The nation's health department is taking steps to dismantle LGBT health initiatives, as political appointees have halted or rolled back regulations intended to protect LGBT workers and patients, removed LGBT-friendly language from documents and reassigned the senior adviser dedicated to LGBT health.

The sharp reversal from Obama-era policies carries implications for a population that's been historically vulnerable to discrimination in health care settings, say LGBT health advocates. A Health Affairs study last year found that many LGBT individuals have less access to care than heterosexuals; in a Harvard-Robert Wood Johnson-NPR survey one in six LGBT individuals reported experiencing discrimination from doctors or at a clinic.


The Trump administration soon after taking office also moved to change the agency's LGBT-related health data collection, a window into health status and discrimination. Last month it established a new religious liberty division to defend health workers who have religious objections to treating LGBT patients.

The changes at the Department of Health and Human Services represent "rapid destruction of so much of the progress on LGBT health," said Kellan Baker, a researcher at the Johns Hopkins School of Public Health who worked with HHS on LGBT issues for nearly a decade. “It’s only a matter of time before all the gains made under the Obama administration are reversed under the Trump administration, for purposes that have nothing to do with public health and have everything to do with politics.”

The policy reversals also come after President Donald Trump repeatedly pledged during his campaign that he would support LGBT causes. "Thank you to the LGBT community!" Trump tweeted in June 2016. "I will fight for you while Hillary brings in more people that will threaten your freedoms and beliefs."

The Trump administration defended its approach to LGBT health as part of its broader health care strategy.

"The policies of the Trump administration are intended to improve the lives of all Americans, including the LGBTQ community," White House principal deputy press secretary Raj Shah said in a statement. "Through actions aimed at making health care more affordable, rolling back burdensome regulations, and combating the opioid crisis, the administration is working to ensure a healthier America."

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The new leader of HHS — Alex Azar, who was sworn in as secretary last month — is thought to be more pragmatic than his predecessor Tom Price. Azar previously led U.S. operations for Eli Lilly, a pharmaceutical company that has been hailed by the Human Rights Campaign, among others, for its pro-LGBT policies. Lilly opposed Indiana's religious liberty law, advanced by then-Gov. Mike Pence, that LGBT groups said was discriminatory.

However, staff inside the health department have raised concerns about several other Trump appointees now in senior roles who had a history of anti-LGBT comments before joining the agency. Among them is Roger Severino, a former Heritage Foundation official who has said that the Supreme Court's 2015 decision on same-sex marriage was "wrong" and repeatedly warned of its consequences.

"[S]ame-sex marriage was merely the start, not end, of the left’s LGBT agenda," Severino wrote in May 2016, about 10 months before he was tapped by Trump to be the health department's top civil rights official. "The radical left is using government power to coerce everyone, including children, into pledging allegiance to a radical new gender ideology over and above their right to privacy, safety, and religious freedom."

Asked in an interview this month if he stood by those comments, Severino pointed out that since joining the health department he had reached out to LGBT advocates. He also said his responsibility as civil rights chief is to uphold constitutional protections for all Americans.

"Statements I've made in the past are not binding on what I do in my role as a public servant," Severino said. "What I'm guided by, and what I'm required to follow, is the law… I'm dedicated to treating everybody fairly and in accordance with the law."

HHS officials also pointed to a listening session that Severino convened in April 2017 with more than a dozen LGBT advocates as well as several follow-up conversations with medical experts. "The outreach has been significant," an agency spokesperson said.

But nearly all of those LGBT advocates said they've essentially been ignored since sitting down with Severino nearly a year ago.

"There’s been no communication since then through all the channels that he and his staff know how to reach us," said Mara Youdelman of the National Health Law Program, who attended last year's listening session and submitted subsequent requests for information that haven't been returned. "It was a one-shot deal — and all of their actions speak much louder than words and one listening session."

New direction under Trump

Though Barack Obama as a candidate for president opposed same-sex marriage, his administration immediately took steps to advance LGBT health issues, like loosening the rules on hospital visitation rights after some same-sex couples had been barred from seeing each other.

"[A]ll across America, patients are denied the kindnesses and caring of a loved one at their sides… [and] uniquely affected are gay and lesbian Americans," Obama wrote in a 2010 memorandum, instructing HHS to expand visitation rights, a policy that still stands.

The Obama administration in 2016 also finalized a regulation, Section 1557 of the Affordable Care Act, that banned discrimination in health care based on sexual orientation and extended those protections to transgender individuals for the first time.

While some conservative groups said that the Obama administration moved too quickly on LGBT health priorities, its leaders argue their efforts were necessary, even overdue. "The purpose of the agency is to serve all Americans, not just straight people. Our job was helping everyone," said Kathy Greenlee, who was appointed as an assistant HHS secretary in 2009 and is openly lesbian. "There was pent-up support for these issues."

But upon taking office last year, the Trump administration swiftly froze a series of LGBT-friendly rules, including proposed new regulations to further ban discrimination in Medicare and Medicaid. A regulation that would have allowed transgender HHS staff more protections when using the department's bathrooms and other facilities also was ignored.

"It was signed and technically finished on Jan. 19, 2017, but not posted online," said one staffer. "And the new administration considered it unpublished and pulled it back."

The Trump administration also reinterpreted the ACA's Section 1557 anti-discrimination mandate, with the White House declining to fight a court battle to enforce it and signaling that it would roll back the rule. The health agency's new Conscience and Religious Freedom Division, which POLITICO first reported last month, is expected to offer greater protections for health care workers who do not wish to treat LGBT patients.

Meanwhile, the agency's senior adviser for LGBT health — a lawyer named Elliot Kennedy — was reassigned from the HHS secretary's office to an HHS office in Rockville, Md., to work on disease prevention. Kennedy's previous portfolio, including leading a committee to review and advance LGBT policy issues across HHS, also has lost influence, after openly LGBT leaders left the agency and current LGBT staffers say they've been dissuaded from attending. The committee's annual report has not been publicly posted since 2016.

"Elliot Kennedy currently serves in the Office of Disease Prevention and Health Promotion as liaison for Healthy People 2020’s LGBT Health Topic and Objectives," an HHS spokesperson said, in response to questions about the reassignment. "He continues to serve on the HHS LGBT Policy Coordinating Committee."

Another quiet battle has been over a pair of HHS surveys, with the Trump administration moving to strike questions about sexual orientation that had been added by the Obama administration in order to understand health disparities and LGBT specific health issues. The two surveys are used to shape policy for older and disabled Americans, respectively. The Trump administration subsequently reinstated some of the questions after an outcry.

"A lot of people think data are really boring. But data are fundamental, especially to public health," said Baker, the Johns Hopkins researcher. "The only way to have the evidence you need to prioritize and spend wisely to address disparities is to have data about those disparities."

A listening session followed by silence

The Trump administration says that it’s worked hard to engage LGBT health advocates, pointing to the listening session convened by Severino in April 2017 and attended by 17 representatives from groups that specifically deal with LGBT health.

"We've done a lot of outreach to the LGBT community to hear people's concerns to be open, to listen and to learn," Severino said. "And we will continue to do that because it's important. I see my role as serving everybody."

But all of the LGBT advocacy organizations represented at the April 2017 listening session said that they had concerns about HHS' approach to LGBT health. Nearly every attendee said they hadn't had meaningful interactions with Severino or the civil rights division in 10 months and they were underwhelmed by last year's meeting.

"There’s a difference between hearing and listening," said Robin Maril of the Human Rights Campaign, one of the attendees. "For a listening session to actually be successful, we would’ve had to see actual, meaningful engagement. And we’ve seen nothing but disappointing and harmful policies come out of HHS and [the civil rights office] since the meeting."

"A number of us struggled with whether we would participate in something that would be used for exactly this purpose … a charade to be used by folks to suggest they are open-minded," added Sharon McGowan of Lambda Legal, who also attended. "That was the lost cause that we suspected that it was."

The Human Rights Campaign and Lambda Legal were among more than a dozen advocacy organizations that sent follow-up letters to Severino in April 2017 and July 2017 that warned HHS to halt rolling back LGBT protections and better engage the patient community. The advocates say they were ignored.

Only one attendee of last year's listening session who responded to POLITICO — Ezra Young, a lawyer who has since left the Transgender Legal Defense and Education Fund and is now in private practice — said that he's been reassured by Severino and HHS' actions.

"I'm trying to be fair to them. There was a lot of fear based on what Roger wrote in the past," said Young, a transgender, Latino man. "I don’t know at this point if all that fear is rational based on what has and hasn’t been done." Young added that he's been in dialogue with Severino, saying that the two men discussed lunch plans as recently as December.

However, Young's former employer holds a different view. "This administration continues taking actions that harm our community, which already faces immense bias," the organization said in a statement to POLITICO.

Christian conservatives hail HHS

Since Trump took office, multiple agencies have pursued policy reversals related to LGBT priorities. Under Attorney General Jeff Sessions, the Justice Department suggested that federal law doesn't ban sex discrimination in the workplace for transgender employees, a turnaround from the Obama administration. The Department of Education this month said that it would no longer investigate transgender students' complaints about access to bathrooms.

But Christian conservatives are noticing, and specifically praising, the reversals at the health department. "Few departments have [historically] given Christians more grief than HHS," Tony Perkins of the Family Research Council wrote last month. But "from about-faces on radical sex ed to abortion policy, the White House is turning the Health and Human Services into a virtual promise-keeping factory."

The Trump administration also has put its mark on the language it has — and hasn't — included in formal HHS documents.

One recent flashpoint was the department's four-year strategic plan, a document that's required by federal law, prepared by career staff and used as an agency roadmap. The latest draft plan, which was released in October, did not make a single reference to LGBT health issues — a notable break from the two previous strategic plans, dating back to 2010. The agency removed the draft plan, which also contained strong anti-abortion language, from its web site late last year.

However, the plan originally contained references to LGBT health, two HHS staffers told POLITICO, until political appointees ordered that the language be stripped from the document. The effort was spearheaded by Shannon Royce, the agency's liaison with religious groups, who staff say also took steps to include other language favorable to Christian conservatives.

"In our strategic plan, we actually affirmed life from conception to natural death," Royce said, touting the new language at the Evangelicals for Life conference last month.

HHS did not respond to a question about why references to LGBT health were removed.

Past comments cited by LGBT staff

Beyond policy, staff say there have been clear signals about the personnel chosen to steer the department. For instance, the Obama administration tapped multiple LGBT officials for senior roles, including Richard Sorian to run the agency's public affairs.

In contrast, the current public affairs chief is Charmaine Yoest, a prominent anti-abortion leader who for years advocated against same-sex marriage and other LGBT issues. For instance, Yoest a decade ago said that same-sex couples shouldn't be allowed to adopt children and that transgender individuals suffered from mental disorders; she declined to comment on whether she still holds those positions now. (POLITICO first reported on Friday that Yoest will soon be leaving HHS.) Royce, the head of the faith-based office, previously worked as a senior leader for organizations that fought same-sex marriage and promoted "conversion therapy," a controversial practice to change the sexual orientation of LGBT individuals.

Several other top officials also criticized LGBT priorities just months before joining the administration. "Vote LGBT if you want to be forced to have your baby delivered at an abortion clinic by an abortionist," Matthew Bowman tweeted in April 2016, about nine months before being tapped by Trump to join the health department, where he is currently deputy general counsel. After the Obama administration in June 2016 expanded protections for transgender military members, Severino wrote that the "decision has nothing to do with the Constitution and everything to do with politics and a gender ideology run amok."

HHS did not respond to specific questions about Yoest, Bowman, Severino and Royce's past public comments, and made only Severino available for comment. But a spokesperson said that LGBT staff should not be concerned.

"All the HHS staff you refer to in your story have sworn to uphold the law and believe that everyone deserves to be treated with respect because of their inherent human dignity," HHS spokesperson Matt Lloyd said in a statement. "The belief that marriage is between one man and one woman is a mainstream view held by millions of Americans, a belief the Supreme Court has said is based on 'decent and honorable premises.'"

Severino, the son of Colombian immigrants, added that he's spent his life working to combat bigotry after experiencing it growing up in California.

"I faced actual discrimination and mistreatment,” Severino said, who said he heard slurs while learning to swim at a public pool and was wrongly steered to remedial classes in high school. "Those sort of inflection points drives me and my passion for civil rights," he added, pointing to his education at Harvard Law School and subsequent work in the Department of Justice, where he served as an attorney for seven years under the George W. Bush and Obama administrations.

Career staff say that, regardless of what agency leaders believe or maintain now, their past comments on LGBT priorities have been widely passed around the 80,000-person department. "I photocopied them and left them in the cafeteria," said one staffer. "It's important for people to know these are the leaders they work for."

It's also fostered a climate where six staffers who are LGBT described removing their wedding rings before coming to work in the morning, taking down photos of their partners and families or ultimately finding new jobs further away from certain political appointees. They did not want to be identified; two said they feared being reassigned for being gay.

"When you have to hide a major part of who you are … it’s really debilitating," said one staffer. "I wish I had more courage to be out with these people."

Some LGBT staffers told POLITICO they hesitated to raise their concerns while the agency was run by then-Secretary Tom Price, who as a congressman voted against LGBT priorities and as secretary was backed by the Family Research Council, an anti-LGBT group that holds an official position that "homosexual conduct is harmful."

Long-serving staff who worked with new HHS Secretary Azar, when he served as a senior agency leader in the George W. Bush administration, or observed his work in the private sector say they're hoping he'll take a different approach. Under Azar's watch, Eli Lilly was hailed by the Human Rights Campaign as a company committed to inclusion and LGBT protections. The Indiana-based company also opposed a state law that critics feared could be discriminatory against LGBT people.

"Alex always struck me as a very pragmatic person. Not an ideologue. Very business-like. Very smart," said one LGBT staffer. "I’m hoping he’ll put some brakes on the ideological stuff."

Staff also suggested that HHS has bigger priorities than rolling back LGBT health gains. "To the vast majority of Americans, this isn’t that big a deal anymore," said an employee. "It’s perplexing why they spend so much time on it."

