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When Project 2025 Came to Town:  Part 3 - When Making America Healthy Again Goes Wrong. The Plan to Overhaul HHS.

As measles and bird flu ravage this country, Medicare and Medicaid are being threatened with funding cuts. Meanwhile, our new HHS Secretary, Robert F. Kennedy, Jr., is focused on the type of oil Steak 'N Shake restaurants use to cook french fries. It's all so absurd that it's almost laughable. Unfortunately, though, none of this is funny. People will die due to the incompetence of this administration. However, incompetence isn't the only thing we need to be concerned about.

We have spent the past few weeks discussing Project 2025's primary goal for America, which is dismantling the "administrative state." We took a look at its specific plans for eliminating the Department of Education, which are already being implemented. Now let's take a deep dive into Project 2025's plans for another cabinet department: Health and Human Services (HHS).

The Department of Health and Human Services affects the daily lives of average Americans more than any other cabinet department. Its $1.7 trillion budget supports various agencies, including the Centers for Disease Control (CDC), National Institutes of Health (NIH), Food and Drug Administration (FDA), Center for Medicare and Medicaid Services, Head Start, Office of the Surgeon General, Office of Child Support Enforcement, Office of Civil Rights, Agency for Toxic Substances and Disease Registry, Administration for Community Living, Administration for Children and Families, Indian Health Service, Office of Refugee Resettlement, Office of Global Affairs, and others.

The Plan to Transform  Healthcare in America

Project 2025's plan to transform healthcare in America begins with privatizing and reorganizing HHS. It addresses vaccines and the next pandemic, Medicare, Medicaid, and conservative family values. It also includes aggressive anti-abortion and anti-LGBTQ agendas. Let's dig into the details:

When in Doubt, Privatize and Reorganize

This administration's plans for the Department of Health and Human Services begin with reducing regulations for healthcare in rural areas and incentivizing private alternatives to government services. According to Project 2025, "America’s broken insurance system, run largely through confusing provider networks and third-party payers (employers), induces overconsumption of health care, limits consumer shopping, and hides true costs from patients."

Whether they believe it or not, these regulations are important rules that help keep us all safe. This means there will be a lot of unintended consequences from this administration's reckless decisions. Make sure to pay close attention to the food, medicine, and medical services you receive over the next few years. Expect more recalls and less oversight. We should also expect cuts to important services and rising prices as private businesses decide to take advantage.

Project 2025 also calls for reorganizing parts of HHS:

  • Similar to its plans for the Department of Education, it calls for any programs that deal with healthcare for American Indians and Alaska Natives to be moved to the Bureau of Indian Affairs in the Department of the Interior.

  • The Assistant Secretary for Health is a four-star admiral for the United States Public Health Service Commissioned Corps, and the Surgeon General is a three-star admiral. Project 2025 calls for combining these positions into one four-star position with the rank, responsibilities, and authority of the former and the title of the latter.

  • The deputies for these two positions (Principal Deputy Assistant Secretary for Health and Deputy Surgeon General) would also be combined. The new Deputy Surgeon General would be a three-star position with operational control and financial and deployment decision-making authority.

  • Additionally, the Office of Refugee Resettlement will be moved to the Department of Homeland Security, deprioritizing our focus on the healthcare of incoming refugees. The Flores Settlement Agreement, which establishes minimum standards of care for all children involved with our immigration system, will be eliminated, and there will be a complete ban on abortions in immigration detention centers.

Vaccines and the Next Pandemic

Nothing has broken the right-wing of American politics like the COVID-19 pandemic--not even electing Barack Obama. They convinced themselves that they were living in Nazi Germany in 2020 and Dr. Anthony Fauci was Hitler. As a result, a significant portion of Project 2025's plans for HHS focus on ensuring that lockdowns, masking, and vaccine mandates will never happen again.

  • Project 2025 specifically blames the CDC for recommending mask mandates across America, and they blame the NIH for recommending COVID-19 vaccine mandates. To be clear, they are not accusing these agencies of incompetence. Instead, they don't think any of the lockdowns, masking, or vaccines were ever necessary; they were just a conspiracy that Dr. Fauci pushed on us for his own personal financial gain. Of course, none of this isn't true, but the truth never stopped these guys before. They think Dr. Fauci personally received royalties for every COVID-19 vaccine shot because he was leading the NIH when it funded research for the vaccine. They have combined this flawed assumption with outrage over NIH funding for transgender research in an effort to stop NIH from funding any scientific research. Here's a FactCheck.org article from 2023 that explains what really happened.

  • Project 2025 also recommends splitting the CDC into two separate entities: one to publish epidemiological data gathered from states and one that is responsible for public health but has no ability to make policy recommendations.

  • They want to move all vaccine safety programs to the FDA, including the Vaccine Adverse Event Reporting System, Vaccine Safety Datalink, and Clinical Immunization Safety Assessment project. They also want to rewrite the rules about testing for COVID-19 and other diseases to make sure that congressional authority outweighs the FDA, Medicare, and Medicaid.

  • They want the FDA to force drug companies to share samples of their brand-name products with other companies developing generic alternatives in order to bring down costs.

  • They want to end all public–private partnerships at the CDC, NIH, and FDA, claiming they represent a conflict of interest. This is why they also want to mandate a specific "cooling off period" for former HHS employees before they can go to work for drug companies. (I have to admit that this is the only decent idea included in all of this madness.)

  • They think paying television stations to air drug commercials influences makes those stations and their news coverage of the drugs biased and untrustworthy, so they plan to stop drug companies from advertising their products to the public.

  • They want to start importing vaccines from other countries because they believe that American vaccine research uses fetal tissue and stem cells, which violates people's anti-abortion beliefs. They claim Biden revoked the authorization to import competing vaccines in violation of their religious freedom. For clarity, here's a FactCheck.org article from 2022 explaining that COVID-19 vaccines do not include any fetal tissue.

  • Before the next pandemic, they want to create a threshold for what constitutes a public health emergency based on the number of cases, hospitalizations, and deaths that occur. This may seem like a good idea, but replacing the expertise of health professionals and the flexibility to make real-time decisions with a one-size-fit-all solution would be a mistake. The next pandemic may be nothing like COVID-19. It could be harder to detect or harder to kill, which would affect the number of reported cases and hospitalizations. Alternatively, it could incapacitate its victims instead of killing them, which would prevent us from reaching the number of deaths required to take action.

  • Project 2025 calls for ending all mask and COVID-19 vaccine mandates for healthcare facilities and personnel. It also calls for revoking any corresponding guidance and regulations in order to make sure that no new mandates can be imposed in the future.

  • They will pay damages to every medical professional who was dismissed because of vaccine mandates.

  • They will also walk back the legal analysis that authorized HHS to stop rental evictions during the COVID-19 pandemic to make sure it can never happen again. In addition, they plan to minimize FEMA's role in making healthcare recommendations once a national emergency has been declared.

Medicare is on the Chopping Block

Project 2025 blames Medicare and Medicaid for turning HHS into "the belly of the massive behemoth that is the modern administrative state." It calls them the principal drivers of the national debt and claims that Lyndon Johnson set them on autopilot with no plans for how to pay for them. Once again, this is inaccurate, but these people never let facts get in the way of a good story.

  • The first step in the plan to cut Medicare is to try to send it to the states as block grants, similar to the way we handle Medicaid. According to Project 2025, "States should be the primary regulators of the medical profession, and the federal government should not restrict providers’ ability to discharge their responsibilities or limit their ability to innovate through government pricing controls or irrational Medicare and Medicaid reimbursement schemes."

  • Next, they plan to remove the restrictions on which hospitals are eligible for Medicare reimbursements, clearing the way to shift funding toward physician-owned, religious, and specialty hospitals.

  • They seem to really like Medicare Advantage and plan to make it the default Medicare enrollment option. According to Project 2025, "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." If the authors of Project 2025 get their way, this will be the only part of Medicare left. They plan to make the following changes:

  • Give Medicare beneficiaries direct control of how their money is spent by removing the regulations on Medicare Advantage plans, including the rules about prescription drugs, hospice care, and medical savings account plans.

  • Replace the complex formula-based payment model for Medicare services with a more competitive bidding model, and update the risk adjustment model we currently use.

  • Determine payment amounts based on the patient's health status or the intensity of the service instead of where the services are received.

    • Replace the current fee-for-service system with value-based payments to empower patients to find the care that best serves their needs. This means they want to create subscription plans for healthcare services instead of paying a different fee for each service rendered. This would mean completely transforming the way providers charge for their services.

    • Update the rules for prescription drug subsidies so they start reimbursing patients instead of hospitals.

    • Pass a law that requires price transparency for all Medicare services.

  • The Biden Administration's Inflation Reduction Act created a drug price negotiation program in Medicare that replaced the private-sector negotiations from Medicare Part D with pricing restrictions for prescription drugs. According to Project 2025, "these government price controls will limit access to medications and reduce patient access to new medication." This is why they want to repeal the Medicare Shared Savings Program, as well as other parts of the Inflation Reduction Act.

  • They also want to remove any funding or support for physician-assisted suicide and recommend that Medicare covers palliative care only.

Medicaid is also on the Chopping Block

The authors of Project 2025 plan to make significant changes to the Medicaid program as well, even though it is run by the states. They actually want to eliminate the current block grant and waiver process for the states and replace with a new program that adds more flexibility.

  • For example, when it comes to Medicaid eligibility:

    • They want more detailed eligibility determinations in every state, and they will punish states for any mistakes that are made when determining patient eligibility.

    • Specifically, they want stronger asset tests to make sure that Medicaid recipients have no valuable possessions.

    • They also want to add work requirements and start scaling benefit amounts to match the patient's level of financial need. These would be significant changes to the way the system is currently run.

  • They want to make Medicaid recipients pay for their own healthcare, claiming they are just "incentivizing personal responsibility."

  • They also want to introduce more competition among private health insurance plans that are offered through Medicaid and remove the restrictions on the type of insurance plans allowed to participate in the Healthcare.gov marketplace.

  • They plan to update the No Surprises Act about medical billing to strengthen hospital price transparency.

  • They want to separate and offer different plans for subsidized and unsubsidized patients on the Healthcare.gov marketplace.

  • They plan to redefine the laws on Telehealth services so they base payment rates on the location of the providers instead of the location of the patients.

  • They also want to expand the number of services that qualify for Medicaid reimbursements in low-complexity and moderate-complexity clinical laboratories. In addition, they plan to create a certification process for non-clinical laboratories as well.

Conservative Family Values

In addition to dismantling the administrative state, a primary goal of Project 2025 is to embed "conservative family values" into the fabric of America's government, including all of its laws and policies.

  • Ironically, a key element of these supposed family values is eliminating Head Start, a program that educates and cares for preschoolers. The misguided justification for this is unsubstantiated claims of child abuse in Head Start programs. Project 2025 also claims that Head Start isn't making any difference in its students' long-term educational outcomes. In reality, the real reason is that they don't want to spend their money educating low-income children when they think that should be the parents' job.

  • Another HHS program called Temporary Assistance for Needy Families (TANF) will become harder to qualify for. Eligibility for TANF is determined by recipients' income and assets. However, Project 2025 also wants to start counting non-cash benefits of $50 or more that recipients receive for six months or more. Think about that for a minute. If a single mom or dad has to live with relatives for six months or more, that lodging could be considered a non-cash benefit that prevents them from getting federal assistance. The same goes for a friend or family member lending them a car for six months. Non-cash benefits could be anything. That's why this is an obvious attempt to decimate the TANF program by raising the requirements for eligibility.

  • The Center for Medicare and Medicaid Services will start collecting data on marriage and family so their effect on health outcomes can be measured. According to Project 2025, "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."

  • The authors of Project 2025 believe that "family planning" should focus on abstinence and marriage education instead of birth control and abortion. This is why they plan to redirect federal funding toward programs like Healthy Marriage and Relationship Education (HMRE), Sexual Risk Avoidance (SRA), Teen Pregnancy Prevention (TPP), and Personal Responsibility Education Program (PREP). In a surprise to absolutely no one, they also want to stop providing condoms to students, claiming that federal funds can only be spent on female contraception methods, and condoms are for males.

  • When it comes to adoption and foster care services:

    • Project 2025 called for Congress to "pass the Child Welfare Provider Inclusion Act to ensure that providers and organizations cannot be subjected to discrimination for providing adoption and foster care services based on their beliefs about marriage." This would allow facilities to legally deny adoption services based on marital status or sexual orientation.

    • Additionally, it calls for honoring "requests for religious accommodation from people, families, and doctors who cannot in good conscience take or administer vaccines, including those made or tested with aborted fetal cell lines."

  • The Department of HHS is home to the Office of Child Support Enforcement, so Project 2025 includes a specific agenda for fathers who pay support:

  • Create a child support tax credit

    • Allow child support to be paid using smartphone apps

    • Allow fathers to decrease the amount of child support they are required to pay by spending more time spent with their children

    • Allow the government to terminate parental rights if a judge determines that one or both parents are not making enough effort

The Anti-Abortion Agenda

Abortion is one of the most important and controversial issues on the right-wing of American politics. Project 2025 accuses HHS of using abortion as healthcare, "subsidizing single-motherhood, disincentivizing work, and penalizing marriage." Its authors celebrate the 2022 Dobbs v. Jackson Supreme Court decision and propose several new policies to support it:

  • Outlaw 'chemical abortions,' which is the term they use for medications like Mifepristone and Misoprostol, as well as the Morning After Pill. According to Project 2025, "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."

  • Prohibit any federal funding for travel related to abortions.

  • Enforce the Hyde Amendment and audit the entire HHS department for compliance. Also make sure that Congress passes the Protecting Life and Taxpayers Act to back this up.

  • Force states to collect and report detailed abortion-related statistics by threatening federal funding.

  • Make the CDC fund research about the risks and complications of abortions, including a study about whether abortions lead to cancer.

  • Outlaw the practice of using "aborted fetal cells and aborted baby body parts" for scientific research. Eliminate all stem cell research, as well as the NIH Human Embryonic Stem Cell Registry. Reinstate the Embryonic Stem Cell Research Oversight Committee.

  • Prohibit Planned Parenthood and any other entity that offers elective abortions from receiving Medicaid funds for any form of healthcare.

  • Withhold Medicaid block grants from the seven states that require health insurance providers to cover abortions: California, Illinois, Maine, Maryland, New York, Oregon, and Washington.

  • Outlaw the practice of killing babies that survive abortions. (To be clear, this is murder, which is already illegal last time I checked. However, here's a FactCheck.org article from 2019 that provides a bit of nuance on this issue.)

  • Withdraw federal funding from every school and training program that teaches healthcare providers how to perform abortions.

  • Replace the HHS Reproductive Healthcare Access Task Force with a pro-life task force and create a new position for a Dedicated Special Representative for Domestic Women’s Health.

  • Withdraw guidance from the Office of Civil Rights on protecting patient privacy after abortions as part of the Health Insurance Portability and Accountability Act (HIPAA).

  • Make sure Congress passes the Conscience Protection Act, which allows people to sue healthcare providers directly about abortion issues instead of only being able to file complaints with the Office of Civil Rights. Restore and fully fund the Office of the Deputy Director position in the Conscience and Religious Freedom Division.

The Anti-LGBTQ Agenda

Under the guise of protecting children’s minds and bodies and respecting parental rights, Project 2025 also includes an aggressive anti-LGBTQ agenda, which calls for eliminating any mention of gender identity or sexual orientation from HHS guidance and programs. It also includes the following proposals:

  • Stop the CDC from collecting any data on gender identity. According to Project 2025, this "legitimizes the unscientific notion that men can become women (and vice versa) and encourages the phenomenon of ever-multiplying subjective identities."

  • Eliminate all federal funding for gender reassignment surgery. Withdraw any support for the research ideas behind gender-affirming care.

  • End the woke policies at the NIH that encourage women-led panels at conferences and support transgender research.

  • Remove any language about gender or COVID-19 from the National Strategy to Support Caregivers.

  • Roll back the Title IX updates made during the Biden Administration concerning sexual orientation and gender identity. Stop any enforcement of anti-LGBTQ discrimination laws.

Implementing Their Plans

Now that we know what Project 2025's true plans are for the Department of Health and Human Services, it's easy to see that RFK, Jr.'s recent escapades at Steak 'N Shake are nothing but a distraction. Trump has only been in office for two months, but he has already taken several concrete steps toward achieving Project 2025's goals. According to the Project 2025 Tracker, which is an amazing resource, 30% of the plans for HHS have already been implemented.

  • On Trump's first day in office, he revoked several of Biden's executive orders that strengthened Medicare, Medicaid, and the Affordable Care Act (commonly known as Obamacare).

  • On January 24, Trump signed the Enforcing the Hyde Amendment executive order, which brings an "end the forced use of Federal taxpayer dollars to fund or promote elective abortion" and rescinds two of Biden's abortion-related executive orders from 2022.

  • On January 27, the Office of Management and Budget issued a memo freezing all federal grants and loans. Although the memo was blocked in court and eventually rescinded, federal payments were never resumed for some programs. Head Start was among the hardest hit. According to an article from Wisconsin public radio on February 3, "One week after the Trump administration ordered a pause on federal grants and loans, many Head Start programs in Wisconsin are still unable to access needed funds and are facing uncertainty about whether they can stay open."

  • On January 28, Trump signed the Protecting Children from Chemical and Surgical Mutilation executive order, which states that "it is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called 'transition' of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures."

  • On January 30, Huffpost reported on a Department of Transportation memodirecting employees to prioritize funding and resources for "communities with 'marriage and birth rates higher than the national average.' The unusual four-page memo also directs thousands of employees to give special priority to projects and activities that improve transportation for 'families with young children.' The directive applies to all Transportation Department-supported grants, loans and contracts, including existing agreements."

  • On February 7, Trump signed the Establishment of The White House Faith Office executive order, which establishes a presidential advisory committee of hand-picked faith leaders from across the U.S. The committee will advise the President and executive branch officials on policies related to religion and will consult with business leaders across the country on the implementation of these policies.

  • On February 3, Jessica Valenti published an article called "Trump is Scrubbing HIPAA Info off HHS Website." According to Valenti, "the Trump administration has scrubbed information about HIPAA protections for reproductive rights from the Department of Health and Human Services (HHS) website. They’ve also erased guidance on pharmacies’ obligation not to discriminate against patients seeking reproductive health care."

I have to be honest, the scope of all this is breathtaking. Think about it. The party that calls themselves "conservative" is planning to make sweeping changes to nearly every aspect of our lives. They are using language like "Make America Healthy Again," family values, and parental rights to privatize our healthcare and discriminate against specific communities. They are trying to dismantle the government services and social programs that have served vulnerable Americans for more than sixty years. This is personal for every American, but it is also ideological. It turns out the party that is always complaining about the government is actually trying to dismantle the government now that they are in power. None of this is random. It is a well-planned assault on the concept of liberal governance.

The best thing Americans can do now is educate ourselves about their true plans and RESIST them as much as possible. Contact your representatives at the federal, state, and local levels with specific items you want them to focus on and specific actions you want them to take. File lawsuits if you can! We have already seen the judicial branch issue injunctions and reversals of some of Trump's orders, but judges can not rule on cases that do not exist. Attend as many protests as you can! It is important to show this administration that we will not allow them to dismantle our government with no pushback.

There's no denying that Trump's administration is much worse this time around. That's because last time, he didn't have a plan. This time, he's been given a 900-page playbook to follow, and he is all too happy to oblige.

When Project 2025 Came to Town: Roadmap

Each installment of When Project 2025 Came to Town will cover detailed plans for overhauling one or more federal government agencies taken straight from the Project 2025 playbook. Then we'll compare those plans with the concrete actions Trump has taken in office so far. We'll also highlight any pushback that may be happening and discuss what regular people can do to thwart these plans.

  1. Dismantling the "Administrative State"

  2. How to Destroy Education in America in 10 Easy Steps

  3. When Making America Healthy Again Goes Wrong

  4. Immigration and Border Patrol

  5. Defense, State Dept., Intelligence Community, and Homeland Security

  6. Foreign Policy and USAID

  7. The Justice Department and the Media

  8. Housing and Urban Development

  9. Labor and Transportation

  10. Interior, Agriculture, and Energy

Make sure to subscribe to get the rest of my When Project 2025 Came to Town series delivered directly to your inbox. Leave a comment below or follow Civics4All on BlueSky to continue the conversation. I want to hear your thoughts!
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