President Donald Trump’s appointees in the health department have deleted positive references to Obamacare, altered a report that undermined the administration’s positions on refugees and added anti-abortion language to the strategic plan — part of an ideological overhaul of the agency’s research office.
While every administration puts its imprint on the executive branch and promotes ideas that advance its own agenda, this one has ventured several steps further — from scrubbing links to climate change studies from an Environmental Protection Agency website to canceling an Interior Department study on coal mining risks and suppressing reports on water contaminationand the dangers of formaldehyde.
Inside the Health and Human Services policy research shop, staffers say the political pressures to tailor facts to fit Trump’s message have been unprecedented.
Several pointed to embarrassments such as PolitiFact grading a lawmaker’s statement, based on the agency’s May 2017 report on Obamacare premium hikes, as “false,” and concluding the study had serious methodological problems.
Another report suggesting that millions more people would get health coverage if Obamacare were rolled back — a finding at odds with nearly every independent analysis — was widely mocked and produced over the objections of career staff at the office of the assistant secretary for planning and evaluation, known as ASPE, say several sources.
“The heartbreaking part is that ASPE is the source of the evidence and the science for how decisions are made,” said a former senior official, who worked under both Republican and Democratic administrations. “It’s just another example of how we’re moving to a post-fact era.”
The office has been especially vulnerable to political pressure because its leadership remains in flux. The University of Minnesota health economist tapped to lead the office by Trump has been dogged by questions about his financial entanglements, leaving his nomination in limbo for more than a year. The acting head of ASPE was recently reassigned to a regional office, and the top deputy altered McKinsey-produced data to make it more favorable to the Trump administration, according to multiple sources with knowledge of the changes.
“I find the attack on the integrity and the culture of the office to be disturbing,” said Richard Frank, a Harvard health economist who ran ASPE as an Obama administration political appointee. “This is really a departure to an office that has a 50-year history to it.”
HHS officials vigorously disputed portrayals of the office as ideologically driven.
“I reject the premise of your question and allegation,” said spokeswoman Caitlin Oakley. “Secretary [Alex] Azar has made very clear that HHS is a science- and evidence-based organization and it will operate accordingly.”
Oakley said the 120-person office has been refocused to work on Trump administration priorities like drug pricing and the opioid epidemic. Two staffers say those topics are regarded as safer ground because they are not part of the health care culture wars. Under Azar, who assumed leadership of the agency about six months ago — after most of these incidents occurred — the office has produced a six-page research brief on drug pricing, which published this week, and two studies on the opioid epidemic. Oakley said more reports are coming.
But the group’s morale and role remain diminished, as key staff and teams have dwindled; there are just three staffers working on analyzing health coverage, down from about a dozen at the end of the Obama administration, said a staffer.
Republican health policy analyst Lanhee Chen, who served as an HHS senior counselor in the George W. Bush administration, scoffed at the notion that this policy shop is more partisan than the one that preceded it.
“I don’t believe the Trump administration ASPE has put out reports that are any less analytically or methodologically rigorous than those of the Obama administration ASPE,” Chen said. “Those who express concerns regarding the quality of reports ‘falling off’ are probably using that argument as a cover for the fact that they disagree with the findings of the reports.”
Chen said he regards the policy shop as a vehicle to advance administration policy, “so in that sense, methodological rigor has not necessarily been a metric I have used to evaluate their reports. That’s why we have studies from academics and analysts outside of government.”
This story is drawn from interviews with nine individuals with knowledge of ASPE operations, most of whom asked for confidentiality to speak freely, as well as with outside observers.
Shift in office’s focus
ASPE historically has been used to investigate the impact of HHS policies and help shape future strategy, and under the Obama administration, it focused closely on the expansion of health insurance coverage and the Affordable Care Act — issues on which Barack Obama had campaigned heavily and made central to his presidency. The office published 43 reports on the ACA’s effects on rural hospitals, women’s health and other discrete corners of health care between January 2015 and January 2017 alone, generally extolling the effects and sometimes overlooking the drawbacks.
For instance, one 2016 study on choosing health plans in the ACA market was criticized for slanting its findings.
[Politico]
