive them.
Ensure that training for medical professionals (doctors, nurses, etc.)
and doulas is not being used for abortion training. HHS should ensurethat training programs for medical professionals—including doctors, nurses,
and doulas—are in full compliance with restrictions on abortion funding
and conscience-protection laws. In addition, HHS should:— 485 —

Mandate for Leadership: The Conservative Promise

1.

Investigate state medical school compliance with the Coats–Snowe
Amendment,71 which prohibits discrimination against health care
entities that do not provide or undergo training for abortion.

2. Ensure that the Accreditation Council for Graduate Medical Education(ACGME) complies with all relevant conscience statutes andregulations and that states have taken the affirmative steps (for example,
by issuing regulations) to assure compliance with Coats–Snowe.
3. Communicate to medical schools that any abortion-related training
must be on an opt-in rather than opt-out basis.
4. Require states that receive HHS funds to issue regulations or enter into
arrangements with accrediting bodies to comply with the Coats–Snowe
Amendment’s prohibition of mandatory abortion training by individuals
or institutions. The Coats–Snowe Amendment specifically requires
such state regulations or arrangements.

﻿

l

l

Prioritize funding for home-based childcare, not universal day care.
As HRSA’s Early Childhood Health page outlines, “Currently, only about
half of U.S. preschoolers are on-track with their development and readyfor school. And more than one in four of children (28%) who experience
abuse or neglect are under 3 years old.”72 Concurrently, children who spend
significant time in day care experience higher rates of anxiety, depression,and neglect as well as poor educational and developmental outcomes.
Instead of providing universal day care, funding should go to parents
either to offset the cost of staying home with a child or to pay for familial,
in-home childcare.
Provide education and resources on early childhood health. By
partnering with new organizations like the Center on Child and Family
Poverty, HRSA should provide resources and information on the importanceof the mother–child relationship in child well-being. This should include
relationship education curricula that equip mothers and caregivers toconnect with and improve their understanding of their infants, toddlers, andyoung children.

Maternal and Child Health. Currently, the HRSA Maternal and Child Healthprogram is collecting data on the benefits of doulas in improving the health, safety,
and emotional well-being of mothers at birth. Doulas provide a patient-focused,
nonmedical support system for single or married mothers that “decreases the— 486 —

Department of Health and Human Services

overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by
40%, and requests for an epidural by 60%. Doulas often use the power of touchand massage to reduce stress and anxiety during labor.”73
Given concerns about maternal mortality or postpartum depression that isworsened by poor birth experiences, doulas should be an active option for all
women whether they are giving birth in a traditional hospital, through midwifery,or at home. Additionally, since most Doulas’ services are not covered by traditional
insurance programs, the Maternal and Child Health program should work to provide funding for low-income mothers.
INDIAN HEALTH SERVICE (IHS)

RURAL HEALTH

A growing concern is the decreasing access to health care services for Americans
living in rural, less populated areas. Many find themselves in regions that were notpreviously as rural as industries move away, taking with them economic prosperity
and often medical providers. Others are in essential professions such as farmingthat by nature necessitate living in regions with fewer city accommodations andeconomic opportunities. Seeking space for one’s family and cultivating the land
are valued goals that are deeply rooted in America’s fabric.
Both Congress and an Administration must continually keep in mind how
health care policies uniquely affect these regions because their market trends
and populations are different from those of more populous regions. Often, ruralpatients face an hour’s drive to the nearest medical provider or facility or have

— 487 —

﻿The Indian Health Service serves our American Indian and Alaska Native populations. Reforms are needed to improve America’s ability to deliver on its promises
to these important populations and must take account of cultural preferences andlifestyles, limitations due to geography (such as challenging terrain), and limited
Internet access. For example, contacting individuals within some of these communities and tribes during the COVID-19 pandemic proved to be difficult because
many had transient addresses and unreliable cell service.
During the transition to the Biden Administration, IHS abandoned tribes as
their sources of COVID-19 tests and vaccine supplies disappeared. It is importantto guard against such situations in order to preserve these tribes’ access to healthresources during public health emergencies (PHEs). Even before the pandemic,
services available to these populations through federal resources and personnel(such as vision care) were often scarce or nonexistent.
Patients in these populations should be empowered to rely on alternatives to
IHS through better access to private health care providers. Exploring positivereforms contained in the VA MISSION Act74 could reveal similar opportunities
for increased options and access for American Indians and Alaska Natives.

Mandate for Leadership: The Conservative Promise

limited or no Internet access, which restricts their access to telehealth services(especially video visits).
To improve its health care policies that affect rural regions, HHS should:lllReduce the regulatory burden and unleash private innovation that candiscover solutions to unique, local needs.
Implement or encourage policies that increase the supply of health careproviders, such as increased telehealth access and interstate licensure(a historically state matter), including for volunteers wishing to provide
temporary, charitable services across state lines.
Encourage flexibility in modes of health care delivery, including lessexpensive alternatives to hospitals and telehealth independent of expensive
air ambulances.

﻿

OFFICE OF THE SECRETARYThe Secretary of Health and Human Services and the Office of the Secretarynecessarily set the tone for the entire department. The Secretary is the mostaccountable individual within HHS and, along with his or her immediate staff,
should therefore be responsible for setting the policies that govern the department’s operations instead of allowing the operational divisions to assume theleading role in policymaking, thereby diffusing responsibility.
Practical reforms to enhance the Secretary’s accountability should include
the following:lllRestrict HHS’s ability to declare indefinite public health emergencies(PHEs). Currently, HHS is merely required to notify Congress of such a
declaration within 48 hours. Congress should establish a set time frame
for any PHE, placing on the Secretary the burden of proof as to why anextension of the PHE is necessary.
Reinstate the HHS SUNSET (Securing Updated and Necessary
Statutory Evaluations Timely) rule.75 Congress should codify the nowreversed Trump Administration rule that required all HHS agencies toreview regulations retrospectively and publish results; without such a
review, regulations expire.
Investigate, expose, and remediate any instances in which HHS
violated people’s rights by:— 488 —

Department of Health and Human Services

1.

Colluding with Big Tech to censor dissenting opinions during COVID.

2. Colluding with abortion advocates and LGBT advocates to violate
conscience-protection laws and the Hyde Amendment.

OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH(OASH) / OFFICE OF THE SURGEON GENERAL (OSG)

The Assistant Secretary for Health (ASH) is the four-star admiral for the UnitedStates Public Health Service Commissioned Corps (USPHS), and the Surgeon General (SG) is the three-star admiral.
The ASH is tasked with overseeing not only the USPHS, but also 10 regional
health offices, multiple presidential and secretarial advisory committees, and otheroffices such as the Offices of Minority Health, Women’s Health, and Population
Affairs. The Secretary can further expand the ASH’s responsibilities (for example, by— 489 —

﻿

The Life Agenda. The Office of the Secretary should eliminate the HHS Reproductive Healthcare Access Task Force and install a pro-life task force to ensurethat all of the department’s divisions seek to use their authority to promote the lifeand health of women and their unborn children. Additionally, HHS should return
to being known as the Department of Life by explicitly rejecting the notion thatabortion is health care and by restoring its mission statement under the Strategic
Plan and elsewhere to include furthering the health and well-being of all Americans“from conception to natural death.”
The next Administration should create a dedicated Special Representativefor Domestic Women’s Health. In the Trump Administration, there was a Special
Representative for Global Women’s Health that focused on international issues,
but this position lacked authority to be the lead on international policies becauseof overlapping issues with the U.S. Department of State and USAID (and at timesa lack of clarity as to the lead point of contact and policy decisions at the WhiteHouse). The new Special Representative would serve as the lead on all matters offederal domestic policy development related to life and family with support fromthe DPC for implementation and coordination among agencies. In the post-Dobbs
era, advancing support for mothers will include coordination among agencies outside of HHS, and the Special Representative would provide a clear focal point for
all issues related to protecting life and serving families.
The Family Agenda. The Secretary’s antidiscrimination policy statements
should never conflate sex with gender identity or sexual orientation. Rather, theSecretary should proudly state that men and women are biological realities thatare crucial to the advancement of life sciences and medical care and that married
men and women are the ideal, natural family structure because all children havea right to be raised by the men and women who conceived them.

﻿

Mandate for Leadership: The Conservative Promise

designating the ASH as liaison to the CDC). The SG officially oversees the daily operations of the USPHS, although those are actually under the control of the Directorof the USPHS Commissioned Corps Headquarters. The SG also issues information
to the public (Surgeon General’s advisories, Calls to Action, and Reports), serving
in effect as a key public health spokesperson for the federal government.
USPHS officers are assigned to various agencies such as the CDC, NIH, andBureau of Prisons. Their organizational structure is similar in some respects to the
National Guard’s, and their salaries are paid primarily by the agencies to which they
are assigned (which serves to limit USPHS appropriations). USPHS officers can be
deployed on missions to respond to domestic or international crises (for example,
a hurricane in Florida or an Ebola outbreak in Africa) at any time.
The USPHS should be restructured to make it more like its sister uniformed
services with a more streamlined chain of command and corresponding appropriations to ensure efficiency and clarity of mission. Its core mission should be
refocused to emphasize prompt, responsive deployments that meet specific criteria
and are less dependent on the various agencies to which the officers are assigned.
Fulfillment of specific tasks should not be duplicated by non-uniformed civil servants and USPHS officers, and any roles that can be filled by civilians should be
filled by them.
The ASH and SG positions should be combined into one four-star position withthe rank, responsibilities, and authority of the ASH retained but with the title ofSurgeon General and some of the SG’s communications responsibilities, which
would include disseminating other HHS messages and sharing general medical
advice without legal weight. The holder of this consolidated position, which should
be filled by a health care provider, would be better positioned to ensure that the
USPHS is properly focused and deployed.
With such reforms, the supporting office (previously the OASH and OSG) would
be better equipped than other HHS offices or agencies to reduce silos and consolidate or eliminate duplicative functions. Congress should consider legislationthat would require this office to take such actions or at least make such recommendations to the Secretary. Such legislation would require a thorough analysisof the various legal authorities impacting the department’s current organizational structure.
The position previously known as the Principal Deputy Assistant Secretary for
Health should be combined with and have the title of Deputy Surgeon Generaland become a three-star position with operational control including financial anddeployment decisions. The Director of the Headquarters should be responsible for
implementing the decisions of the Deputy Surgeon General.
Promoting Life and Family. In dealing with sexually transmitted diseases andunwanted pregnancies, the OASH should focus on root-cause analysis with a focus
on strengthening marriage and sexual risk avoidance. Strong leadership is needed— 490 —

Department of Health and Human Services

ADMINISTRATION FOR STRATEGICPREPAREDNESS AND RESPONSE (ASPR)

ASPR vs. FEMA. When the President declares a national emergency (per theStafford Act) related to a public health emergency declared by the HHS Secretary,
FEMA is activated and controls instead of HHS/ASPR. While this arrangement
has some benefits because of FEMA’s unique logistical capabilities, the arrangement should be reviewed—especially considering the COVID-19 pandemic—for
improvements in efficiency according to expertise and available resources, reduced
confusion for ASPR and among HHS agencies, and avoidance of duplicated efforts
among agencies and personnel.

— 491 —

﻿in the Office of Science and Medicine to drive investigative review of literature for avariety of issues including the effect of abortion on prematurity and breast cancer;
lack of evidence for so-called gender-affirming care; and physical and emotional
damage following cross-sex treatments, especially on children. The OASH should
withdraw all recommendations of and support for cross-sex medical interventionsand “gender-affirming care.”Title X. The Title X family planning program should be reframed with a focus
on better education around fertility awareness and holistic family planning and a
Deputy Assistant Secretary for Population Affairs that understands the programand is able to work within its legislative framework (ideally, an MD). In addition,
the Office of Population Affairs should eliminate religious discrimination in grant
selections and guarantee the right of conscience and religious freedom of healthcare workers and participants in the Title X program.
In 2021, HHS reversed a Trump Administration regulation that required grantees to maintain strict physical and financial separation between Title X activity andabortion-related activity.76 Under the Biden Administration’s regulation,77 Title X
activity can be conducted alongside abortion activity without strict physical andfinancial separation. The regulation also requires grantees to refer for abortions
despite sincere moral or religious objections. This effectively bans otherwise qualified pro-life grantees from participating in the program.
HHS should rescind the Biden Administration’s regulation and reinstate the
Trump Administration regulation for the program. It should also do this quickly(the Biden Administration completed its regulatory process and issued a final rulein less than nine months) and expand the potential grantee population beyond
abortion providers like Planned Parenthood.
Congress should complement these efforts by passing legislation such as the
Title X Abortion Provider Prohibition Act,78 which would prohibit family planning
grants from going to entities that perform abortions or provide funding to otherentities that perform abortions. This would help to protect the integrity of the
Title X program even under an abortion-friendly Administration.

Mandate for Leadership: The Conservative Promise

Strategic National Stockpile. The President should invoke the Defense Production Act,79 which is a form of temporary takeover of private enterprises, onlyin the gravest circumstances. The Strategic National Stockpile (SNS) should bereformed to consider the potential supply chain disruptions of pandemics or global
conflicts. Also, during the COVID pandemic, many states received ventilators fromthe SNS and hoarded them in places where a rush of COVID patients needing ventilators never materialized. The SNS should clarify its mission as supplier of lastresort to the federal government, state governments, or first responders and key
medical staff and should not portray itself as serving the public as a whole.
OFFICE OF GENERAL COUNSEL (OGC)The Office of General Counsel is essential to ensuring that HHS is operating
within the bounds of its numerous governing statutes. However, legal caution canoutweigh practical necessity and often slows processes and decisions when time isof the essence. Such problems were evident both before and during the COVID-19
pandemic. Internal processes should be reformed to streamline necessary legal
determinations during crises, and general processes should be reviewed for efficiency. OGC should also:

﻿

l

l

l

l

l

Rescind its PREP Act liability memo. OGC issued a PREP Act liability
memo that suspended application of civil rights and other laws in thecontext of the administration of covered countermeasures during the
pandemic. It should be rescinded as contrary to law.
Rescind efforts to curtail OCR authority over conscience andreligious freedom. All OGC memos and Federal Register notices oforganization or delegations of authority moving any OCR conscienceand religious freedom enforcement to OGC, including RFRA, should
be rescinded, and independent authority over these matters should berestored to OCR.
Encourage DOJ to repeal OLC memos allowing abortion funding
despite Hyde and memos allowing federal enclave immunity toperform abortions despite the Assimilative Crimes Act.80
Rescind legal analysis that authorized HHS to impose a moratorium
on rental evictions during COVID.
Rescind the OGC legal analysis saying that the injunction in Bowen
v. American Hospital Association81 prevents any proposed HHS
regulations or enforcement actions concerning the denial of care
— 492 —

Department of Health and Human Services

to newborn infants with disabilities by covered health care entities
without or against parental consent.
llRescind the legal analysis supporting the Biden Administration’s
decision to dismiss the University of Vermont Medical Center
case dealing with the forced participation of a nurse in abortion in
violation of law.
Rescind the legal analysis restoring $200 million in Medicaid funds
to California after having been found to be in violation of the Weldon
Amendment by OCR.

OFFICE OF GLOBAL AFFAIRS (OGA)The Director of the Office of Global Affairs should have the title of Assistant
Secretary so that he or she can adequately represent HHS and the Secretary andserve as the lead on global health diplomacy for the government. The designation“Director” is not understood to indicate the leadership role that this position holds
in the international arena. In addition:
l

l

l

l

OGA should have a clear and consistent voice for the Administration’s
pro-life and pro-family priorities in all international engagements.
OGA should hold oversight authority for implementation of the
Mexico City policy throughout all divisions.
Every effort should be made to locate all OGA staff in the samebuilding for better oversight and communication.
Health attachés in various global locations should be trained in the
Administration’s policies with clear expectations communicatedand with accountability, including replacement, when theirconduct and advocacy are contrary to Administration policies andprogrammatic priorities.

OFFICE FOR CIVIL RIGHTS (OCR)

Conscience Enforcement. Existing statutes that protect rights of conscience(such as the Church, Coats–Snowe, and Weldon amendments) do not explicitly— 493 —﻿l

All divisions that work on international health efforts should be
responsive to requests and direction from the Assistant Secretarywith coordination for all health diplomacy emanating from OGA.

Mandate for Leadership: The Conservative Promise

provide a private right of action that would allow victims to seek legal redress incourt. At the same time, when it continues to fund governmental and private entities that violate these laws, HHS is spending taxpayer funds unlawfully. Under
liberal Administrations, OCR has amassed a poor record of devoting resources toconscience and religious freedom enforcement and is often complicit in approving
or looking the other way at the Administration’s own attacks on religious liberty.
Congress should pass the Conscience Protection Act so that victims can pursue
redress through courts without having to depend exclusively on OCR. In addition:l

OCR should return to Trump Administration policies that initiatedrobust enforcement of these conscience laws. It should restore and fully
fund the Office of the Deputy Director for the Conscience and Religious
Freedom Division (CRFD) and ensure that it has the necessary delegations
from the Secretary to enforce these laws. The Secretary should giveadequate delegations to OCR to pursue enforcement of conscience laws,
including RFRA, and require all HHS components that provide funding or
grants to cooperate with OCR CRFD investigations.

﻿

The Secretary, the Deputy Secretary, and principals in other HHS divisions
should endorse the remedial measures recommended by OCR CRFD andlimit territorial objections and slow-down attempts by other divisional
officials including OGC. HHS should withdraw funding from any violating
entities that refuse to correct their behavior, and OCR CRFD should workwith ASFR to ensure that all grant announcements and instruments inform
grantees and applicants of their obligations to comply with federal healthcare conscience laws specifically as a condition of obtaining or maintaining
their funding.
ll

A draft OCR RFRA and religious freedom rule from the Trump
Administration should be issued and finalized. These regulations would
provide a clear process for OCR’s enforcement in coordination with other
HHS divisions and existing HHS grants regulations.
HHS should reestablish waivers for state and child welfare agencies
for religious exemptions, especially for faith-based adoption andfoster care agencies. It should also rescind subjective case-by-case evaluations for religious and faith-based organizations that request religious
exemptions. These case-by-case determinations are currently coordinatedwith ACF and OCR. The recommended waivers should be granted to allstates and agencies that request them, and OCR memos finding that RFRA
would be violated if the waivers are not granted should be restored.

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Department of Health and Human Servicesll

HHS should restore OCR authority to review requests for andrender opinions on the application of RFRA to requests for religious
accommodation of people, families, and doctors who cannot in good
conscience take or administer vaccines, including those made ortested with aborted fetal cell lines.
HHS should restore Section 1557, Section 504, and other OCR
regulations and fix guidance documents. In 2020, the Trump
Administration’s OCR published regulations under Section 1557 of the
Affordable Care Act that restored the agency’s enforcement of that law
to the limits of its statutory text, deferred to the ACA’s widespread use ofa binary biological conception of sex discrimination, and specified thatthe regulation must comply with the religious exemption and abortion
neutrality clauses in Title IX from which it is derived as well as the Religious
Freedom Restoration Act and other laws. Courts blocked core provisions ofthat rule from going into effect.

l

OCR should return its enforcement of sex discrimination
to the statutory framework of Section 1557 and Title IX.
Specifically, it should:
1.

Remove all guidance issued under the Biden Administration
concerning sexual orientation and gender identity under Section 1557,
particularly the May 2021 announcement of enforcement82 and March2022 statement threatening states that protect minors from genital
mutilation.83

2. Issue a general statement of policy specifying that it will not enforce any
prohibition on sexual orientation and gender identity discrimination in
the Section 1557 regulation and that it will prioritize compliance with
the First Amendment, RFRA, and federal conscience laws in any case
implicating those claims. DOJ should commit to defending these actions
aggressively against inevitable court challenges, including under casessuch as Heckler v. Chaney.84— 495 —

﻿In 2022, the Biden Administration proposed to reinstate a rule
contradicting the scope of the statute and imposing nondiscrimination on
the basis of sexual orientation and gender identity. It is expected that thisrule will be finalized in 2023 even though several courts have issued rulings
against the interpretation on which it is based.

Mandate for Leadership: The Conservative Promise

3. Issue a proposed rule to restore the Trump regulations under Section
1557, explicitly interpreting the law not to include sexual orientationand gender identity discrimination based on the textual approach tomale and female biology taken by Congress in the ACA, the need torecognize biological distinctions as part of the sound practice of healthcare, and the need to ensure protections of medical judgment andconscience. DOJ should agree to defend this rule to the Supreme Court
if necessary.

﻿

4. Issue a general statement of policy announcing that it plans to enforce
Section 1557 discrimination bans by refocusing on serious cases ofrace, sex, and disability discrimination. In particular, OCR should
highlight its 2019 investigation and voluntary resolution agreementwith Michigan State University based on the sexual abuse of gymnasts
by Larry Nassar. OCR should also coordinate with the Department of
Education on a public education and civil rights enforcement campaign
to ensure that female college athletes who become pregnant are nolonger pressured to obtain abortions; pursue race discrimination claims
against entities that adopt or impose racially discriminatory policies
such as those based on critical race theory; and announce its intention
to enforce disability rights laws to protect children born prematurely,
children with disabilities, and children born alive after abortions.
5. Issue and finalize the Trump-era draft disability rights regulations
concerning crisis standards of care and use of Quality of Life
Adjusted Years (QALYs), and reissue and finalize a disability
regulation (withdrawn by the Biden Administration) that prohibited
discriminatory application of assisted suicide and denial of life-saving
treatments for disabled newborns.
l

OCR should withdraw its pharmacy abortion mandate guidance. OCR
should withdraw its “Obligations Under Federal Civil Rights Laws to Ensure
Access to Comprehensive Reproductive Health Care Services” guidance
for retail pharmacies,85 which purports to address nondiscrimination
obligations of pharmacies under federal civil rights laws and in fact orders
them to stock and dispense first-trimester abortion drugs. The guidance
invents this so-called requirement and fails to acknowledge that pharmacies
and pharmacists have the right not to participate in abortions, including
pill-induced abortions, if doing so would violate their sincere moral or
religious objections. Moreover, no federal civil rights laws preempt state
pro-life statutes.

— 496 —

Department of Health and Human Servicesl

OCR should withdraw its Health Insurance Portability andAccountability Act (HIPAA)86 guidance on abortion. OCR should
withdraw its June 2022 guidance87 that purports to address patient privacy
concerns following the Dobbs decision but is actually a politicized statementin favor of abortion and against Dobbs. HIPAA covers patients in the womb,
but this guidance treats them as nonpersons contrary to law. The guidanceis unnecessary and contributes to ideologically motivated fearmongering
about abortion after Dobbs.

﻿

AUTHOR’S NOTE: The preparation of this chapter was a collective enterprise of selfless individuals involvedin the 2025 Presidential Transition Project. All contributors to this chapter are listed at the front of this volume
and include former officials in the U.S. Department of Health and Human Services and other agencies, as well as
academics, attorneys, and experts in the health care and insurance fields.

— 497 —

Mandate for Leadership: The Conservative Promise
ENDNOTES﻿

1.

U.S. Department of Health and Human Services, Strategic Plan, FY 2018–2022, p. 50, https://aspe.hhs.gov/
sites/default/files/documents/feac346aca967bfadc446398679e14ec/hhs-strategic-plan-fy-2018-2022.pdf(accessed February 7, 2023).
2. “Strategic Goal 1: Protect and Strengthen Equitable Access to High Quality and Affordable Healthcare” in ibid.
“In the context of HHS, this Strategic Plan adopts the definition of underserved communities listed in Executive
Order 13985: Advancing Racial Equity and Support for Underserved Communities through the Federal
Government to refer to ‘populations sharing a particular characteristic, as well as geographic communities,
who have been systematically denied a full opportunity to participate in aspects of economic, social, and civic
life’; this definition includes individuals who belong to underserved communities that have been denied suchtreatment, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and PacificIslanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, andqueer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise
adversely affected by persistent poverty or inequality. Individuals may belong to more than one underserved
community and face intersecting barriers. This definition applies to the terms underserved communities andunderserved populations throughout this Strategic Plan.” Ibid. Emphasis in original.
3. Karen Weintraub, “Americans’ Life Expectancy Continues to Fall, Erasing Health Gains of the Last Quarter
Century,” USA Today, December 22, 2022, https://www.usatoday.com/story/news/health/2022/12/22/us-lifeexpectancy-continues-fall-erasing-25-years-health-gains/10937418002/ (accessed February 6, 2023).
4. Apoorva Mandavilli, “The C.D.C. Isn’t Publishing Large Portions of the Data It Collects,” The New York Times,
updated February 22, 2022, https://www.congress.gov/117/meeting/house/114450/documents/HHRG-117IF02-20220302-SD004.pdf (accessed March 22, 2023).
5. Zachary B. Sluzala and Edmund F. Haislmaier, “Lessons from COVID-19: How Policymakers Should Reform theRegulation of Clinical Testing,” Heritage Foundation Backgrounder No. 3696, March 28, 2022, https://www.
heritage.org/public-health/report/lessons-covid-19-how-policymakers-should-reform-the-regulation-clinical.
6. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, “Centers for
Disease Control and Prevention (C),” https://www.cdc.gov/maso/pdf/cdcmiss.pdf (March 16, 2023).
7. Judith Garber, “CDC ‘Disclaimers’ Hide Financial Conflicts of Interest,” Lown Institute Accountability Blog,
November 6, 2019, https://lowninstitute.org/cdc-disclaimers-hide-financial-conflicts-of-interest/ (accessed
February 6, 2023). See also U.S. Department of Health and Human Services, Centers for Disease Control
and Prevention, “CDC Foundation Active Programs (October 1, 2014–September 30, 2015),” https://www.
cdcfoundation.org/sites/default/files/upload/pdf/CDCFoundation-ActivePrograms-FY2015.pdf (accessed
February 7, 2023); “CDC Active Programs (October 1, 2015–September 30, 2016),” https://www.cdcfoundation.
org/sites/default/files/upload/pdf/CDCFoundation-ActivePrograms-FY2016.pdf (accessed February 7, 2023);“CDC Foundation Active Programs (October 1, 2016–September 30, 2017),” https://www.cdcfoundation.org/
sites/default/files/upload/pdf/CDCFoundation-ActivePrograms-FY2017.pdf (accessed February 7, 2023); “CDC
Foundation Active Programs (October 1, 2017–September 30, 2018),” https://www.cdcfoundation.org/sites/default/
files/upload/pdf/CDCFoundation-ActivePrograms-FY2018.pdf (accessed February 7, 2023); “CDC Foundation
Active Programs, October 1, 2018–September 30, 2019,” https://www.cdcfoundation.org/sites/default/files/upload/
pdf/CDCFoundation-ActivePrograms-FY2019.pdf (accessed February 7, 2023); “CDC Foundation Active Programs,
October 1, 2029–September 30, 2020,” https://www.cdcfoundation.org/CDCF-ActivePrograms-CDC-FY20?inline(accessed February 7, 2023); and “CDC Foundation Active Programs, October 1, 2020–September 30, 2021,”
https://www.cdcfoundation.org/CDCF-ActivePrograms-CDC-FY21?inline (accessed February 7, 2023).
8. Joel White and Doug Badger, “In Order to Defeat COVID-19, the Federal Government Must Modernize Its
Public Health Data,” Heritage Foundation Backgrounder No. 3527, September 3, 2020, https://www.heritage.
org/sites/default/files/2020-09/BG3527_0.pdf.
9. S. 15, Ensuring Accurate and Complete Abortion Data Reporting Act of 2023, 118th Congress, introduced
January 23, 2023, https://www.congress.gov/118/bills/s15/BILLS-118s15is.pdf (accessed March 22, 2023), and
H.R. 632, Ensuring Accurate and Complete Abortion Data Reporting Act of 2023, 118th Congress, introduced
January 30, 2023, https://www.congress.gov/118/bills/hr632/BILLS-118hr632ih.pdf (accessed March 22, 2023).
10. Doug Badger, “How Congress Can Make Real Progress on Drug Prices,” Heritage Foundation Issue Brief No.
5016, December 9, 2019, https://www.heritage.org/sites/default/files/2019-12/IB5016_1.pdf.

— 498 —

Department of Health and Human Services— 499 —

﻿

11. Sluzala and Haislmaier, “Lessons From COVID-19: How Policymakers Should Reform the Regulation ofClinical Testing.”
12. Ibid.
13. H.R. 5471, Clinical Laboratory Improvement Amendments of 1988, Public Law No. 100-578, 100th Congress,
October 31, 1988, https://uscode.house.gov/statutes/pl/100/578.pdf (accessed March 17, 2023).
14. Sluzala and Haislmaier, “Lessons From COVID-19: How Policymakers Should Reform the Regulation ofClinical Testing.”
15. Edmund F. Haislmaier, “Ensuring Americans’ Access to Pharmaceuticals: A Primer and Road Map for
Policymakers,” Heritage Foundation Backgrounder No. 3545, October 20, 2020, https://www.heritage.org/
sites/default/files/2020-10/BG3545.pdf.
16. 18 U.S.C. 1461, https://www.law.cornell.edu/uscode/text/18/1461 (accessed March 16, 2023), and 18 U.S.C. 1462,
https://www.law.cornell.edu/uscode/text/18/1462 (accessed March 16, 2023).
17. H.R. 1308, Religious Freedom Restoration Act of 1993, Public Law No. 103-141, 103rd Congress, November 16,
1993, https://www.congress.gov/103/statute/STATUTE-107/STATUTE-107-Pg1488.pdf (accessed March 18, 2023).
18. Charles Piller, “Is FDA’s Revolving Door Open Too Wide?” Science, Vol. 361, No. 6397 (July 6, 2018), p. 21,
https://www.science.org/doi/epdf/10.1126/science.361.6397.21 (accessed February 6, 2023).
19. Joel Achenbach, “NIH Halts $100 Million Study of Moderate Drinking That Is Funded by Alcohol Industry,” The
Washington Post, May 17, 2018, https://www.washingtonpost.com/news/to-your-health/wp/2018/05/17/nihhalts-controversial-study-of-moderate-drinking/ (accessed February 6, 2023).
20. Alexander Tin, “Moderna Offers NIH Co-ownership of COVID Vaccine Patent amid Dispute with Government,”
CBS News, November 15, 2021, https://www.cbsnews.com/news/moderna-covid-vaccine-patent-disputenational-institutes-health/ (accessed February 6, 2023).
21. Informed Consent Action Network, “NIH Officials Profiting from COVID-19 Vaccine,” June 3, 2021, https://www.
icandecide.org/nih-officials-profiting-from-covid-19-vaccine/ (accessed February 6, 2023).
22. Adam Andrzejewski, “Substack Investigation: Fauci’s Royalties and the $350 Million Royalty Payment
Stream HIDDEN by NIH,” Open the Books Substack, May 9, 2022, https://openthebooks.substack.
com/p/faucis-royalties-and-the-350-million?utm_source=/profile/24758236-adam-andrzejewski&utm_
medium=reader2&s=w (accessed February 6, 2023).
23. Robert E. Moffit, “Time to Reverse Hospital Market Consolidation,” Heritage Foundation Commentary, January 5,2022, https://www.heritage.org/health-care-reform/commentary/time-reverse-hospital-market-consolidation.
24. H.R. 3590, Patient Protection and Affordable Care Act, Public Law No. 111-148, 111th Congress, March 23, 2021,
https://www.congress.gov/111/plaws/publ148/PLAW-111publ148.pdf (accessed March 16, 2023).
25. Brian J. Miller, Robert E. Moffit, James Ficke, Joseph Marine, and Jesse Ehrenfeld, “Reversing Hospital
Consolidation: The Promise of Physician-Owned Hospitals,” Health Affairs Forefront, April 12, 2021, https://www.healthaffairs.org/do/10.1377/forefront.20210408.980640/ (accessed February 13, 2023).
26. Robert E. Moffit, “Medicare’s Future: Challenges and Opportunities,” testimony before the Special Committee
on Aging, U.S. Senate, November 21, 2022, https://www.heritage.org/testimony/medicares-future-challengesand-opportunities.
27. 42 U.S. Code § 256b, https://www.law.cornell.edu/uscode/text/42/256b (accessed March 16, 2023).
28. H.R. 3590, Patient Protection and Affordable Care Act, § 3022.
29. H.R. 5376, Inflation Reduction Act of 2022, Public Law No. 117-169, 117th Congress, August 16, 2022, https://www.congress.gov/117/plaws/publ169/PLAW-117publ169.pdf (accessed March 16, 2023).
30. Robert E. Moffit, “Reducing Patient Access to New Medications Is the Left’s Latest Medicare Price-Fixing
Scheme,” Heritage Foundation Commentary, July 22, 2022, https://www.heritage.org/medicare/commentary/
reducing-patient-access-new-medications-the-lefts-latest-medicare-price-fixing, and Badger, “How Congress
Can Make Real Progress on Drug Prices.”
31. Nina Owcharenko Schaefer, “Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to
Improve the Health Care Safety Net,” Heritage Foundation Backgrounder No. 3604, April 14, 2021, https://www.heritage.org/sites/default/files/2021-04/BG3604_0.pdf, and Brian C. Blase, “Punishing Conservative
States: Payment Cuts to Hospitals Where Federal Spending Is Already Low,” Paragon Health Institute,
December 2021, https://paragoninstitute.org/wp-content/uploads/2022/06/Punishing-Conservative-StatesHTML.html (accessed February 13, 2023).

﻿

Mandate for Leadership: The Conservative Promise
32. Owcharenko Schaefer, “Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to Improve
the Health Care Safety Net.”
33. Brian Blase, “Managed Care in Medicaid: Need for Oversight, Accountability, and Reform,” Paragon HealthInstitute Policy Brief, October 13, 2022, https://paragoninstitute.org/wp-content/uploads/2022/10/20221012Managed-Care-in-Medicaid-Need-for-Oversight-Accountability-and-Reform-FOR-DISTRIBUTION-V2.pdf(accessed February 13, 2023).
34. Owcharenko Schaefer, “Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to Improve
the Health Care Safety Net.”35. 42 U.S. Code § 1315, https://www.law.cornell.edu/uscode/text/42/1315 (accessed March 17, 2023).
36. Chad D. Savage and Lee S. Gross, “Direct Primary Care: Update and Road Map for Patient-Centered Reforms,”
Heritage Foundation Backgrounder No. 3635, June 28, 2021, https://www.heritage.org/sites/default/
files/2021-06/BG3635.pdf.
37. H.R. 133, Consolidated Appropriations Act, 2021, Public Law No. 116-260, 116th Congress, December 27,
2020, Division BB, Title I, https://www.congress.gov/116/plaws/publ260/PLAW-116publ260.pdf (accessed
March 17, 2023).
38. Doug Badger, “On Surprise Medical Bills, Congress Should Side with Consumers, Not Special Interests,”
Heritage Foundation Commentary, January 31, 2020, https://www.heritage.org/health-care-reform/
commentary/surprise-medical-bills-congress-should-side-consumers-not-special.
39. Edmund F. Haislmaier and Abigail Slagle, “Premiums, Choices, Deductibles, Care Access, and Government
Dependence Under the Affordable Care Act: 2021 State-by-State Review,” Heritage Foundation BackgrounderNo. 3668, November 2, 2021, https://www.heritage.org/sites/default/files/2021-11/BG3668.pdf.
40. U.S. Department of the Treasury, Internal Revenue Service; U.S. Department of Labor, Employee Benefits
Security Administration; and U.S. Department of Health and Human Services, “Transparency in Coverage,”
Final Rule, Federal Register, Vol. 85, No. 219 (November 12, 2020), pp. 72158–72310, https://www.govinfo.gov/
content/pkg/FR-2020-11-12/pdf/2020-24591.pdf (accessed March 17, 2023).
41. David N. Bernstein and Robert E. Moffit, “New Price Transparency Rule Will Help Transform America’s HealthCare System,” Heritage Foundation Commentary, November 1, 2020, https://www.heritage.org/health-carereform/commentary/new-price-transparency-rule-will-help-transform-americas-health-care.
42. Sluzala and Haislmaier, “Lessons from COVID-19: How Policymakers Should Reform the Regulation ofClinical Testing.”
43. Ibid.
44. Most recently enacted in H.R. 2471, Consolidated Appropriations Act, 2022, Public Law No. 117-103, 117th
Congress, March 15, 2022, Division H, Title V, §§ 506–507, https://www.congress.gov/117/plaws/publ103/
PLAW-117publ103.pdf (accessed March 17, 2023).
45. President Joseph R. Biden Jr., Executive Order 14079, “Securing Access to Reproductive and Other Healthcare
Services,” August 3, 2022, in Federal Register, Vol. 87, No. 154 (August 11, 2022), pp. 49505–49507, https://www.govinfo.gov/content/pkg/FR-2022-08-11/pdf/2022-17420.pdf (accessed March 16, 2023).
46. Planned Parenthood, 2020–2021 Annual Report, p. 27, https://www.plannedparenthood.org/uploads/
filer_public/40/8f/408fc2ad-c8c2-48da-ad87-be5cc257d370/211214-ppfa-annualreport-20-21-c3-digital.pdf(accessed March 22, 2023).
47. Ibid., pp. 30 and 31. Total revenue of $1,714.4 million (p. 30) minus $1,580.7 million in total expenses (p. 31)
yields $133,7 million.
48. Ibid., p. 28.
49. Ibid., p. 30.
50. H.R. 372, Protecting Life and Taxpayers Act of 2023, 118th Congress, introduced January 17, 2023, https://www.
congress.gov/118/bills/hr372/BILLS-118hr372ih.pdf (accessed March 17, 2023).
51. 42 U.S. Code § 18023, https://www.law.cornell.edu/uscode/text/42/18023 (accessed March 17, 2023).
52. H.R. 3128, Consolidated Omnibus Budget Reconciliation Act of 1985, Public Law No. 99-272, 99th Congress,
April 7, 1986, Title IX, Subtitle A, Part 1, Subpart B, § 9121, https://www.congress.gov/99/statute/STATUTE-100/
STATUTE-100-Pg82.pdf (accessed March 17, 2023).
53. H.R. 8070, Rehabilitation Act of 1973, Public Law No. 93-112, 93rd Congress, September 26, 1973, https://www.
congress.gov/93/statute/STATUTE-87/STATUTE-87-Pg355.pdf (accessed March 17, 2023).

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Department of Health and Human Services— 501 —

﻿

54. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Office of Civil
Rights, and Office of the Secretary, “Special Responsibilities of Medicare Hospitals in Emergency Cases andDiscrimination on the Basis of Disability in Critical Health and Human Service Programs or Activities,” draftof Proposed Rule, January 14, 2021, https://www.hhs.gov/sites/default/files/infants-nprm.pdf (accessed
March 17, 2023).
55. H.R. 26, Born-Alive Abortion Survivors Protection Act, 118th Congress, introduced January 9, 2023, https://www.congress.gov/118/bills/hr26/BILLS-118hr26pcs.pdf (accessed March 17, 2023).
56. H.R. 7, No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2023, 118th Congress,
introduced January 9, 2023, https://www.congress.gov/118/bills/hr7/BILLS-118hr7ih.pdf (accessed March 17, 2023).
57. S. 401, Conscience Protection Act of 2021, 117th Congress, introduced February 24, 2021, https://www.congress.
gov/117/bills/s401/BILLS-117s401is.pdf (accessed March 17, 2023).
58. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, and Office of theSecretary, “Nondiscrimination in Health Programs and Activities,” Notice of Proposed Rulemaking; Notice of
Tribal Consultation, Federal Register, Vol. 87, No. 149 (August 4, 2022), pp. 47824–47920, https://www.govinfo.
gov/content/pkg/FR-2022-08-04/pdf/2022-16217.pdf (accessed March 17, 2023).
59. Ibid., p. 47916.
60. The regulation was not finalized before the end of the Administration. U.S. Department of Agriculture,
Food and Nutrition Services, “Revision of Categorical Eligibility in the Supplemental Nutrition Assistance
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61. 45 Code of Federal Regulations § 75.300(c) and (d), https://www.ecfr.gov/current/title-45/subtitle-A/
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