The project creates video game-like avatars with which people can envision specific body parts they want to target with surgery to make themselves look more masculine or feminine.
The National Institutes of Health is funding a study to create 3D avatars for transgender-identifying people to envision the body they imagine they should have and then medically alter their figure accordingly. Another NIH-funded project aims to allow trans folks to adopt a voice congruent with their sex-denying identity. Multiple taxpayer-funded studies on transgender issues focus on “intersectionality,” disparity, and HIV.
The NIH Reporter database, which lists active federally funded research projects, shows 75 with “transgender” in the title, totaling more than $26 million of taxpayers’ money annually.
The NIH is wasting taxpayer dollars on a project titled “Personalized 3D avatar tool development for measurement of body perception across gender identities,” which purports to help people with gender dysphoria by mapping the difference between their actual physical embodiment and what they believe their body to be. But instead, it indulges their illness by defying science and denying the immutability of sex.
The tool (a prototype is pictured here) would scan individuals to create personalized 3D visualizations with which they can interact on mobile and desktop devices. Those behind the project say they are trying to create technology that “can potentially improve clinical outcomes by identifying specific sets of body parts as targets for treatments to improve body congruence.” In other words, the research project will create video game-like avatars with which people can envision specific body parts they want to target with surgery — which includes removing healthy organs, shaving facial bones, and more — to make themselves look more masculine or feminine.
The study is at the University of Toronto, Canada, and has received $288,000 so far. It began in 2021 and is scheduled to run through 2024.
Other Taxpayer-Funded Research on Ideal Voice, Acne, and Sex Ed
Another taxpayer-funded study addresses how transgender-identifying people experience challenges in adopting a voice characteristic of their so-called identity. Trans individuals “report that producing a voice congruent with their gender identity is crucial to affirming their gender identity. There are a variety of gender affirming services available, but medical interventions, such as surgery or hormones do not … ensure satisfaction with vocal gender.”
A third NIH-funded study looks at acne in the trans-identifying population. “Little is known about the interplay of endogenous and exogenous hormones on acne incidence, severity, impact, treatment, and experience,” the summary says.
NIH is also funding “A fully functional online interactive sexual education tool” for “transgender and gender expansive (TGE) youth.” Such children “are at high risk of several sexual health outcomes that have life-long impacts including sexually transmitted infections, early, unwanted pregnancies, and unwanted sexual contact/intimate partner violence. … [C]urrent educational and clinical structures largely ignore their experiences,” according to the project summary. The tool will clarify “that gender-affirming medical interventions do not prevent unintended pregnancies.” It will also address what it calls “difficulties navigating partner consent because it is often described in heteronormative, binary terms in sexual education classes.”
The bluehead wrasse, a small fish and sequential hermaphrodite, meaning it contains both types of reproductive organs, will be the subject of another taxpayer-funded transgender study: “Organisms that naturally undergo sex transformations in response to changes in their social environment provide excellent systems in which to investigate mechanisms of behavioral sex specification.” Adult female bluehead wrasses can rapidly switch sex in response to changes in social structure, according to the project.
Four ongoing NIH-funded studies related to transgenderism mention “disparities” in their project titles and three mention “stigma.” NIH even issued a Notice of Special Interest in understanding how so-called “intersectional stigmas” harm health. About half of all NIH-funded transgender research, including that which has been completed, relates to higher rates of HIV among the transgender population, totaling approximately $80 million since 1985.
Despite all the possible health risks, President Joe Biden has issued executiveorders charging “HHS to work with states to promote expanded access to gender-affirming care.” The administration has issued directives that federal health insurance benefits must “provide comprehensive gender-affirming care.”
Taxpayers are already paying for transgender procedures, as they are covered by some insurers and Medicaid in some states.
Woke Waste
House Budget Committee Republicans have announced “woke waste” is among the spending cuts they want in a debt limit deal. According to the House Budget Committee:
The recent omnibus included millions of dollars in funding for woke policies that American taxpayers shouldn’t be footing the bill for, including $1.2 million for “LGBTQIA+ Pride Centers,” $1 million for a space for “gender-expansive people of color” … and $750,000 for “Transgender and Gender nonconforming and Intersex (TGI) immigrant women in Los Angeles.”
Under the Republican plan, billions of dollars in savings would also come from ending the Environmental Protection Agency’s “environmental justice” programs, enacting new work requirements for welfare, halting Biden’s student loan forgiveness, and getting back unspent Covid-19 pandemic funds.
This byline marks several different individuals, granted anonymity in cases where publishing an article on The Federalist would credibly threaten close personal relationships, their safety, or their jobs. We verify the identities of those who publish anonymously with The Federalist.
NIH is funding many studies premised upon how little research has been conducted on the long-term health risks of cross-sex hormones. Yet HHS is pushing for more transgender ‘care.’
As the Biden administration pushes the Department of Health and Human Services to make “gender-affirming health care” more widely available, HHS’s own National Institutes of Health is funding multiple studies premised upon how little research has been conducted on the long-term risks of taking cross-sex hormones and whether they improve mental health. The NIH research on transgender issues also emphasizes intersectionality and about half has been on HIV prevention.
The NIH Reporter database, which lists active federally funded research projects, shows 74 with “transgender” in the title, totaling more than $26 million of taxpayers’ money annually. Several NIH-funded studies examine specific health risks of cross-sex hormone treatment — such as associated bone loss and possible increased risk of thrombosis, drug overdose, heart attack, and stroke.
Onlyafew studies evaluate the risk of infertility, even though “the impact of long-term cross-sex hormone therapy on reproductive health is largely unknown,” as one such project states and experts have warned. In contrast, seven studies examine stigma and disparities in health care for transgender people, in response to NIH’s Notice of Special Interest in understanding the role of alleged intersectional stigmas and how they harm health.
Manystudiesaddresshigherincidence of sexually transmitted infections in transgender people, and whether hormone therapy might increase that risk. About half of all NIH-funded research on transgender health, including that which has been completed, relates to HIV prevention among the transgender population, totaling approximately $80 million since 1985.
Transgender males “have some of the highest concentrated HIV epidemics in the world, with a pooled global prevalence of 19% and a 49-fold higher odds ratio of acquiring HIV than non-transgender adults,” according to one project summary. Behavioral factors contribute, another project says, but the role of sex hormones needs further study, since they “are known to modulate the immune response, resulting in changes in host susceptibility to pathogens, vaccine efficacy and drug metabolism.”
Many Ongoing Projects Highlight Lack of Research
While suicide prevention is often cited as a major reason to give dysphoric children puberty blockers and cross-sex hormones, only one of the current studies is focused specifically on suicide risk, although several emphasize the lack of long-term studies of cross-sex hormones administered to children and their relation to mental health.
Medical professionals “say more specific research is needed to determine whether medically transitioning as a minor reduces suicidal thoughts and suicides compared with those who socially transition or wait before starting treatment,” according to Reuters.
One NIH-funded project summary acknowledges that the long-term effect of puberty suppression on mental health needs further study and will evaluate children already taking puberty blockers.
During puberty, hormones change the structure and organization of the brain. Puberty blockers “may also disrupt puberty-signaled neural maturation in ways that can undermine mental health gains over time and impact quality of life in other ways,” the Nationwide Children’s Hospital project summary says. “The overall impacts” of puberty blockers “have not been systematically studied,” the summary says.
One of the larger NIH-funded transgender studies, funded at $743,000 annually, is at Boston Children’s Hospital. It notes, “Little is known [emphasis added] about how pubertal blockade, the first step in the medical management of a young transgender adolescent, affects bone health and psychological well-being. … In an exploratory aim, we will also consider the effect of pubertal blockade on anxiety, depression, and health-related quality of life.”
Another research project, “Psychological consequences of medical transition in transgender youth,” begun last year at Princeton University and anticipated to end in 2025, notes the lack of quality research in this area:
Five studies to date have longitudinally examined the relationship between one or both of these interventions [puberty suppression and hormone therapy] and mental health in transgender youth. However, these studies have had relatively small samples, none have been able to isolate the effects of endocrine interventions, none have included a cisgender [non-transgender] comparison group, and none have examined the mechanisms by which endocrine interventions might improve mental health.
A longitudinal study that began in 2015 and will run through at least 2026 acknowledges, “Transgender children and adolescents are a poorly understood and a distinctly understudied population in the United States. … Continuing our current research is imperative to expand the scant evidence-base currently guiding the clinical care of TGD [transgender and gender diverse] youth and thus, is of considerable public health significance.”
As the summary of one ongoing NIH-funded research project on sex hormones’ effects on the developing brain says, “There is little to no empirical data guiding clinical practices” of cross-sex hormone therapy in early pubertal adolescents, “highlighting the need for further research to address the critical knowledge gap.” The research, funded at $3 million so far to Stanford University, “will provide a much-needed foundation for understanding the longitudinal impact of treatments that are already being used [emphasis added] in clinical settings.”
The project will elucidate “how sex hormone therapy alters sex-specific risk for disease … and [its] impact on neural networks implicated in psychiatric disorders.” The research proposed “has never been conducted in early pubertal adolescents,” the summary reads.
NIH Acknowledges Limited Evidence, FDA Hasn’t Approved
The NIH, the largest public funder of biomedical research in the world, told Reuters that “the evidence is limited on whether these treatments pose short- or long-term health risks for transgender and other gender-diverse adolescents.” Additionally, the Food and Drug Administration has not approved puberty blockers and sex hormones for children’s transgender medical interventions. As Reuters reported:
No clinical trials have established their safety for such off-label use. The drugs’ long-term effects on fertility and sexual function remain unclear. And in 2016, the FDA ordered makers of puberty blockers to add a warning about psychiatric problems to the drugs’ label after the agency received several reports of suicidal thoughts in children who were taking them. More broadly, no large-scale studies have tracked people who received gender-related medical care as children to determine how many remained satisfied with their treatment as they aged and how many eventually regretted transitioning.
Countries such as Finland, Sweden, and the United Kingdom have begun to limit children’s access to transgender health interventions. Early, foundational research from 2011 on transgender medical interventions has been criticized as failing to meet basic research standards.
Before 2012, “there was no scientific literature on girls ages eleven to twenty-one ever having developed gender dysphoria at all,” according to Abigail Shrier’s book “Irreversible Damage.” Studies show most children grow out of gender dysphoria, Shrier says.“There are no good long-term studies indicating that either gender dysphoria or suicidality diminishes after medical transition,” according to Shrier.
Meanwhile, despite all the possible health risks, President Joe Biden has issued executiveorders charging “HHS to work with states to promote expanded access to gender-affirming care.” The administration has issued directives that federal health insurance benefits must “provide comprehensive gender-affirming care.” The administration also opposes “conversion therapy — efforts to suppress or change an individual’s sexual orientation, gender identity, or gender expression.”
Taxpayers are already paying for transgender procedures, as they are covered by some insurers and Medicaid in some states.
I’ll ask again. WHY ARE THESE MENTAL PATIENT LEFTEST SO HYPER ABOUT MUTILATING AMERICA’S CONFUSED CHILDREN? WHAT IS THEIR END GAME?
HHS’s Office of Population Affairs, which is overseen by transgender Dr. Rachel Levine, states there’s no debate: “Research demonstrates that gender-affirming care improves the mental health and overall well-being of gender diverse children and adolescents.” Other proponents acknowledge a lack of research on these hormones’ effect on brain development, but say the pros outweigh the cons.
Growing Transgender Identification
The number of transgender adults in the U.S. is estimated at 1.4 million to 2 million, with an estimated 150,000 to 300,000 transgender children. The number of American children who started on puberty blockers or hormones totaled 17,683 from 2017 to 2021 and has been increasing, according to Reuters.
From 2019 to 2021, at least 56 patients ages 13 to 17 had genital surgeries, and from 2019 to 2021, at least 776 children that age had mastectomies, not including procedures that weren’t covered by insurance, according to Reuters.
The transgender surgery industry grosses more than $2 billion annually and expects to double that by 2030.
Debate Among Medication Providers
“Puberty delay medications are safe and effective,”according to the World Professional Association for Transgender Health (WPATH), a pro-transgender organization that sets standards for trans medical interventions. “Every person, including every TGD person, deserves an opportunity to be their true selves and has the right to access medically-necessary affirming care to enable this opportunity,” WPATH says.
When WPATH recently updated its guidance, authors “were acutely aware that any unknowns that the working group acknowledged — any uncertainties in the research — could be read as undermining the field’s credibility and feed the right-wing effort to outlaw gender-related care,” The New York Times reported. The newspaper is in the midst of an internal fight about its coverage of transgender issues, with some saying it has been too critical of transgender medical interventions.
A draft of the WPATH chapter for adolescents included minimum recommended ages for hormone treatments and breast removal or augmentation, but after criticism from providers and transgender activists, “it was determined that the specific ages would be removed to ensure greater access to care for more people,” WPATH said.
The final guidelines also walked back a recommendation that preteens and teenagers should provide evidence of several years of persistently identifying as transgender, to differentiate from kids whose change in identification is recent, and changed it to a vaguer “sustained” gender incongruence. “In the end, the chapter sided with the trans advocates who didn’t want kids to have to wait through potentially painful years of physical development,” according to the Times.
The final guidelines acknowledged that because of the limited long-term research, treatment without a comprehensive diagnostic assessment “has no empirical support and therefore carries the risk that the decision to start gender-affirming medical interventions may not be in the long-term best interest of the young person at that time.”
Reuters found that gender facilities across the country are not conducting recommended months-long assessments before administering hormones to children. Parents of 28 of 39 minors who had sought transgender interventions told Reuters they “felt pressured or rushed to proceed with treatment.” Gender-care professionals also said some of their peers are “pushing too many families to pursue treatment for their children before they undergo the comprehensive assessments recommended in professional guidelines.”
Studying Causes of Gender Dysphoria
Some of the taxpayer-funded studies may bring clarity to the issue of gender dysphoria by examining its causes. One study will examine social media’s influence on children becoming transgender. A second will study “the life history calendar to examine young transgender women’s trajectories of violence, mental health, and protective processes.”
Another government-funded study will help determine how chromosomes, sexual organs, and hormones combine to create sex differences. Another will “uncover genetic underpinnings of female sexual orientation.”
This byline marks several different individuals, granted anonymity in cases where publishing an article on The Federalist would credibly threaten close personal relationships, their safety, or their jobs. We verify the identities of those who publish anonymously with The Federalist.
When Congress authorized $80 billion this year to beef up Internal Revenue Service enforcement and staffing, Republican House Minority Leader Kevin McCarthy warned that “Democrats’ new army of 87,000 IRS agents will be coming for you.” A video quickly went viral racking up millions of views, purporting to show a bunch of clumsy bureaucrats receiving firearms training, prompting alarm that the IRS would be engaged in military-style raids of taxpayers. The GOP claims were widely attacked as exaggerations — since the video, though from the IRS, didn’t show official agent training — but the criticism has shed light on a growing trend: the rapid arming of the federal government.
A report issued last year by the watchdog group Open The Books, “The Militarization of The U.S. Executive Agencies,” found that more than 200,000 federal bureaucrats now have been granted the authority to carry guns and make arrests — more than the 186,000 Americans serving in the U.S. Marine Corps. “One hundred three executive agencies outside of the Department of Defense spent $2.7 billion on guns, ammunition, and military-style equipment between fiscal years 2006 and 2019 (inflation adjusted),” notes the report. “Nearly $1 billion ($944.9 million) was spent between fiscal years 2015 and 2019 alone.”
The watchdog reports that the Department of Health and Human Services has 1,300 guns including one shotgun, five submachine guns, and 189 automatic firearms. NASA has its own fully outfitted SWAT team, with all the attendant weaponry, including armored vehicles, submachine guns, and breeching shotguns. The Environmental Protection Agency has purchased drones, GPS trackers, radar equipment, and night vision goggles, and stockpiled firearms.
A 2018 Government Accountability Office report noted that the IRS had 4,487 guns and 5,062,006 rounds of ammunition in inventory at the end of 2017 — before the enforcement funding boost this year. The IRS did not respond to requests for information, though the IRS’s Criminal Investigation division does put out an annual report detailing basic information such as how many warrants the agency is executing in a given year.
More than a hundred executive agencies have armed investigators, and apparently no independent authority is monitoring or tracking the use of force across the federal government. Agencies contacted by RealClearInvestigations from HHS to EPA declined to provide, or said they did not have, comprehensive statistics on how often their firearms are used, or details on how they conduct armed operations.
“I would be amazed if that data exists in any way,” said Trevor Burrus, a research fellow in constitutional and criminal law at the libertarian Cato Institute. “Over the years of working on this, it’s quite shocking how much they try to not have their stuff tracked on any level.”
All this weaponry raises questions about whether the 200,000 armed federal agents are getting adequate weapons and safety training. HHS did not respond to a request for comment on the $14 million in guns, ammunition, and military equipment it purchased between 2015 and 2019 or its new National Training Operations Center within the Washington, D.C. Beltway. Another government agency — Federal Law Enforcement Training Centers — also declined to speak with RCI for this article.
According to Burrus, recent history helps explain the militarization of the federal government. “This is 20 years of the war on terror, with the production of an excessive amount of access to weaponry,” he says.
The Homeland Security Act of 2002 extended law enforcement authority to special agents of 24 Offices of Inspectors General in agencies throughout the government, with provisions to enable other OIGs to qualify for law enforcement authority. As a result, even obscure agencies such as the U.S. Railroad Retirement Board’s Office of Inspector General now have armed federal agents. This summer, before the expansion of the IRS was approved by Congress, Republican Rep. Matt Gaetz singled out the RRB as an example of the excesses of an armed bureaucracy. He introduced a bill to stop federal agencies from stockpiling ammunition.
Federal agencies doing their own criminal investigations raises important constitutional and civil rights questions. Last year, the EPA raided a number of small auto shops across the country for allegedly selling equipment that helped car owners circumvent emissions regulations.
“It was 12 armed federal agents, and they had little EPA badges on and everything,” John Lund, the owner of Lund Racing in West Chester, Pennsylvania, told the Washington Examiner. The EPA did not respond to a request for comment.
While it’s hardly a new complaint that federal bureaucracies are overstepping their rulemaking authority, the idea that executive agencies are broadly empowered to effectively create their own laws and go out and enforce them with armed federal agents is another matter.
“So many of the regulations that can be enforced at the point of a gun have almost nothing to do with what people would normally call dangerous crime, that would be the kind of thing where you might want armed agents there,” said Burrus. “And especially coming from agencies such as the EPA and other agencies that are more quality-of-life agencies dealing with regulatory infractions, rather than involved in solving real crimes.”
The nation’s public-health establishment lost all credibility during the Covid era by either ignoring or politicizing scientific data. But health bureaucrats seem to have learned nothing. With respect to the highly charged issue of gender dysphoria, they continue to substitute politics for science when necessary to advance the leftist narrative.
The Department of Health and Human Services (HHS) recently released an official document designed to enshrine experimental medical interventions as the standard treatment for transgender-identifying children. Prepared by HHS’s Office of Population Affairs (OPA), the document is a political statement unmoored from actual medical research.
According to “Gender-Affirming Care and Young People,” medical interventions such as puberty-blocking drugs, wrong-sex hormones, and surgical mutilation are “crucial to overall health” of young people confused about their sex. (For what it’s worth, OPA falls under the supervision of Dr. Rachel Levine, a man who identifies as a woman.) The document complements a proposed rule announced by HHS in March, mandating insurance coverage for such “gender-affirming care.”
But the claims made in HHS’s new release have been deftly dismantled by an organization of physicians and scientists who still care about reality, and about ethical medical practice. The Society for Evidence Based Gender Medicine (SEGM) — which exists “to promote safe, compassionate, ethical and evidence-informed healthcare for children, adolescents, and young adults with gender dysphoria”—points out that HHS’s discussion is deeply misleading and indeed dangerous. SEGM identifies seven serious misrepresentations of fact crammed into the two-page HHS document. Most of these involve cherry-picking, distorting, or simply ignoring the results of studies on the many facets of so-called gender-affirming treatment.
HHS Mischaracterizes Studies
For example, HHS flatly mischaracterizes a study that failed to find any benefits of “social transition” (presenting oneself as the opposite sex, with a new name, hairstyle, dress, etc.). As SEGM notes, the HHS document cites that study for the opposite conclusion, “wrongly assert[ing] that social transition improves functioning.” HHS presumably assumes readers won’t read the actual study and thus will accept the agency’s false claims about its findings.
SEGM identifies other falsifications of the supposed mental-health benefits of wrong-sex hormones and surgeries. HHS’s “claims of benefits coming from cherry-picked studies do not hold up when the entire body of evidence is properly evaluated in a systematic and reproducible way,” according to SEGM.
The design of the studies cited by HHS made it impossible to link medical interventions and improved mental health, SEGM observes. By contrast, multiple European studies “concluded that there is a lack of convincing evidence for the mental health benefit for children and adolescents of either puberty blockers or cross-sex hormones.”
SEGM notes, in fact, that the Swedish health authority warned that “the risks of puberty suppressing treatment . . . and gender-affirming hormonal treatment currently outweigh the possible benefits, and that the treatments should be offered only in exceptional cases.”
HHS ignored all this research, which would have led honest medical professionals to at least acknowledge the scholarly debate about the wisdom of these interventions. But HHS isn’t run by honest medical professionals. It’s in the grip of ideologues determined to drive troubled children and their families into the clutches of the trans industry.
Dishonest Use of Data on Suicide
SEGM also criticizes the HHS document for dishonesty about the related issue of suicide among trans-identifying youth. In claiming alarmingly high rates of suicidal ideation in this population — a claim routinely used to pressure desperate parents into consenting to dangerous medical interventions — HHS relies only on “a low quality, non-probability online survey.”
In fact, SEGM reports, “recent research from one of the world’s largest pediatric gender clinics estimated the rate of suicide in trans-identified youth as 0.03% over a 10-year period, which is comparable to youth presenting for care with mental health problems.”
Even more critically, despite HHS’s strong implication that drugs, hormones, and surgeries reduce suicide rates, SEGM clarifies that “no study to date has demonstrated that transition reduces the rate of serious suicide attempts.” Is HHS afraid that telling the truth about suicide will make parents less likely to place their troubled children on the trans-industry conveyor belt?
Puberty Blockers Are Not Fully Reversible
The mendacity of HHS extends beyond misrepresenting or ignoring studies. For example, the document states, without supporting citation, that puberty blockers are fully reversible (i.e., natural puberty will resume once the drugs are discontinued). But SEGM warns about the utter dearth of research supporting this claim. In fact,
concerns have been raised that puberty blockers are psychologically irreversible (since over 95% of all treated youth proceed to cross-sex hormones), that they may harm bone development, may permanently alter the brain, that it is not yet known how they affect other vital organs, all of which undergo significant structural changes during uninterrupted puberty.
Once again, public-health agencies in Europe are more honest. As SEGM reports, Britain’s National Health Service says that “[l]ittle is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.”
But ignoring the risks of these interventions is HHS’s modus operandi. SEGM calls out the HHS ideologues for mentioning only the supposed (in some cases imaginary) benefits of interventions while failing to mention documented risks to bone development, cardiovascular health, and the mental health of patients who later regret their transition decisions.
Sterility Expected After Trans Treatments
SEGM particularly targets HHS’s failure to mention the effect on reproductive health, which is supposed to be the focus of Levine’s Office of Population Affairs. “When puberty blockers are administered in early puberty and followed by cross-sex hormones,” SEGM notes, “sterility is expected.”
HHS is silent about this potentially devastating consequence. Nor does it acknowledge the “serious ethical questions about whether adolescents can be considered competent to waive their future reproductive rights at an age when they are unlikely to be able to appreciate or predict the importance of fertility to their adult selves.”
Ethics, it appears, is not HHS’s strong suit.
HHS also misleads in stating that mutilating surgeries are “typically used in adulthood or case-by-case in adolescence.” In fact, as SEGM notes, draft recommendations from the influential (though highly politicized) World Professional Association for Transgender Health (WPATH) urge broad availability of mastectomies to patients at age 16.
Even worse, patients as young as 13 had their healthy breasts removed as part of a study funded by the National Institutes of Health – i.e., by you and me through our tax dollars. The HHS bureaucrats who prepared this report surely knew this, but distort the facts.
This HHS document, then, is a farce. As SEGM summarizes, HHS inadequately reviewed the scientific literature, issued “biased recommendations that do not acknowledge the low quality of evidence,” failed to solicit input from professionals and patients whose experiences contradict the government narrative, and utterly ignored possible alternatives to medical interventions, such as psychotherapy. The result:
This incomplete representation of the relevant issues is likely to mislead the public to believe that this is the best and only alternative, particularly when no other alternatives are mentioned. The public is also likely to erroneously assume that the risks of affirmative care are low. Patients and families are not capable of providing valid informed consent when the information they receive is inaccurate and incomplete
If the public-health establishment wants to rehabilitate its tattered reputation after the Covid debacle, this isn’t the way to do it. Health policy is too important to be entrusted to political hacks.
Jane Robbins is an attorney and a retired senior fellow with the American Principles Project in Washington DC. In that position she crafted federal and state legislation designed to restore the constitutional autonomy of states and parents in education policy, and to protect the rights of religious freedom and conscience. She is a graduate of Clemson University and the Harvard Law School.
March 18 marks one year since pro-abortion radical Xavier Becerra was confirmed as President Joe Biden’s appointee for secretary of the U.S. Department of Health and Human Services (HHS). Although both men claim to be faithful Catholics, they have launched unprecedented attacks on people of faith by eliminating vital conscience and religious freedom protections and funneling millions of taxpayer dollars to the abortion industry.
At the HHS Accountability Project at the Ethics and Public Policy Center in Washington, D.C., we have been keeping tabs on HHS personnel and policy. The oft-heard maxim “personnel is policy” is no exception for HHS, the largest federal agency by budget. While Becerra was AWOL on the Covid fight, he was outright zealous on culture war issues, leading HHS’s singular focus on pushing pro-abortion and anti-religion policies on the American people.
Here are the top 10 lowlights for year one.
1. Dismantling HHS’s Conscience and Religious Freedom Division
One of Becerra’s early acts as secretary was to strip the Conscience and Religious Freedom Division within the HHS Office for Civil Rights (OCR) of its independent ability to investigate violations of conscience and religious freedom laws. The division was created during the Trump administration to guarantee enforcement rather than neglect of laws that protect these fundamental and inalienable rights.
Becerra’s first budget proposal would have effectively eliminated this division as a standalone entity, despite Becerra having promised Congress that “the work [of the Conscience and Religious Freedom Division] will not change.” He, along with OCR political staff (such as political ideologue Laura Durso), refused to even consult with the dedicated career professionals of the division while they methodically removed conscience and religious freedom protections from the American people.
These developments were foreshadowed by transgender activist Dr. Rachel Levine who, prior to being elevated to the number-three position at HHS, proclaimed the division should be “either disbanded or certainly redirected.”
2. Removing OCR’s First Amendment Enforcement Power
Becerra removed OCR’s authority to enforce conscience and religious projections under the bipartisan Religious Freedom Restoration Act (RFRA) and the First Amendment. A leaked memo revealed this move came at the request of Lisa Pino, the Biden-appointed director of OCR. She is tasked with enforcing civil rights protections in health and human services, not finding ways to remove them.
Remember, it was HHS under Obama that went after the Little Sisters of the Poor and lost under RFRA. Now Becerra has removed the only internal entity that would hold HHS accountable to the law.
3. Pushing a Ridiculously ‘Woke’ Budget
The Biden-Becerra HHS budget for fiscal year 2022 removed references to “conscience,” “religion,” and “Conscience and Religious Freedom Division.” But don’t worry, the new budget replaces references to these constitutional and statutory rights HHS is responsible for enforcing with a bunch of woke terms like “equity” — the Biden administration’s preferred priority.
4. Backing Forcing Nuns to Pay for Abortion
While Becerra was attorney general of California before becoming HHS secretary, OCR issued two notices of violation against Becerra and his state for violating federal conscience protections by forcing nuns (and others) to provide insurance coverage of abortion. Apart from the clear conflict of interest with Becerra leading the very office that previously found him in violation of the law, OCR under Becerra “reassessed” the conscience violations, magically finding there were none.
5. Abandoning Nurse Illegally Forced to Participate in Abortion
In 2019, OCR found a hospital had violated a nurse’s conscience rights by forcing her to participate in an abortion over her known conscience objection. When the hospital refused to change its policies to comply with the law, the federal government sued the hospital in federal court.
But on Becerra’s watch and despite his many promises to continue enforcing federal conscience laws, the Biden administration quietly dismissed the case without any settlement, agreement, or compensation for the nurse. Because federal conscience protection laws do not provide a private right of action, she cannot sue on her own and the violating hospital has been let off with impunity.
6. Relentlessly Pushing Abortion With Federal Resources
In response to Texas’ law protecting unborn children with beating hearts from abortion, the Biden-Becerra HHS announced, despite prohibitions on federal funds going to abortion, ways the department could “bolster access to safe and legal abortions in Texas.” HHS is awarding $10 million in additional funding to increase access to abortifacients for those affected by the Texas law.
OCR issued pro-abortion guidance explaining how a federal conscience protection law can protect abortion providers and patients seeking abortions. If HHS’s actions weren’t clear enough, Becerra stated, “We are telling doctors and others involved in the provision of abortion care, that we have your back.” Becerra and OCR clearly don’t want to enforce the law for those who do not want to participate in abortion.
7. Directly Funding Big Abortion
Becerra, who has oddly and repeatedly refused to acknowledge that partial-birth abortion is illegal, led HHS’s charge to fund Big Abortion. In 2021, Planned Parenthood received more than $5.4 million in taxpayer funds from HHS, an amount that is sure to increase over the next three years.
In an effort to further fund Planned Parenthood, the Biden-Becerra HHS ignored democratic norms to rush through new Title X regulations. Title X is a federal program that provides grants for a range of family planning services, but per the statute, such services cannot include abortion.
The new regulations, however, remove the requirement of physical and financial separation between Title X projects and abortion services, require abortion counseling and referrals, and remove conscience protections for Title X providers. Planned Parenthood had dropped out of the Title X program under those regulations, forfeiting that funding stream, but under the new regulations the abortion giant is expected to receive significant Title X funding.
8. Comingling Insurance Payments for Abortion
Last summer, HHS rushed through new insurance regulations that, contrary to the text of the Affordable Care Act, no longer require separate insurance payments for abortion services, allowing those payments to be comingled with payments for other covered services. Besides violating the law, combined payments create a lack of transparency and accountability. Consumers with conscience objections to abortion will no longer be on notice that their insurance plan covers abortion or that they are subsidizing abortions, including for any adult children on their plan.
9. Rescinding Faith-Based Waivers
Prompting a congressional inquiry, the Biden-Becerra HHS gratuitously rescinded waivers previously issued to faith-based adoption and foster care agencies in Michigan, South Carolina, and Texas that allowed the agencies to qualify for HHS grants while operating in accordance with their deeply held religious beliefs. In the press release announcing the rescission, Becerra unironically stated: “At HHS, we treat any violation of civil rights or religious freedoms seriously.”
Please. This action comes on the heels of a unanimous ruling by the Supreme Court affirming the constitutional right of foster-care agencies to act according to their religious beliefs on human sexuality in certifying foster parents.
10. Issuing Totalitarian Anti-Conscience Rules
HHS announced its new interpretation and enforcement of Section 1557 of the Affordable Care Act that would force health-care professionals to perform gender transition surgeries and provide minors with harmful and sterilizing puberty blockers and cross-sex hormones. A new rule codifying this interpretation is anticipated in April and would likely not exempt providers with medical or conscience objections. HHS is also planning to rescind conscience regulations that protect health-care professionals from being forced to assist with abortions and protect others from having to pay for abortions.
Rachel N. Morrison is an attorney and fellow at the Ethics and Public Policy Center, where she works on EPPC’s HHS Accountability Project.
A regulatory change in California has placed abortion in the category of ‘basic health services’ all insurance plans must cover. Even those churches buy. Photo John Ragai / Flickr
For the past four years, the Obama administration and its friends on the Left were careful to claim that they still strongly support religious liberty while arguing that Hobby Lobby’s Green family, Conestoga Wood Specialties’ Hahn family, and others like them must lose. Principally, they contended, religious liberty protections could not be applied to Hobby Lobby because (1) It is a for-profit corporation, (2) It isn’t a church (and thus not a true “religious employer,” and (3) It is wrong on the science—Plan B, a copper intrauterine device, et cetera, they claimed, do not cause abortions. They implied, if not claimed outright, that they would surely support religious freedom in another case, but Hobby Lobby was unworthy to claim its protections.
The State of California is now calling their bluff. California’s Department of Managed Health Care has ordered all insurance plans in the state to immediately begin covering elective abortion. Not Plan B. Not contraceptives. Elective surgical dismemberment abortion.
At the insistence of the American Civil Liberties Union, the DMHC concluded that a 40-year-old state law requiring health plans to cover “basic health services” had been misinterpreted all these decades. Every plan in the state was immediately ordered, effective August 22, to cover elective abortion. California had not even applied this test to its own state employee health plans (which covered only “medically necessary” abortions). But this novel reading was nevertheless quietly imposed on every plan in the state by fiat.
The news has slowly leaked out as insurers grappling with this change have begun quietly informing employers of this sudden change in the terms of their policy. This is how Kaiser Permanente broke the news to one California church that its insurance policy for its pastors and staff would now include elective abortion coverage:
I want to formally share with you that on August 22, 2014, the Department of Managed Health Care (DMHC) notified Kaiser Permanente and other affected health plans in writing regarding group contracts that exclude ‘voluntary termination of pregnancy.’
This letter made clear that the DMHC considered health care services related to the termination of pregnancies – whether or not a voluntary termination – a medically necessary basic health care service for which all health care services plans must provide coverage under the Knox-Keene Health Care Service Plan Act. You may recall that at the request of some employer groups with religious affiliations, Kaiser Permanente submitted a regulatory filing in May 2012 properly notifying the DMHC of a benefit plan option that excluded coverage of voluntary terminations of pregnancies. The DMHC did not object to this filing, permitting Kaiser Permanente to offer such a coverage contract to large group purchasers that requested it. The DMHC acknowledged that it previously permitted these contract exclusions, but now is requiring health care service plans to provide coverage of all terminations of pregnancies, effective immediately. To that end, the DMHC requires Kaiser Permanente and similar health care service plans to initiate steps to modify their plan contracts accordingly.
Effective August 22, Kaiser Permanente will comply with this regulatory mandate.
Churches Can Exclude Chemical Baby Killing, But Not Surgical
Several other California churches have received similar notices from their insurers, and others will follow. While California (like the U.S. Department of Health and Human Services, or HHS) exempts churches from its contraceptive mandate, there is no exception to this bureaucratic abortion mandate. This leaves California churches in the illogical and impossible position of being free to exclude contraceptives from their health plan for reasons of religious conscience but required to provide their employees with abortion coverage.
This California mandate is in blatant violation of federal law that specifically prohibits California from discriminating against health care plans on the basis that they do not cover abortion. Alliance Defending Freedom and Life Legal Defense Foundation have filed administrative complaints with the HHS Office of Civil Rights (which oversees this federal law) on behalf of individual employees and seven California churches forced into abortion coverage in violation of their conscience.
What will be the administration and the Left’s response to this unprecedented attack on religious liberty? If they couldn’t stand with Hobby Lobby because it was a for-profit business, not a church, and because they thought its conscience concern was misplaced on the abortifacient nature of Plan B, will they now demand religious liberty for churches forced to cover elective abortion? If not now for religious liberty, when?
Do the administration and the left-wing commentariat continue to see any life in the First Amendment’s religious liberty protections at all? The Left’s response to California’s abortion mandate will reveal whether their claims of respect for religious liberty in the Hobby Lobby case were serious or mere fig leafs for an even more dismal view of religious liberty than they have let on.
Timing is everything. And just as Congress’s focus seems to be drifting from Obamacare’s ravages on the economy, Americans are learning the reason this law’s implementation was postponed until after the presidential election.
That reason is becoming clear as person after person opens the mail. Insurance costs are going up. For many, not just going up—skyrocketing.
Ross, a married father of three small boys in Florida, tells us his insurance will be going up $525 per month. “I feel completely helpless,” he says.
Kevin, who also has three small boys, just found out his wife’s individual health insurance premium will be jumping from $79 per month to $311.82 per month.
“For whom exactly is the Affordable Care Act making care affordable?” asked Kevin, who lives in Alabama.
But this isn’t all. While people are receiving notices that their premiums are going up or perhaps their health plans are being discontinued, there’s a secret in Obamacare’s exchanges, too.
One of the reasons the Obamacare website has been so slow and glitchy? It requires people to enter personal information before they’re able to see insurance plan options. Health and Human Services does this so that if you’re eligible for a subsidy, you won’t see the true cost of your health plan.
Obamacare is laden with mandates that are driving up the cost of health insurance. And it didn’t stop with the original law. Federal bureaucrats are continuing to write more Obamacare regulations. One estimate is that these paper pushers have added 30 words of regulations for every word in the original law.
No small tweak to Obamacare can fix this. No small tweak can give relief to these hard-working dads who are supporting their families and getting the wind knocked out of them by hundreds of dollars in insurance hikes.
If Congress does anything less than defund Obamacare, it is turning its back on all of these suffering Americans.
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