On Friday, the Washington Post published a story that began:

The Trump administration is prohibiting officials at the nation’s top public health agency from using a list of seven words or phrases — including “fetus” and “transgender” — in official documents being prepared for next year’s budget.

The story goes on to complicate this claim a little bit, noting, for instance, some distinctions between terms that were supposedly flagged as prohibited in draft budget documents and others regarding which a prohibition “had been conveyed verbally” in a meeting among career officials at the Centers for Disease Control and Prevention. But the basic claim of the story is that HHS is telling its employees they’re not allowed to use seven words or terms—“vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.”



Naturally, this assertion has caused a big stir, setting loose everything from charges of censorship to worries that the CDC won’t be able to help victims of terrible diseases if they can’t communicate openly about their work. I was pretty startled by the story myself, and it sent me reaching out to a number of officials at HHS and its sub-agencies for an explanation. These conversations have left me persuaded that the impression created by the Post’s story is not accurate.

What seems to have happened here involves two sets of circumstances. First, the budget office at HHS sent the various divisions of the department a style guide to use in their budget-proposal language and “congressional justification” documents for the coming year. That style guide, which sets out a standard style for everything from capitalization of the titles of key offices to some commonly disputed points of grammar and punctuation, also sets out some words to be avoided. These, I am told, are avoided because they are frequently misused or regularly overused in departmental documents (make of that what you will) and they include three terms on the Post’s list: “vulnerable,” “diversity,” and “entitlement.” The style guide does not prohibit the use of these terms, but it says they should be used only when alternatives (which it proposes in some cases) cannot be.


I don’t remember there being a style guide for budget documents when I worked at HHS and at the White House in the Bush years, but one person I spoke with suggested there was one and that the Obama administration also used a style guide. Either way, many organizations in and out of government do the same, of course, as indeed the Washington Post does. No one denied, however, that these three terms were added to the budget-proposal style guide in this administration.


Did it make sense to suggest avoiding these terms? “Entitlement” really isn’t a term that should be used in congressional-justification documents (where “mandatory” is the technical, if actually less correct, term of art). The common practice of substituting the term “vulnerable” for “poor” has a long history of annoying some Republicans on Capitol Hill, and presumably that accounts for the instruction to avoid it in congressional-justification documents—although this has come up more often in the work of the Centers for Medicare and Medicaid Services than in that of the Centers for Disease Control and Prevention. In public health, after all, “vulnerable” has a distinct definition, and there are some CDC programs that couldn’t really avoid using the term in justifying their budget requests (like the Social Vulnerability Index). Presumably the guidance wasn’t intended for them. Your guess is as good as mine (and probably similar to mine) as to why HHS career officials might have thought “diversity” was not a good word to use with congressional Republicans. But these three are “avoid when possible” terms in a style guide specifically intended for budget documents. They’re not words that are banned in the department.


Second, these three terms to avoid apparently came up in the course of a meeting among career officials at the CDC late last week about preparing next year’s congressional-justification documents. That discussion then led to a conversation in the meeting about other terms that might be best avoided. (To be very clear: I did not speak with anyone who was present at that meeting, though I did speak with people who later spoke with the career CDC person who was in charge of the meeting and briefed the other career people there.) This meeting did not involve any political appointees, and apparently the conversation about terms beyond “diversity,” “entitlements,” and “vulnerable” was not about terms that anyone in the department had said should be avoided but about terms that it might be wise to avoid so as not to raise red flags among Republicans in Congress.


In other words, what happened regarding these other terms (“transgender,” “fetus,” “evidence-based,” and “science-based”) was not that retrograde Republicans ordered career CDC officials not to use these terms but that career CDC officials assumed retrograde Republicans would be triggered by such words and, in an effort to avoid having such Republicans cut their budgets, reasoned they might be best avoided. With regard to “evidence-based” and “science-based” in particular, I gather the reasoning was simpler than that, and that the group thought these terms are so overused in the CDC budget documents they were discussing as to become nearly meaningless and that their use should be limited to where it actually made a point.


This suggests two significant caveats to the Post story and the firestorm that has followed it. First, the question of these terms (both those in the style guide and those that came up in last week’s CDC meeting) relates only to a distinct subset of budget documents and not to the general work of the CDC or other agencies. No one is saying people can’t use these terms at HHS, though some people clearly think they shouldn’t be used in budget requests sent to Congress. And second, the most peculiar and alarming of the reported prohibitions on terms were not prohibitions at all and did not come from higher-ups in the department but emerged in the course of an internal conversation at CDC about how to avoid setting off congressional Republicans and so how to maximize the agency’s chances of getting its budget-request approved.


If all of that is correct (and I can only report what I gather from the HHS officials I’ve spoken with) it does make for an interesting story. But it’s not nearly as interesting as the Washington Post made it seem, and it doesn’t point to quite the same lessons either. In fact, it probably tells us more about the attitudes and assumptions of the career officials in various HHS offices than about the political appointees of the administration they are now supposed to be working for.