If the US Department of Health and Human Services (HHS) were a

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DEPARTMENT OF HEALTH

AND HUMAN SERVICES

Roger Severino

f the U.S. Department of Health and Human Services (HHS) were a separate coun-

try, 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.”

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.

As a result of HHS’s having lost its way, U.S. life expectancy, instead of return-

ing to normal after the COVID-19 pandemic, continued to drop precipitously to

levels not seen since 1996 with white populations alone losing 7 percent of their

expected life span in just one year.

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.

OVERVIEW

HHS consists of 11 operating divisions that have varying degrees of practical

independence from the Secretary of Health and Human Services and 15 sta

divisions that are directly under the Oce of the Secretary. This chapter’s rec-

ommendations are limited to those divisions that most need reform and address,

wherever possible, ﬁve cross-cutting goals.

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Mandate for Leadership: The Conservative Promise

Goal #1: Protecting Life, Conscience, and Bodily Integrity. The Secretary

should pursue a robust agenda to protect the fundamental right to life, protect con-

science 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 gov-

ernments 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 the

letter 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” and

bases 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 as

well as the health and well-being of children and adults alike. The next Secretary

must 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 eco-

nomics 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 and

market-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’ abil

ity to discharge their responsibilities or limit their ability to innovate through

government pricing controls or irrational Medicare and Medicaid reimburse-

ment schemes.

Finally, America’s broken insurance system, run largely through confusing pro-

vider networks and third-party payers (employers), induces overconsumption of

health care, limits consumer shopping, and hides true costs from patients.

The federal government should focus reform on reducing burdens of regulatory

compliance, unleashing innovation in health care delivery, ceasing interference in

the 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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Department of Health and Human Services

Goal #3: Promoting Stable and Flourishing Married Families. Families

comprised of a married mother, father, and their children are the foundation of

a well-ordered nation and healthy society. Unfortunately, family policies and

programs under President Biden’s HHS are fraught with agenda items focusing

on “LGBTQ+ equity,” subsidizing single-motherhood, disincentivizing work, and

penalizing 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 their

children, 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 diculty 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 child

to 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 biolog-

ical parents who are found by a court to be unﬁt because of abuse or neglect, the

process of adoption should be speedy, certain, and supported generously by HHS.

Goal #4: Preparing for the Next Health Emergency. The COVID-19 pan-

demic demonstrated how catastrophic a micromanaging, misinformed, centralized,

and politicized federal government can be. Basic human rights, medical choice, and

the doctor–patient relationship were trampled without scientiﬁc justiﬁcation and

for extended periods of time. Excess deaths, not due to COVID-19, skyrocketed

because 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 funda-

mentally restructured to ensure a transparent, scientiﬁcally grounded, and more

nimble, ecient, transparent, and targeted response that respects the unique

needs 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 a

public health emergency—how many cases, hospitalizations, deaths, etc.—was

never 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 such

broad, unchecked power to issue health “guidelines” that will certainly be the basis

for federal and state mandates. Never again should public health bureaucrats be

allowed to hide information, ignore information, or mislead the public concerning

the ecacy 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 Over-

sight. The next Administration should guard against the regulatory capture of our

public health agencies by pharmaceutical companies, insurers, hospital conglomer-

ates, 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 pri-

vate biopharmaceutical funding. In this realm, “public–private partnerships” is a

euphemism 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 o period” on their contracts (15 years

would not be too long) that prevents them from working for companies they have

regulated. Similarly, pharmaceutical company executives should be restricted from

moving from industry into positions within regulatory agencies.

Finally, HHS should adopt metrics across the agency that can objectively deter-

mine the extent to which the agency’s policies and programs achieve desired health

and 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, from

its 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 of

interference 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 func-

tions. On the one hand, the CDC is now responsible for collecting, synthesizing,

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Department of Health and Human Services

and publishing epidemiological data from the individual states—a scientiﬁc

data-gathering function. This information is crucial for medical and public health

researchers 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 February

2022, for example, it was reported that “[t]wo full years into the pandemic, the

agency leading the country’s response to the public health emergency has pub-

lished only a tiny fraction of the data it has collected,” much of which “could [have

helped] state and local health ocials better target their eorts to bring the virus

under control.” A CDC spokesman said that one of the reasons was “fear that the

information might be misinterpreted.”

These distinct functions should be separated into two entirely separate agen-

cies 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 of

health 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 the

price of shutting down churches on the holiest day of the Christian calendar and

far 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 agen-

cy’s prioritizing its own development and production of tests using its internal

sta and facilities. The private sector is much better positioned to tackle the chal-

lenges 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 eorts of private test developers, academic laboratories, state

public health laboratories, and clinical testing providers. When responding to a

novel 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—and

throughout HHS more broadly.

Most problematically, the CDC presented itself as a kind of “super-doctor” for

the 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

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Mandate for Leadership: The Conservative Promise

control, environmental health, and health promotion and health education activi-

ties.”

It is not qualiﬁed to oer (and usually does not purport to oer) professional

medical opinions applicable to speciﬁc patients.

From time to time, the CDC oers ﬁndings and recommendations that compe-

tent 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 a

prescriptive character. For example, never again should CDC ocials be allowed to

say in their ocial 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 by

severe punishments, including criminal penalties. CDC should report on the risks

and eectiveness 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 money

from the pharmaceutical industry, but in 1992, the agency discovered a loophole in

federal law that allowed it to accept pharma contributions through the nonproﬁt

CDC Foundation. The money started ﬂowing immediately: From 2014 through

2018, the CDC Foundation received $79.6 million from pharmaceutical corpo-

rations like Pﬁzer, Biogen, and Merck.

This practice presents a stark conﬂict of

interest that should be banned.

Data Systems. The COVID-19 pandemic has revealed the disastrous public

health consequences of the CDC’s failure to follow multiple congressional

mandates to modernize its data infrastructure. Current reporting methods are

burdensome for frontline medical workers, yet they result only in fragmented data

that are not available in real time or usable across systems.

Congress should require HHS to prioritize the electronic collection and dis-

semination 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 crit-

ical information available to health care workers and policymakers in real time.

The CDC operates several programs related to vaccine safety including the Vac-

cine Adverse Event Reporting System (VAERS); Vaccine Safety Datalink (VSD);

and Clinical Immunization Safety Assessment (CISA) Project. Those functions and

their associated funding should be transferred to the FDA, which is responsible for

post-market surveillance and evaluation of all other drugs and biological products.

Respect for Life and Conscience. The CDC should eliminate programs and

projects that do not respect human life and conscience rights and that undermine

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Department of Health and Human Services

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 that

it corrects and does not promote misinformation regarding the comparative health

and 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 vac-

cine 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 their

consciences or faith on this question, which could have been avoided with a

modicum of concern for this issue from CDC. There is never any justiﬁcation for

ending 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 of

law and policy.

CDC should update its public messaging about the unsurpassed eectiveness of

modern 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 evi-

dence-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 by

states 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, HHS

should use every available tool, including the cutting of funds, to ensure that every

state reports exactly how many abortions take place within its borders, at what

gestational age of the child, for what reason, the mother’s state of residence, and

by what method. 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’s

life. Miscarriage management or standard ectopic pregnancy treatments should

never be conﬂated with abortion.

Comparisons between live births and abortion should be tracked across vari-

ous demographic indicators to assess whether certain populations are targeted by

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Mandate for Leadership: The Conservative Promise

abortion 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 2023

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 a

condition 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 ecacy of drugs, biological

products, 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 as

soon as a generic product comes on the market. The vast majority are very aord-

able with 93 percent of generic products costing $20 or less.

Savings would be even higher under proposals that prevent brand-name man-

ufacturers 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 generic

versions of their drugs. Additionally, Congress should create legal remedies for

generic companies to obtain samples of brand-name products for their generic

development eorts and should prohibit meritless “citizen petitions” submitted

by manufacturers to delay approval of a generic competitor.

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, especially

with 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 the

intention of being used solely within one laboratory. A test developed by a lab in

accordance 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 dierent from the initial developing lab. To encourage interlab-

oratory collaboration and discourage duplicative test creation (and associated

regulatory and logistical burdens), the FDA should introduce mechanisms through

which laboratory-developed tests can easily be shared with other laboratories with-

out the current regulatory burdens.

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Department of Health and Human Services

The “laboratory-developed tests” category currently encompasses a range of

possible tests, many of which would be characterized more appropriately as “lab-

oratory-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 access

to such modiﬁed tests.

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 regulated

by the Centers for Medicare and Medicaid Services (CMS). The FDA currently

has regulatory authority over in vitro diagnostics, and under the Clinical Lab-

oratory Improvement Amendments (CLIA),

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.

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 inspec-

tions 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 that

cross-references product codes and facility codes. That would enable wholesalers

and pharmacy beneﬁt managers to identify and preference drugs manufactured at

more 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.

Additionally, FDA and NIH should promote

ecacy trials of new applications for generic drugs, which might include NIH fund-

ing such trials or conducting its own.

Abortion Pills. Abortion pills pose the single greatest threat to unborn chil-

dren in a post-Roe world. The rate of chemical abortion in the U.S. has increased

by more than 150 percent in the past decade; more than half of annual abortions

in the U.S. are chemical rather than surgical.

The abortion pill regimen is typically a two-part process. The ﬁrst pill, mifepris-

tone, causes the death of the unborn child by cutting o the hormone progesterone,

which is required to sustain a pregnancy. The second pill, misoprostol, causes con-

tractions 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

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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 the

risks of chemical abortion, including hemorrhaging, and what to do in such cir-

cumstances. Chemical abortion has been found to have a complication rate four

times 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:

Reverse its approval of chemical abortion drugs because the

politicized approval process was illegal from the start. The FDA

failed to abide by its legal obligations to protect the health, safety, and

welfare of girls and women. It never studied the safety of the drugs

under the labeled conditions of use, ignored the potential impacts of the

hormone-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 ever

acknowledged or addressed federal laws that prohibit the distribution of

abortion drugs by postal mail; to the contrary, the FDA has permitted and

actively 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 to

revisit and withdraw its initial approval, which was premised on pregnancy

being an “illness” and abortion being “therapeutically” eective at treating

this “illness.” The FDA is statutorily charged with guaranteeing the

safety and ecacy of drugs and therefore should withdraw this drug that

is proven to be dangerous to women and by deﬁnition fatally unsafe for

unborn children.

As an interim step, the FDA should immediately restore the REMS by removing

the in-person dispensing requirement to eliminate dangerous tele-abortion and

abortion-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 from

abortion. The FDA should therefore:

Reinstate earlier safety protocols for Mifeprex that were mostly

eliminated in 2016 and apply these protocols to any generic version

of mifepristone. A bare-minimum policy of limiting abortion pills to the

pre-2016 policy of 49 days gestation, returning to the pre-2021 in-person

dispensing requirement, and returning to requiring prescribers to report all

serious adverse events, not just deaths, to the drug sponsor would increase

women’s health and safety.

Address weaknesses in the current FAERS (FDA Adverse Events

Reporting System). The Administration and policymakers should ensure

that 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 pill

prescriber, 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 database

should be a quick and ecient process for busy health care practitioners.

Currently, providers report that the process is dicult 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.

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 all

linked to abortion in this way. There are ethically derived alternatives abroad that

have been used safely there for decades, but the FDA makes it exceedingly dicult

for Americans to import them.

In January 2021, the HHS Oce for Civil Rights (OCR) and the FDA jointly

announced that HHS was required by the Religious Freedom Restoration Act

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Mandate for Leadership: The Conservative Promise

(RFRA)

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 seek-

ing ethically derived alternatives.

To avoid future moral coercion of the sort experienced with the COVID-19 vac-

cines, the FDA and NIH should require the development of drugs and biologics that

are 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-thirds

of FDA reviewers later ended up at the same companies whose products they had

been reviewing while they were working for the government.

This revolving door

is one mechanism by which pharmaceutical companies capture the agencies that

regulate them. The FDA should impose a lengthy cooling o 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 the

United 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 dierent components called Institutes and

Centers. Despite its popular image as a benign science agency, NIH was respon-

sible 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-arming, 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-de-

rived fetal tissue research that fails ethics advisory board review, and in 2019, the

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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:

Promptly restore the ethics advisory committee to oversee abortion-

derived fetal tissue research, and Congress should prohibit such

research 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 embryo-

destructive related research, cell lines, and other testing methods

become both fully obsolete and ethically unthinkable.

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 and

health policy. Because the male–female dyad is essential to human nature and

because every child has a right to a mother and father, three-parent embryo cre-

ation and human cloning research should be banned. A new NCB should convene

leading experts to examine these issues and provide policy recommendations for

the new frontier of bioethical questions that our country will have to address in

the coming years.

Finally, HHS should create and promote a research agenda that supports pro-

life 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.

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.

Rather than pro-

viding grants to university-based investigators to run the clinical trials on their own

Moderna vaccine, the NIH conducted this research internally—a clear conﬂict of

interest. The NIAID will earn millions from this vaccine’s revenue with several

NIH employees (and their heirs) personally receiving up to $150,000 annually

from Moderna vaccine sales.

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Mandate for Leadership: The Conservative Promise

In May 2022, documents obtained pursuant to a FOIA request revealed that

NIH Director Francis Collins, NAIAD Director Anthony Fauci, and Fauci’s Deputy

Director, Cliord Lane, all received royalties from pharmaceutical companies

between 2009 and 2014.

Nonproﬁt watchdog Open the Books estimates that from

2010 to 2020, third parties paid more than $350 million in royalties to NIH and

its 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 ecacy have come mostly from

outside 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 power

for 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 scientiﬁc

research. 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 state

level does not preclude more modest federal funding through the National Insti-

tutes of Health: The two models are not mutually exclusive.

The CDC and NIH Foundations, whose boards are populated with pharma-

ceutical company executives, need to be decommissioned. Private donations to

these 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 #MeToo

movement that it refused to sponsor scientiﬁc conferences unless there were a cer-

tain number of women panelists, which violates federal civil rights law against sex

discrimination. This quota practice should be ended, and the NIH Oce 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, it

should fund studies into the short-term and long-term negative eects of cross-

sex interventions, including “armation,” puberty blockers, cross-sex hormones

and surgeries, and the likelihood of desistence if young people are given counseling

that 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 empow-

ered to make decisions for themselves and have quality options with aordable

prices driven by competition and innovation. Providers who participate should

retain (or have restored) the freedom to practice medicine and take care of their

patients according to their patients’ unique needs.

Medicare. Medicare should be reformed according to four goals and principles:

Increase Medicare beneﬁciaries’ control of their health care.

Patients are best positioned to determine the value of health care

services, working with their health care providers. They also beneﬁt from

increased choice of doctors, hospitals, and insurance plans. Access to

reliable information with respect to physicians, hospitals, and insurers is

therefore essential.

Reduce regulatory burdens on doctors. Doctors must be free to focus on

treating patients ﬁrst, not entering codes on computers, and should not be

tempted to change their medical judgment based on arbitrary or illogical

reimbursement incentives.

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 of

services. 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 care

within 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 and

care. The next Administration should reintroduce and restore regulations and

demonstrations from the Trump Administration that were withdrawn, weakened,

or never ﬁnalized by the Biden Administration, including:

The Medicare Coverage of Innovative Technologies (MCIT) rule;

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Mandate for Leadership: The Conservative Promise

The Risk Adjustment Data Validation (RADV) rule;

The Medicare Advantage Qualifying Payment Arrangement Incentive

(MAQI) demonstration; and

The 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 inpa-

tient-only list and expanding the ambulatory surgical center covered procedures

list. Medicare generally pays more for inpatient hospital procedures and less for

the same procedures performed in an outpatient setting. Whether a medical ser-

vice is delivered in a physician’s oce, a clinic, or a hospital setting, the Medicare

payment for that service should be the same. CMS should expand the application

of site-neutral payment options to more settings. Such a policy would level the

playing ﬁeld among providers and remove the ﬁnancial disabilities for medical

professionals who would compete with hospital systems.

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 PROPOSALS

Remove restrictions on physician-owned hospitals. The Aordable

Care Act (ACA)

imposed restrictions prohibiting Medicare from

reimbursing physician-owned and specialty hospitals. The current

restrictions do little more than serve the special interests of large hospital

systems and undercut consumer choice of high-quality, specialty care.

These restrictions should be removed so that physician-owned hospitals can

compete with other hospitals in serving Medicare patients.

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 for

the future. Speciﬁcally:

— 465 —

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.

Legacy Medicare Reform. Legislation reforming legacy (non-MA)

Medicare should:

Base payments on the health status of the patient or intensity of the

service rather than where the patient happens to receive that service.

Replace the bureaucrat-driven fee-for-service system with value-

based payments to empower patients to ﬁnd the care that best serves

their needs.

Codify price transparency regulations.

Restructure 340B drug subsidies

toward beneﬁciaries rather

than hospitals.

Repeal harmful health policies enacted under the Obama and Biden

Administrations such as the Medicare Shared Savings Program

and

Inﬂation Reduction Act.

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 that

will have meaningful impact for seniors should be pursued. Other reforms should

include eliminating the coverage gap in Part D, reducing the government share in

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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 eects of the law’s

policies and avoiding even worse unintended consequences.

Medicaid. Over the past 45 years, Medicaid and the health safety net have

evolved into a cumbersome, complicated, and unaordable 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 from

performing 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 for

recipients. Recipients are often faced with a “welfare cli” of beneﬁt losses as they

earn 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 maintenance

of eort (MOE) requirements and the Aordable 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 also

essential to genuine, eective reform of our health care system. All components

of the health care system should be part of the reform eorts, and it is imperative

that the system be modiﬁed to assist states with their current programs. Therefore,

the next Administration should:

Reform ﬁnancing. Allow states to have a more ﬂexible, accountable,

predictable, transparent, and ecient 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 and

the ecient delivery of health care services. Federal and state ﬁnancial

participation in the Medicaid program should be rational, predictable, and

reasonable. It should also incentivize states to save money and improve the

quality of health care.

— 467 —

Department of Health and Human Services

Direct dollars to beneﬁciaries more eectively 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 more

rational 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).

Strengthen program integrity. Make program integrity a top priority and

the responsibility of the states. To protect the taxpayers’ investment:

1. Incentivize states. An enhanced contingency fee should be paid to

states that successfully increase their eorts to decrease waste, fraud,

and abuse. The current system’s IT development 90/10 matching rate

should be allowed for improvements in states’ current fraud and abuse

and eligibility systems. Innovative programs that show a positive return

on investment for both the state and federal governments should be

allowed without the onerous waiver process.

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 this

end, CMS should:

a. Hold states accountable for improper eligibility determinations.

b. Require more robust eligibility determinations.

c. Strengthen asset test determinations within Medicaid.

3. Conduct oversight and reform of managed care.

Incentivize personal responsibility. CMS should allow states to ensure

that Medicaid recipients have a stake in their personal health care and a

say in decisions related to the Medicaid program. Personal responsibility

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Mandate for Leadership: The Conservative Promise

and 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 the

freedom to choose their health plans and the responsibility to contribute to

their health care costs at a level that is appropriate to protect the taxpayer.

Add work requirements and match Medicaid beneﬁts to beneﬁciary

needs. Because Medicaid serves a broad and diverse group of individuals, it

should be ﬂexible enough to accommodate dierent designs for dierent

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 able-

bodied individuals (similar to what is required in other welfare

programs) and the ability to broaden the application of targeted

premiums and cost sharing to higher-income enrollees.

2. Add targeted time limits or lifetime caps on beneﬁts to disincentivize

permanent dependence.

Allow private health insurance. Congress should allow states the option

of 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 health

savings account (HSA) for the direct purchase of health care and payment of

cost 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 to

redesign eligibility, ﬁnancing, and service delivery of long-term care to serve

the most vulnerable and truly needy and eliminate middle-income to upper-

income 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, the

federal government’s role should be oversight on broad indicators like cost

eectiveness and health measures like quality, health improvement, and

— 469 —

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 1115

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 INSURANCE

Remove 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 and

misclassiﬁcation. Changes should clarify that DPC’s ﬁxed fee for care does

not constitute insurance in the context of health savings accounts.

Revisit the No Surprises Act on surprise medical billing. The No

Surprises Act

protected consumers against balance bills, but it also

established 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 have

sought to ascertain its meaning. The No Surprises Act should scrap the

dispute resolution process in favor of a truth-in-advertising approach

that 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.

Facilitate the development of shared savings and reference pricing

plan options. Under traditional insurance, patients who choose lower-

cost care do not beneﬁt ﬁnancially from that choice. Barriers to rewarding

patients for cost-saving decisions should be removed. CMS should ensure

that shared savings and reference pricing models that reward consumers

are permitted.

Separate the subsidized ACA exchange market from the non-

subsidized insurance market. The Aordable Care Act has made

insurance more expensive and less competitive, and the ACA subsidy

scheme simply masks these impacts.

To make health insurance coverage

more aordable for those who are without government subsidies, CMS

should develop a plan to separate the non-subsidized insurance market

— 470 —

Mandate for Leadership: The Conservative Promise

from the subsidized market, giving the non-subsidized market regulatory

relief from the costly ACA regulatory mandates.

Strengthen hospital price transparency. In 2020, CMS completed its

rule to require hospitals to post the prices of common hospital procedures.

Future updates of these rules should focus on including quality measures.

Combined with the shared savings models and other consumer tools, these

eorts could deliver considerable savings for consumers.

Center for Consumer Information and Insurance Oversight (CCHO).

CMS also plays an outsized role in overseeing the Obamacare exchanges, includ-

ing managing Healthcare.gov, through the Center for Consumer Information and

Insurance 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 driv-

ing up costs.

Congress should build on the Trump Administration’s eorts 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 reim-

bursement arrangements (including individual coverage HRAs). CCIIO should also

work with the Treasury Department and the Oce of Management and Budget

(OMB) to give consumers more ﬂexibility with their health care dollars through

expanded access to health savings accounts.

EMERGENCY PREPAREDNESS

Expand the scope of practice of low-complexity and moderate-

complexity 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 and

new tests. One way that increasing demand for other medical services

has been accommodated is by revising restrictions on scope of practice

to enable providers to practice at the so-called top of their license. CMS

should similarly revise CLIA rules regarding scope of practice for clinical

laboratories and testing personnel.

Create CLIA-certiﬁcation-equivalent pathways for non-clinical

laboratories and researchers. The COVID-19 pandemic revealed that

the U.S. needs to leverage the expertise of non-clinical laboratories and

researchers in order to bolster clinical testing capacity. To accomplish this,

— 471 —

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 and

certiﬁcation programs. CMS should build on that existing framework so that

those laboratories and personnel can similarly demonstrate their clinical

testing capabilities.

LIFE, CONSCIENCE, AND BODILY INTEGRITY

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 Amendment

has long prohibited the use of HHS funds for elective

abortions, but an August 2022 Biden executive order

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 the

Administration’s goal of helping women to travel out of state to obtain

abortions. Moreover, the Department of Justice Oce 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 in

violation of the plainly broad language that Congress used.

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.

Prohibit Planned Parenthood from receiving Medicaid funds. During

the 2020–2021 reporting period, Planned Parenthood performed more than

383,000 abortions.

The national organization reported more than $133

million in excess revenue

and more than $2.1 billion in net assets.

During

this same year, Planned Parenthood reports that its aliates received more

than $633 million in government funding and more than $579 million in

private contributions.

Planned Parenthood aliates face accusations of

waste, abuse and potential fraud with taxpayer dollars, failure to report

the sexual abuse of minor girls, and allegations of proﬁting from the sale of

organs from aborted babies.

Policymakers should end taxpayer funding of Planned Parenthood and

all other abortion providers and redirect funding to health centers that

provide real health care for women. The bulk of federal funding for Planned

— 472 —

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,

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 to

work with other states to do the same. Abortion is not health care, and states

should be free to devise and implement programs that prioritize qualiﬁed

providers that are not entangled with the abortion industry.

Withdraw Medicaid funds for states that require abortion insurance

or that discriminate in violation of the Weldon Amendment. The

Weldon Amendment

declares that no HHS funding may go to a state

or 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 fund

those 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 with

such pharmacies and clearly violates the Weldon Amendment. The violation

should likewise face the penalties discussed above.

— 473 —

Department of Health and Human Services

Rewrite 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 Trump-

era 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 not

mean “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.

Audit Hyde Amendment compliance. HHS should undertake a full audit

to determine compliance or noncompliance with the Hyde amendment and

similar funding restrictions in HHS programs. This audit should include a

full review of the Biden Administration’s post-Dobbs executive actions to

promote abortion. It should also encompass a review of Medicaid managed

care plans in pro-abortion states.

Reverse distorted pro-abortion “interpretations” added to the

Emergency Medical Treatment and Active Labor Act. The Emergency

Medical Treatment and Active Labor Act (EMTALA)

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 other

funds—and face civil penalties of up to nearly $120,000.

In July 2022, HHS/CMS released guidance mandating that EMTALA-

covered hospitals and the physicians who work there must perform

abortions, to include completing chemical abortions even when the child

might still be alive. The guidance also declared that EMTALA would

protect physicians and hospitals that perform abortions in violation of

state law if they deem those abortions necessary to stabilize the women’s

health. This novel interpretation of EMTALA is baseless. EMTALA requires

— 474 —

Mandate for Leadership: The Conservative Promise

no 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 the

guidance agree to injunctions against CMS and withdraw appeals of

injunctions.

Reissue 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 and

acknowledge that there is insucient scientiﬁc evidence to support such

coverage 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 to

die. HHS should use EMTALA and Section 504 of the Rehabilitation Act,

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 and

Discrimination on the Basis of Disability in Critical Health and Human

Service Programs or Activities,”

to achieve this end. In addition, Congress

should pass the Born-Alive Abortion Survivors Protection Act

to require

that proper medical care be given to infants who survive an abortion

and to establish criminal consequences for practitioners who fail to

provide such care.

Permanently codify both the Hyde family of amendments and the

protections provided by the Weldon Amendment. Congress can

accomplish this through legislation such as the No Taxpayer Funding for

Abortion and Abortion Insurance Full Disclosure Act

(Hyde) and the

Conscience Protection Act

(Weldon).

— 475 —

Department of Health and Human Services

Radical Redeﬁnition of Sex. On August 4, 2022, HHS published a proposed

rule entitled “Nondiscrimination in Health Programs and Activities.”

This rule

addresses nondiscrimination provisions of the Aordable Care Act, known as

Section 1557, which is enforced by the Oce for Civil Rights and the Centers for

Medicare and Medicaid Services. Section 1557 prohibits discrimination on the basis

of race, color, national origin, age, disability, and sex in covered health programs

or 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.”

In other words, the department proposes to

interpret 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 and

pregnancy 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 moti

vated sexualization of their children.

However, while the Biden Administration’s Section 1557 regulation should be

altered 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 were

praised 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 COVID-

19 vaccines with or without complying with onerous masking requirements and

regardless of whether they already had the virus and had gained natural immunity.

With the disease being endemic and constantly mutating, vaccines and univer-

sal 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:

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 care

facilities or personnel.

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Mandate for Leadership: The Conservative Promise

Pay 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 a

federal block grant that gives states signiﬁcant ﬂexibility to fund a broad array of

programs aimed at helping low-income families break the cycle of poverty and

achieve economic self-suciency. States use TANF to fund monthly cash assis-

tance payments to low-income families with children as well as a wide range of

services that include work activities, work supports and supportive services, child-

care, administration and systems, tax credits, pre-K/Head Start, child welfare, and

other 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 fam-

ilies in work for at least 30 hours a week (20 hours a week for single parents with

children 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 engagement

targets 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 receiv-

ing 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.

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 deﬁ-

nitional 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 and

annual 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 cycle

of poverty in meaningful ways. CMS should require explicit measurement of

these goals.

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Department of Health and Human Services

Teen Pregnancy Prevention (TPP) and Personal Responsibility Educa

tion Program (PREP). TPP is operated by the Oce of Population Aairs in the

Oce of the Assistant Secretary for Health; PREP is operated by the ACF Oce

of Planning, Research, and Evaluation. Both programs should ensure that there

is better reporting of subgrantees and referral lists so that they do not promote

abortion 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 eectiveness. 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 a

funnel eect for abortion facilities and school ﬁeld trips to clinics, or for similar

purposes. Parent involvement and parent–child communication should be encour-

aged and be a part of any funded project. Risk avoidance should be prioritized, and

any 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 met-

rics, and a cost analysis of programming as compared to students served should be

a metric in funding (taking into account that in certain cases, intensive programs

will serve fewer students and can have more positive results). These same param-

eters 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 text-

books. HHS should create a list of criteria for evaluating the sort of curriculum

that should be selected for any sex education grant programs, both at OASH and

at 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 the

waiting 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 faith-

based 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 a

child should have a married mother and father.

HHS, through ACF and the Assistant Secretary for Financial Resources (ASFR),

should repeal the unnecessary 2016 regulation

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

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Mandate for Leadership: The Conservative Promise

in their forever homes. ACF and OCR should also survey their programs to consider

whether additional waivers of HHS grant conditions—waivers the Biden Admin-

istration revoked in 2021—are needed for faith-based agencies.

Additionally, Congress should pass the Child Welfare Provider Inclusion Act

ensure that providers and organizations cannot be subjected to discrimination for

providing adoption and foster care services based on their beliefs about marriage.

Oce of Refugee Resettlement (ORR). The Oce of Refugee Resettlement

should be moved to the Department of Homeland Security. Having health and

welfare 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 free

programs that incentivize people to come to the U.S. illegally. Even more troubling,

ORR has too often placed children into dangerous situations when releasing them

into the country.

Nearly all of HHS’s care, custody, and placement of children is done through

cooperative agreements with private agencies, many of which may have broken

federal law by inducing or being accomplices in illegal immigration. Those

arrangements could be handled far more eectively by DHS. Congress should

reform the Tracking Victims Protection Reauthorization Act

to transfer all

ORR duties for unaccompanied alien children to DHS and eliminate the Flores

settlement agreement.

Regardless of where ORR’s functions reside, ORR sta and care providers should

never be allowed to facilitate abortions for unaccompanied children in its cus-

tody, including by transporting minors across state lines from pro-life states to

abortion-friendly states. Pregnant, unaccompanied girls in ORR custody should

be treated with dignity, not tracked across state lines to be victimized by the

abortion 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 White

House should insist that DOJ ﬁght to defend that policy up to the U.S. Supreme

Court in light of Dobbs.

Oce of Child Support Enforcement (OCSE) Congress established Aid to

Families with Dependent Children in 1935 to assist single-parent families who

were suering ﬁnancially from the loss of a bread-winning husband and father.

Within two decades, however, the majority of families receiving aid were depen-

dent because of paternal abandonment rather than death. Today, nearly a third of

America’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’s

ability to provide full or consistent child support payments. The literature reﬂects

this divide as fathers have been categorized as “deadbeat” dads, then as “deadbroke”

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Department of Health and Human Services

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 receive

a nondependent, child support tax credit. Single ﬁlers of up to $41,756 and married

or 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 history

of 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 and

money rather than creating another government assistance program (or a fully

refundable credit) devoid of the father’s own monetary eorts. This way, the non-

resident father’s role as ﬁnancial provider and relational ﬁgure is armed, and

much-needed ﬁnancial resources are given to the children.

Visitation. Visitation is key to revitalizing child support and increasing pay-

ment frequency. The most eective 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 ensure

that resident and nonresident parents received state-mandated ﬁnancial support

orders and enforceable visitation orders.

Child Support Payment and Interactive Smartphone Application. Each

state should be induced to implement a high-tech, easy-to-use application to cen-

tralize child support payments. As with Venmo or Cash App, nonresident parents

would link their bank accounts and provide one-click monthly payments (or con-

tribute 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 pay-

ment systems: nonresident parents claim that they are spending much of their

own money to provide for children outside of their monthly payments and resident

parents’ claim that they spend little and neglect their ocial 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 the

reason 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 Oce of Family Assistance. The following pol-

icies should be implemented.

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Mandate for Leadership: The Conservative Promise

Utilize 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 and

prevention are much more cost-eective than are eorts to reach people

already in broken relationships.

Allow child welfare funding to be used for marriage and relationship

education. Congress should adopt the following recommendation from a

report issued by members of Congress’s Joint Economic Committee:

Children are far more likely to experience abuse when they are raised

outside of their married-parent family. Title II of the Child Abuse Preven-

tion and Treatment Act provides grants to communities for the purpose

of preventing child abuse and neglect, and one of the stated purposes

for which the grants can be used is for eorts to increase family stability.

However, Congress could change the law to make it clear that Title II

funding 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 and

relationship education for families at risk of having their children placed

in foster care.

Provide educational information on healthy marriage and

relationships at Title X family planning clinics. HHS should require

clinics 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 a

poor methodology or tried to measure program success prematurely. Recent

assessments have shown increasing eectiveness and positive community-

level marital outcomes.

The HMRE program should receive a fair and realistic assessment.

Additionally, the positive role of faith-based programs should be protected

— 481 —

Department of Health and Human Services

and prioritized so that these programs do not receive undue scrutiny or

pressure to conform to nonreligious deﬁnitions of marriage and family as

put forward by the recently enacted Respect for Marriage Act.

Protect faith-based grant recipients from religious liberty violations

that maintain a biblically based, social science–reinforced deﬁnition

of 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 arm that children

require and deserve both the love and nurturing of a mother and the play

and protection of a father. Despite recent congressional bills like the

Respect for Marriage Act that redeﬁne marriage to be the union between

any two individuals, HMRE program grants should be available to faith-

based recipients who arm 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 Oce of Family Assistance. Its goal, like that

of the HMRE program, is to provide marriage and parenting guidance for low-in-

come fathers. This includes fatherhood and marriage training, curriculum, and

subsequent research.

Implement 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 arm

the role fathers play in the lives of their children, that recognize the ﬁnancial

hardships the fathers themselves face, and that seek to provide relationship

education to fathers who were raised without a father in the home.

Fund eective HMRF state programs. Grant allocations should protect

and prioritize faith-based programs that incorporate local churches and

mentorship programs or increase social capital through multilayered

community support (including, for example, job training and social

events). Programs should arm and teach fathers based on a biological and

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Mandate for Leadership: The Conservative Promise

sociological understanding of what it means to be a father—not a gender-

neutral parent—from social science, psychology, personal testimonies, etc.

ADMINISTRATION ON CHILDREN, YOUTH, AND FAMILIES (ACYF)

Allocate funding to strategy programs promoting father involvement

or terminate parental rights quickly. ACYF is currently considering

dierent programs to encourage parents, especially fathers, to engage with

their children in foster care. While these program ideas and initiatives are

still in the early planning stages, promoting responsible parenthood to

reintegrate children or at least keep a consistent male ﬁgure in the minor’s

life is crucial. At the same time, in cases where the father or mother does

not make a sincere or serious eort 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)

Eliminate the Head Start program. Head Start, originally established

and funded to support low-income families, is fraught with scandal and

abuse. 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.”

Research has demonstrated that

federal 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)

Support 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 and

intergenerational 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 quality

of life by alleviating pain and other distressing symptoms of a serious

illness. HHS ACL should survey their programs to ensure that they are

supporting vulnerable persons of age or disability and are not facilitating or

encouraging participation in PAS.

— 483 —

Department of Health and Human Services

Readdress the National Strategy to Support Family Caregivers. While

in theory the strategy aims to support family members with duties to care

for older family members, the plan is overly focused on racial and “LGBTQ+

equity.” The strategy should be examined to establish an ecient plan to

support caregivers and their families. There should also be a review of its

COVID-19 policies.

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)

Congress should allow CMS to use the 340B data that HRSA collects

rather than having CMS conduct its own survey, especially in view

of the U.S. Supreme Court’s American Hospital Association v. Becerra

decision.

The legislation should also create penalties for those who do not

respond to HRSA’s data collection.

Legally deﬁne the locus of service as where the provider is located

during the telehealth visit rather than where the patient is. With such

a deﬁnition, states could continue to reserve their powers to establish the

standards 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 than

they 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 Oce for the Advancement

of Telehealth includes a program known as the Licensure Portability Grant

Program, which bolsters state eorts to reform licensing laws to maximize

telehealth ﬂexibility. HRSA does not have the authority through this oce

to dictate licensure laws; that power has typically been reserved to the

states. However, telehealth across state lines, when permitted, is interstate

commerce, which can be regulated by the federal government according to

the Constitution.

Restore Trump religious and moral exemptions to the contraceptive

mandate (also a CMS rule). HHS should rescind, if ﬁnalized, the

regulation titled “Coverage of Certain Preventive Services Under the

Aordable Care Act,” proposed jointly by HHS, Treasury, and Labor.

This

rule proposes to amend Trump-era ﬁnal rules regarding religious and

moral exemptions and accommodations for coverage of certain preventive

services under the ACA. Preventive services include contraception, and

— 484 —

Mandate for Leadership: The Conservative Promise

it appears the proposed rule would change the existing regulations for

religious and moral exemptions to the ACA’s contraception mandate.

There is no need for further rulemaking that curtails existing exemptions

and accommodations.

Require 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 o not requiring coverage of fertility awareness–based

methods of family planning, then requiring them, and then removing the

requirement without notifying the public. A federal judge recently ruled

that 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 that

is compliant with the Administrative Procedures Act.

Moreover, since the Obama Administration HRSA entered into long-

term 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 were

sometimes 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 and

establish 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.

Expand 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 and

screenings 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 of

which are mandated by the Administrative Procedures Act. In August

— 485 —

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 from

requirements that cover at least 58 million women, and the judge made his

ruling 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 under

the ACA. FABMs often involve costs for materials and supplies, and HHS

should make clear that coverage of those items is also required. FABMs

are highly eective and allow women to make family planning choices in a

manner that meets their needs and reﬂects their values.

Eliminate 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 for

years that it had no authority to do so because Congress explicitly limited

the mandate to “women’s” preventive care and screenings. HRSA should not

incorporate exclusively male contraceptive methods into guidelines that

specify they encompass only women’s services.

Eliminate the week-after-pill from the contraceptive mandate as a

potential 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 a

woman’s uterus. HRSA should eliminate this potential abortifacient from

the 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-arming 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 ensure

that 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:

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Mandate for Leadership: The Conservative Promise

1. Investigate state medical school compliance with the Coats–Snowe

Amendment,

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 and

regulations and that states have taken the armative 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.

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 ready

for school. And more than one in four of children (28%) who experience

abuse or neglect are under 3 years old.”

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 oset 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 importance

of the mother–child relationship in child well-being. This should include

relationship education curricula that equip mothers and caregivers to

connect with and improve their understanding of their infants, toddlers, and

young children.

Maternal and Child Health. Currently, the HRSA Maternal and Child Health

program 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

— 487 —

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 touch

and massage to reduce stress and anxiety during labor.”

Given concerns about maternal mortality or postpartum depression that is

worsened 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 pro-

vide funding for low-income mothers.

INDIAN HEALTH SERVICE (IHS)

The Indian Health Service serves our American Indian and Alaska Native popu-

lations. Reforms are needed to improve America’s ability to deliver on its promises

to these important populations and must take account of cultural preferences and

lifestyles, limitations due to geography (such as challenging terrain), and limited

Internet access. For example, contacting individuals within some of these com-

munities and tribes during the COVID-19 pandemic proved to be dicult 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 important

to guard against such situations in order to preserve these tribes’ access to health

resources 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 positive

reforms contained in the VA MISSION Act

could reveal similar opportunities

for increased options and access for American Indians and Alaska Natives.

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 not

previously as rural as industries move away, taking with them economic prosperity

and often medical providers. Others are in essential professions such as farming

that by nature necessitate living in regions with fewer city accommodations and

economic 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 aect these regions because their market trends

and populations are dierent from those of more populous regions. Often, rural

patients face an hour’s drive to the nearest medical provider or facility or have

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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 aect rural regions, HHS should:

Reduce the regulatory burden and unleash private innovation that can

discover solutions to unique, local needs.

Implement or encourage policies that increase the supply of health care

providers, 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 less

expensive alternatives to hospitals and telehealth independent of expensive

air ambulances.

OFFICE OF THE SECRETARY

The Secretary of Health and Human Services and the Oce of the Secretary

necessarily set the tone for the entire department. The Secretary is the most

accountable individual within HHS and, along with his or her immediate sta,

should therefore be responsible for setting the policies that govern the depart-

ment’s operations instead of allowing the operational divisions to assume the

leading role in policymaking, thereby diusing responsibility.

Practical reforms to enhance the Secretary’s accountability should include

the following:

Restrict 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 an

extension of the PHE is necessary.

Reinstate the HHS SUNSET (Securing Updated and Necessary

Statutory Evaluations Timely) rule.

Congress should codify the now-

reversed Trump Administration rule that required all HHS agencies to

review 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:

— 489 —

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.

The Life Agenda. The Oce of the Secretary should eliminate the HHS Repro-

ductive Healthcare Access Task Force and install a pro-life task force to ensure

that all of the department’s divisions seek to use their authority to promote the life

and health of women and their unborn children. Additionally, HHS should return

to being known as the Department of Life by explicitly rejecting the notion that

abortion 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 Representative

for 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 because

of overlapping issues with the U.S. Department of State and USAID (and at times

a lack of clarity as to the lead point of contact and policy decisions at the White

House). The new Special Representative would serve as the lead on all matters of

federal domestic policy development related to life and family with support from

the DPC for implementation and coordination among agencies. In the post-Dobbs

era, advancing support for mothers will include coordination among agencies out-

side 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, the

Secretary should proudly state that men and women are biological realities that

are 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 have

a right to be raised by the men and women who conceived them.

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 United

States Public Health Service Commissioned Corps (USPHS), and the Surgeon Gen-

eral (SG) is the three-star admiral.

The ASH is tasked with overseeing not only the USPHS, but also 10 regional

health oces, multiple presidential and secretarial advisory committees, and other

oces such as the Oces of Minority Health, Women’s Health, and Population

Aairs. The Secretary can further expand the ASH’s responsibilities (for example, by

— 490 —

Mandate for Leadership: The Conservative Promise

designating the ASH as liaison to the CDC). The SG ocially oversees the daily oper-

ations of the USPHS, although those are actually under the control of the Director

of the USPHS Commissioned Corps Headquarters. The SG also issues information

to the public (Surgeon General’s advisories, Calls to Action, and Reports), serving

in eect as a key public health spokesperson for the federal government.

USPHS ocers are assigned to various agencies such as the CDC, NIH, and

Bureau 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 ocers 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 appro-

priations to ensure eciency 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 ocers are assigned.

Fulﬁllment of speciﬁc tasks should not be duplicated by non-uniformed civil ser-

vants and USPHS ocers, 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 with

the rank, responsibilities, and authority of the ASH retained but with the title of

Surgeon 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 oce (previously the OASH and OSG) would

be better equipped than other HHS oces or agencies to reduce silos and con-

solidate or eliminate duplicative functions. Congress should consider legislation

that would require this oce to take such actions or at least make such recom-

mendations to the Secretary. Such legislation would require a thorough analysis

of the various legal authorities impacting the department’s current organiza-

tional structure.

The position previously known as the Principal Deputy Assistant Secretary for

Health should be combined with and have the title of Deputy Surgeon General

and become a three-star position with operational control including ﬁnancial and

deployment 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 and

unwanted pregnancies, the OASH should focus on root-cause analysis with a focus

on strengthening marriage and sexual risk avoidance. Strong leadership is needed

— 491 —

Department of Health and Human Services

in the Oce of Science and Medicine to drive investigative review of literature for a

variety of issues including the eect of abortion on prematurity and breast cancer;

lack of evidence for so-called gender-arming 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 interventions

and “gender-arming 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 Aairs that understands the program

and is able to work within its legislative framework (ideally, an MD). In addition,

the Oce of Population Aairs should eliminate religious discrimination in grant

selections and guarantee the right of conscience and religious freedom of health

care workers and participants in the Title X program.

In 2021, HHS reversed a Trump Administration regulation that required grant-

ees to maintain strict physical and ﬁnancial separation between Title X activity and

abortion-related activity.

Under the Biden Administration’s regulation,

Title X

activity can be conducted alongside abortion activity without strict physical and

ﬁnancial separation. The regulation also requires grantees to refer for abortions

despite sincere moral or religious objections. This eectively bans otherwise qual-

iﬁed 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 rule

in less than nine months) and expand the potential grantee population beyond

abortion providers like Planned Parenthood.

Congress should complement these eorts by passing legislation such as the

Title X Abortion Provider Prohibition Act,

which would prohibit family planning

grants from going to entities that perform abortions or provide funding to other

entities that perform abortions. This would help to protect the integrity of the

Title X program even under an abortion-friendly Administration.

ADMINISTRATION FOR STRATEGIC

PREPAREDNESS AND RESPONSE (ASPR)

ASPR vs. FEMA. When the President declares a national emergency (per the

Staord 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 arrange-

ment should be reviewed—especially considering the COVID-19 pandemic—for

improvements in eciency according to expertise and available resources, reduced

confusion for ASPR and among HHS agencies, and avoidance of duplicated eorts

among agencies and personnel.

— 492 —

Mandate for Leadership: The Conservative Promise

Strategic National Stockpile. The President should invoke the Defense Pro-

duction Act,

which is a form of temporary takeover of private enterprises, only

in the gravest circumstances. The Strategic National Stockpile (SNS) should be

reformed to consider the potential supply chain disruptions of pandemics or global

conﬂicts. Also, during the COVID pandemic, many states received ventilators from

the SNS and hoarded them in places where a rush of COVID patients needing ven-

tilators never materialized. The SNS should clarify its mission as supplier of last

resort to the federal government, state governments, or ﬁrst responders and key

medical sta and should not portray itself as serving the public as a whole.

OFFICE OF GENERAL COUNSEL (OGC)

The Oce of General Counsel is essential to ensuring that HHS is operating

within the bounds of its numerous governing statutes. However, legal caution can

outweigh practical necessity and often slows processes and decisions when time is

of 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 e-

ciency. OGC should also:

Rescind its PREP Act liability memo. OGC issued a PREP Act liability

memo that suspended application of civil rights and other laws in the

context of the administration of covered countermeasures during the

pandemic. It should be rescinded as contrary to law.

Rescind eorts to curtail OCR authority over conscience and

religious freedom. All OGC memos and Federal Register notices of

organization or delegations of authority moving any OCR conscience

and religious freedom enforcement to OGC, including RFRA, should

be rescinded, and independent authority over these matters should be

restored to OCR.

Encourage DOJ to repeal OLC memos allowing abortion funding

despite Hyde and memos allowing federal enclave immunity to

perform abortions despite the Assimilative Crimes Act.

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 Association

prevents any proposed HHS

regulations or enforcement actions concerning the denial of care

— 493 —

Department of Health and Human Services

to newborn infants with disabilities by covered health care entities

without or against parental consent.

Rescind 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 Oce of Global Aairs should have the title of Assistant

Secretary so that he or she can adequately represent HHS and the Secretary and

serve 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:

All divisions that work on international health eorts should be

responsive to requests and direction from the Assistant Secretary

with coordination for all health diplomacy emanating from OGA.

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 eort should be made to locate all OGA sta in the same

building for better oversight and communication.

Health attachés in various global locations should be trained in the

Administration’s policies with clear expectations communicated

and with accountability, including replacement, when their

conduct and advocacy are contrary to Administration policies and

programmatic 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

— 494 —

Mandate for Leadership: The Conservative Promise

provide a private right of action that would allow victims to seek legal redress in

court. At the same time, when it continues to fund governmental and private enti-

ties that violate these laws, HHS is spending taxpayer funds unlawfully. Under

liberal Administrations, OCR has amassed a poor record of devoting resources to

conscience 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:

OCR should return to Trump Administration policies that initiated

robust enforcement of these conscience laws. It should restore and fully

fund the Oce 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 give

adequate 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 and

limit territorial objections and slow-down attempts by other divisional

ocials including OGC. HHS should withdraw funding from any violating

entities that refuse to correct their behavior, and OCR CRFD should work

with ASFR to ensure that all grant announcements and instruments inform

grantees and applicants of their obligations to comply with federal health

care conscience laws speciﬁcally as a condition of obtaining or maintaining

their funding.

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 and

foster care agencies. It should also rescind subjective case-by-case eval-

uations for religious and faith-based organizations that request religious

exemptions. These case-by-case determinations are currently coordinated

with ACF and OCR. The recommended waivers should be granted to all

states and agencies that request them, and OCR memos ﬁnding that RFRA

would be violated if the waivers are not granted should be restored.

— 495 —

Department of Health and Human Services

HHS should restore OCR authority to review requests for and

render 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 or

tested 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

Aordable 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 of

a binary biological conception of sex discrimination, and speciﬁed that

the 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 of

that rule from going into eect.

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 this

rule will be ﬁnalized in 2023 even though several courts have issued rulings

against the interpretation on which it is based.

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 enforcement

and March

2022 statement threatening states that protect minors from genital

mutilation.

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 cases

such as Heckler v. Chaney.

— 496 —

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 orientation

and gender identity discrimination based on the textual approach to

male and female biology taken by Congress in the ACA, the need to

recognize biological distinctions as part of the sound practice of health

care, and the need to ensure protections of medical judgment and

conscience. 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 of

race, sex, and disability discrimination. In particular, OCR should

highlight its 2019 investigation and voluntary resolution agreement

with 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 no

longer 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.

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,

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.

— 497 —

Department of Health and Human Services

OCR should withdraw its Health Insurance Portability and

Accountability Act (HIPAA)

guidance on abortion. OCR should

withdraw its June 2022 guidance

that purports to address patient privacy

concerns following the Dobbs decision but is actually a politicized statement

in favor of abortion and against Dobbs. HIPAA covers patients in the womb,

but this guidance treats them as nonpersons contrary to law. The guidance

is 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 involved

in the 2025 Presidential Transition Project. All contributors to this chapter are listed at the front of this volume

and include former ocials 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.

— 498 —

Mandate for Leadership: The Conservative Promise

ENDNOTES

 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).

 “Strategic Goal 1: Protect and Strengthen Equitable Access to High Quality and Aordable 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 such

treatment, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and Paciﬁc

Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and

queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise

adversely aected 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 and

underserved populations throughout this Strategic Plan.” Ibid. Emphasis in original.

 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-life-

expectancy-continues-fall-erasing-25-years-health-gains/10937418002/ (accessed February 6, 2023).

 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-117-

IF02-20220302-SD004.pdf (accessed March 22, 2023).

 Zachary B. Sluzala and Edmund F. Haislmaier, “Lessons from COVID-19: How Policymakers Should Reform the

Regulation 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.

 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).



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).

 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.

 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).

 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.

— 499 —

Department of Health and Human Services

 Sluzala and Haislmaier, “Lessons From COVID-19: How Policymakers Should Reform the Regulation of

Clinical Testing.”

 Ibid.

 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).

 Sluzala and Haislmaier, “Lessons From COVID-19: How Policymakers Should Reform the Regulation of

Clinical Testing.”

 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.

 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).

 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).

 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).

 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/nih-

halts-controversial-study-of-moderate-drinking/ (accessed February 6, 2023).

 Alexander Tin, “Moderna Oers 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-dispute-

national-institutes-health/ (accessed February 6, 2023).

 Informed Consent Action Network, “NIH Ocials Proﬁting from COVID-19 Vaccine,” June 3, 2021, https://www.

icandecide.org/nih-ocials-proﬁting-from-covid-19-vaccine/ (accessed February 6, 2023).

 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).

 Robert E. Mot, “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.

 H.R. 3590, Patient Protection and Aordable 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).

 Brian J. Miller, Robert E. Mot, James Ficke, Joseph Marine, and Jesse Ehrenfeld, “Reversing Hospital

Consolidation: The Promise of Physician-Owned Hospitals,” Health Aairs Forefront, April 12, 2021, https://

www.healthaairs.org/do/10.1377/forefront.20210408.980640/ (accessed February 13, 2023).

 Robert E. Mot, “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-challenges-

and-opportunities.

 42 U.S. Code § 256b, https://www.law.cornell.edu/uscode/text/42/256b (accessed March 16, 2023).

 H.R. 3590, Patient Protection and Aordable Care Act, § 3022.

 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).

 Robert E. Mot, “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.”

 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-States-

HTML.html (accessed February 13, 2023).

— 500 —

Mandate for Leadership: The Conservative Promise

 Owcharenko Schaefer, “Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to Improve

the Health Care Safety Net.”

 Brian Blase, “Managed Care in Medicaid: Need for Oversight, Accountability, and Reform,” Paragon Health

Institute Policy Brief, October 13, 2022, https://paragoninstitute.org/wp-content/uploads/2022/10/20221012-

Managed-Care-in-Medicaid-Need-for-Oversight-Accountability-and-Reform-FOR-DISTRIBUTION-V2.pdf

(accessed February 13, 2023).

 Owcharenko Schaefer, “Medicaid at 55: Understanding the Design, Trends, and Reforms Needed to Improve

the Health Care Safety Net.”

 42 U.S. Code § 1315, https://www.law.cornell.edu/uscode/text/42/1315 (accessed March 17, 2023).

 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.

 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).

 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.

 Edmund F. Haislmaier and Abigail Slagle, “Premiums, Choices, Deductibles, Care Access, and Government

Dependence Under the Aordable Care Act: 2021 State-by-State Review,” Heritage Foundation Backgrounder

No. 3668, November 2, 2021, https://www.heritage.org/sites/default/ﬁles/2021-11/BG3668.pdf.

 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).

 David N. Bernstein and Robert E. Mot, “New Price Transparency Rule Will Help Transform America’s Health

Care System,” Heritage Foundation Commentary, November 1, 2020, https://www.heritage.org/health-care-

reform/commentary/new-price-transparency-rule-will-help-transform-americas-health-care.

 Sluzala and Haislmaier, “Lessons from COVID-19: How Policymakers Should Reform the Regulation of

Clinical Testing.”

 Ibid.

 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).

 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).

 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).

 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.

 Ibid., p. 28.

 Ibid., p. 30.

 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).

 42 U.S. Code § 18023, https://www.law.cornell.edu/uscode/text/42/18023 (accessed March 17, 2023).

 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).

 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).

— 501 —

Department of Health and Human Services

 U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Oce of Civil

Rights, and Oce of the Secretary, “Special Responsibilities of Medicare Hospitals in Emergency Cases and

Discrimination on the Basis of Disability in Critical Health and Human Service Programs or Activities,” draft

of Proposed Rule, January 14, 2021, https://www.hhs.gov/sites/default/ﬁles/infants-nprm.pdf (accessed

March 17, 2023).

 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).

 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).

 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).

 U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, and Oce of the

Secretary, “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).

 Ibid., p. 47916.

 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

Program (SNAP),” Proposed Rule, Federal Register, Vol. 84, No. 142 (July 24, 2019), pp. 35570–55581, https://

www.federalregister.gov/documents/2019/07/24/2019-15670/revision-of-categorical-eligibility-in-the-

supplemental-nutrition-assistance-program-snap (accessed March 17, 2023).

 45 Code of Federal Regulations § 75.300(c) and (d), https://www.ecfr.gov/current/title-45/subtitle-A/

subchapter-A/part-75/subpart-D/subject-group-ECFR911e5e1a30bfbcb/section-75.300 (accessed

March 17, 2023).

 H.R. 1750, Child Welfare Provider Inclusion Act of 2021, 117th Congress, introduced March 10, 2021, https://

www.congress.gov/117/bills/hr1750/BILLS-117hr1750ih.pdf (accessed March 17, 2023), and S. 656, Child Welfare

Provider Inclusion Act of 2021, 117th Congress, introduced March 10, 2021, https://www.congress.gov/117/bills/

s656/BILLS-117s656is.pdf (accessed March 17, 2023).

 S. 3949, Tracking Victims Protection Reauthorization Act of 2022, Public Law No. 117-348, 117th Congress,

January 25, 2023, https://www.congress.gov/117/plaws/publ348/PLAW-117publ348.pdf (accessed March 17, 2023).

 Kelsey Y. Santamaria, “Child Migrants at the Border: The Flores Settlement Agreement and Other Legal

Developments,” Congressional Research Service In Focus No. IF11799, April 1, 2021, https://crsreports.congress.

gov/product/pdf/IF/IF11799 (accessed March 17, 2023).

 Report, Building a Happy Home: Marriage Education as a Tool to Strengthen Families, Social Capital Project

Report No. 1-22, March 2022, p. 17, https://www.jec.senate.gov/public/_cache/ﬁles/3d102525-6f0d-48ed-

92f4-d71edd468ad6/building-a-happy-home.pdf (accessed March 17, 2023). The cover of the report reﬂects

that the Social Capital Project is “[a] project of the Joint Economic Committee – Republicans.”

 See, for example, Alan J. Hawkins, “Are Federally Supported Relationship Education Programs for Lower-Income Individuals

and Couples Working? A Review of Evaluation Research,” American Enterprise Institute, September 2019, https://www.

congress.gov/117/plaws/publ228/PLAW-117publ228.pdf (accessed March 17, 2023).

 H.R. 8404, Respect for Marriage Act, Public Law No. 117-228, 117th Congress, December 13, 2022, https://www.

congress.gov/117/plaws/publ228/PLAW-117publ228.pdf (accessed March 17, 2023).

 Madison Marino, “Over 1,000 Safety Violations Mar Head Start. Children Deserve Better,” Heritage Foundation

Commentary, November 10, 2022, https://www.heritage.org/education/commentary/over-1000-safety-

violations-mar-head-start-children-deserve-better.

 American Hospital Association v. Becerra, 596 U.S. ___ (2022), https://www.supremecourt.gov/

opinions/21pdf/20-1114_09m1.pdf (accessed March 17, 2023).

 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, Centers for Medicare and

Medicaid Services, “Coverage of Certain Preventive Services Under the Aordable Care Act,” Notice of

Proposed Rulemaking, Federal Register, Vol. 88, No. 22 (February 2, 2023), pp. 7236–7281, https://www.

govinfo.gov/content/pkg/FR-2023-02-02/pdf/2023-01981.pdf (accessed March 17, 2023).

— 502 —

Mandate for Leadership: The Conservative Promise

 42 U.S. Code § 238n, https://www.law.cornell.edu/uscode/text/42/238n (accessed March 17, 2023).

 U.S. Department of Health and Human Services, Health Resources and Services Administration, “Early

Childhood Health,” last reviewed October 2022, https://mchb.hrsa.gov/programs-impact/focus-areas/early-

childhood-health (accessed March 17, 2023).

 American Pregnancy Association, “Having a Doula—What Are the Beneﬁts?” https://americanpregnancy.

org/healthy-pregnancy/labor-and-birth/having-a-doula/#:~:text=Other%20studies%20have%20shown%20

that%20having%20a%20doula,massage%20to%20reduce%20stress%20and%20anxiety%20during%20labor

(accessed March 17, 2023).

 S. 2372, VA MISSION [Maintaining Internal Systems and Strengthening Integrated Outside Networks] Act

of 2018, Public Law No. 115-182, 115th Congress, June 6, 2018, https://www.congress.gov/115/plaws/publ182/

PLAW-115publ182.pdf (accessed March 17, 2023).

 U.S. Department of Health and Human Services, “Securing Updated and Necessary Statutory Evaluations

Timely,” Final Rule, Federal Register, Vol. 86, No. 11 (January 19, 2021), pp. 5694–5764, https://www.govinfo.

gov/content/pkg/FR-2021-01-19/pdf/2021-00597.pdf (accessed March 22, 2023).

 U.S. Department of Health and Human Services, Oce of the Secretary, Oce of the Assistant Secretary for

Health, “Compliance with Statutory Program Integrity Requirements,” Final Rule, Federal Register, Vol. 84, No.

42 (March 4, 2029), pp. 7714–7791, https://www.govinfo.gov/content/pkg/FR-2019-03-04/pdf/2019-03461.pdf

(accessed March 18, 2023).

 U.S. Department of Health and Human Services, Oce of the Secretary, Oce of the Assistant Secretary for

Health, “Ensuring Access to Equitable, Aordable, Client-Centered, Quality Family Planning Services,” Final

Rule, Federal Register, Vol. 86, No. 192 (October 7, 2021), pp. 56144–56180, https://www.govinfo.gov/content/

pkg/FR-2021-10-07/pdf/2021-21542.pdf (accessed March 18, 2023).

 S. 624, Title X Abortion Provider Prohibition Act, 118th Congress, introduced March 2, 2023, https://www.

congress.gov/118/bills/s624/BILLS-118s624is.pdf (accessed March 18, 2023).

 50 U.S. Code Chapter 55, https://www.law.cornell.edu/uscode/text/50/chapter-55 (accessed March 22, 2023).

 18 U.S. Code § 13, https://www.law.cornell.edu/uscode/text/18/13 (accessed March 18, 2023).

 Bowen v. American Hospital Association, 476 U.S. 610 (1986), https://tile.loc.gov/storage-services/service/ll/

usrep/usrep476/usrep476610/usrep476610.pdf (accessed 22, 2023).

 U.S. Department of Health and Human Services, Oce of the Secretary, “Notiﬁcation of Interpretation and

Enforcement of Section 1557 of the Aordable Care Act and Title IX of the Education Amendments of 1972,”

Federal Register, Vol. 86, No. 99 (May 25, 2021), pp. 27984–27985, https://www.govinfo.gov/content/pkg/FR-

2021-05-25/pdf/2021-10477.pdf (accessed March 18, 2023).

 U.S. Department of Health and Human Services, Oce for Civil Rights, “HHS Notice and Guidance on Gender

Arming Care, Civil Rights, and Patient Privacy,” March 2, 2022, https://www.hhs.gov/sites/default/ﬁles/hhs-

ocr-notice-and-guidance-gender-arming-care.pdf (accessed March 18, 2023).

 Heckler v. Chaney, 420 U.S. 821 (1985), https://caselaw.ﬁndlaw.com/us-supreme-court/470/821.html (accessed

March 18, 2022).

 U.S. Department of Health and Human Services, Oce for Civil Rights, “Guidance to Nation’s Retail

Pharmacies: Obligations Under Federal Civil Rights Laws to Ensure Access to Comprehensive Reproductive

Health Care Services,” content last reviewed July 14, 2022, https://www.hhs.gov/civil-rights/for-individuals/

special-topics/reproductive-healthcare/pharmacies-guidance/index.html (accessed March 18, 2023).

 H.R. 3103, “Health Insurance and Portability and Accountability Act of 1996, Public Law No. 104-191, 104th

Congress, August 21, 1996, https://www.congress.gov/104/plaws/publ191/PLAW-104publ191.pdf (accessed

March 18, 2023).

 U.S. Department of Human Services, “HIPAA Privacy Rule and Disclosures of Information Relating to

Reproductive Health Care,” content last reviewed June 29, 2022, (accessed March 18, 2023). See also

“Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or

Tablet,” content last reviewed June 29, 2022, https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/

cell-phone-hipaa/index.html (accessed March 18, 2023).