Close ties between the administration and a prominent conservative think tank correlate with several Trump administration health policy decisions, according to new information from a liberal government watchdog group shared exclusively with CQ Roll Call.

The 35-page Equity Forward report says that The Heritage Foundation’s influence plays a large role in decisions related to abortion, fetal tissue research, contraception and protections for same-sex couples.

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Think tanks that support an administration are known to yield influence over policy decisions, but Equity Forward calls the ties with The Heritage Foundation “alarming” because the organization says Heritage is succeeding in securing policy decisions that contradict HHS’ intended mission.

“The fundamental difference of what we are seeing with the Heritage Foundation versus think tank influence in the past is what the fundamental reason is for influencing the policy,” said Equity Forward Executive Director Mary Alice Carter, adding that she believes the foundation is “putting forth policies that are harmful to people.”

The report says that Heritage “in many cases — far from delivering so-called ‘conservative’ policy recommendations solely of limited regulations and government — actively celebrate barriers to health care and civil rights for vulnerable populations.”

Carter is worried about attempts within HHS to undermine existing programs such as the 2010 health care law, the federal family planning program that provides contraception, and the Teen Pregnancy Prevention program.

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“They don’t come right out and say we hate birth control. They don’t come right out and say we hate gay people,” she said, adding that they instead come up with reasons as to why a person is violated by a policy. “They can say we just oppose this because someone’s right to refuse outranks your right to have it.”

A separate 2018 report by the Think Tanks and Civil Societies Program of the Lauder Institute at the University of Pennsylvania found that The Heritage Foundation ranked as the think tank with the most significant impact on public policy and the top U.S. think tank to watch in 2019.

The Heritage Foundation is proud of its influence.

“With a history of providing policymakers with proven solutions to complex issues, it’s no surprise that Heritage recommendations have been used by lawmakers and federal agencies,” said Marguerite Bowling, senior communications manager for The Heritage Foundation. “As to former staffers, any real ‘watchdog group’ would note that it is naturally reoccurring for employees of think tanks, nonprofits, and advocacy groups across the ideological spectrum to take positions within the federal government.”

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An administration official said that HHS regularly seeks feedback from a variety of stakeholders on both sides and that agency employees undergo a robust screening process and pledge to be ethical. The agency policy is that employees should not participate in decisions where a former employer is a party to the matter.

Equity Forward acknowledges that it did not receive all the information it sought through public records requests. Numerous nonprofit groups including the left-leaning American Oversight have reported trouble with Freedom of Information Act, or FOIA, requests to the Trump administration.

“Due to information gaps resultant from this lack of transparency, the connections this report has drawn on between individuals associated with The Heritage Foundation and the federal health department cannot necessarily be viewed with policy outcomes as means of direct causation,” says the report. “However, because these same information gaps exist, accountability — through calling out these correlations for what they are — has never been more critical.”

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Heritage’s connections

While a revolving door between the private sector and the government is common, Equity Forward is concerned about the number of individuals coming from just one organization. The group’s report highlights five HHS employees that it says have the closest ties to Heritage.

“You are not going to see many checks and balances on ideas if everyone comes from the exact same background with the exact same narrative,” said Carter. “When you look at just one track of thinking, there is no one to stand in the way to raise questions or raise flags to say maybe this isn’t the right way to do this.”

The largest concentration of Heritage hires is in HHS’ Office For Civil Rights, says Equity Forward.

Roger Severino, a former director of Heritage’s DeVos Center for Religion and Civil Society, joined HHS as the director of OCR in late March 2017. Nine months later, Severnio’s old office at Heritage issued a paper encouraging HHS to increase efforts to protect religious and conscience rights. A month after that, OCR opened a new division dedicated to enforcing religious and conscience protections.

Public records requests obtained by Equity Forward include three emails that show Severino and Maya Noronha, a special advisor within OCR who previously served as a Heritage legal intern, helped launch the new division where they now work. Noronha sent a draft version of the proposed rule on Jan. 17, 2018, before the division’s announcement on Jan. 18 and the rule’s release on Jan. 19.

“Severino has served as a direct liaison from Heritage to Trump since the 2016 election, having worked as a policy implementation member of the transition team just after leaving the think tank and prior to taking on his current role,” the report says.

A separate American Oversight FOIA response of HHS officials’ resumes found that Noronha is a member of Women Speak For Themselves — a group of abortion opponents formed in opposition to the health law’s contraception mandate.

“As a special advisor at the OCR, Noronha is in a position to make her narrow beliefs policy,” the report says.

Other HHS staffers and former Heritage aides include Maximos Nikitas, Judy Stecker and Laura Trueman.

Charmaine Yoest, a top HHS communications official who also served at the White House, was hired by Heritage last month as a vice president.

Abortion issues

Funding for fetal tissue research was thrust into the spotlight last year over concerns about whether this method of research — which uses tissue that can be sourced from abortions — is necessary. Proponents call it essential to researching vaccines and finding possible cures to diseases, while abortion critics disagree.

Last August, Heritage officials recommended in a blog post the end of a fetal tissue contract with Advanced Bioscience Resources, a company that supplied fetal tissue for research purposes to the Food and Drug Administration.

Six weeks after the blog post was published, FDA canceled a $15,900 contract with the supplier over concerns about how the tissue was procured.

HHS is currently investigating whether to continue about $100 million in fetal tissue grant research through the National Institutes of Health.

In November, Heritage hosted an event promoting alternatives to fetal tissue research with two speakers, Tara Sander Lee and David Prentice, from a prominent anti-abortion research organization. Two weeks later, Congress held a hearing on the same subject with the same witnesses invited by House Republicans.

The debate over fetal tissue has been controversial for years, but Equity Forward’s Carter argues that the steps being taken now are especially worrisome.

“It’s a difference of how we’re seeing it talked about — the very direct actions we are seeing by high-level HHS officials to take these requests seriously,” she said. “All the science says this is ethical and scientific study.”

LGBT protections

Liberal groups have spoken out against the administration’s expansion of religious freedom policies, saying that could restrict health care access for LGBT people.

In a recent interview with CQ Roll Call, Severino said that he was not aware of any claims filed to OCR regarding LGBT discrimination. “Everything has been really very hypothetical in saying that conscience protection statues are implicating a whole range of issues that we have not yet seen out in the world,” he said.

Carter said that Severino’s approach could become problematic, noting papers he authored at Heritage, including one that said “maleness and femaleness are biological realities to be respected and affirmed, not altered or treated as diseases.”

“He’s been very, very clear that he believes that gender is something you’re born with and that it’s black and white,” Carter said. “He doesn’t believe in the concept of being transgender, which is a medical fact.”

Equity Forward also questioned recent HHS actions on foster care.

In January, HHS granted approval for a South Carolina-based religious foster agency to continue to receive federal funding. The Protestant agency, Miracle Hill, risked losing its licensing because it used religious criteria in placing children with families. Advocates worry this could negatively impact same-sex couples and individuals of other faiths in the state hoping to foster children.

In May 2018, HHS Center for Faith and Opportunity Initiatives Director Shannon Royce previewed the Trump administration’s policy at a Heritage event where she encouraged attendees to seek waivers for faith-based adoption and fostering.

“If you are engaged in fostering and adoption care, and there is something you believe substantially burdens your religious expression, we would encourage you to file,” said Royce.