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Photo Illustration by Sarah Rogers/The Daily Beast
The Enemy From Within

Team Trump Used Obamacare Money to Run PR Effort Against It

The administration is tasked with overseeing the health care law. Instead, it has made a major social media push to undermine it.

Sam Stein7.20.17 1:00 AM ET

The Trump administration has spent taxpayer money meant to encourage enrollment in the Affordable Care Act on a public relations campaign aimed at methodically strangling it.

The effort, which involves a multi-pronged social media push as well as video testimonials designed at damaging public opinion of President Obama’s health care law, is far more robust and sustained than has been publicly revealed or realized.

The strategy has caught the eye of legal experts and Democrats in Congress, who have asked government agencies to investigate whether the administration has misused funds and engaged in covert propaganda in its efforts to damage and overturn the seven-year-old health care law. It’s also roiled Obama administration veterans, who argue that the current White House is not only abdicating its responsibilities to administer the law but sabotaging it in an effort to facilitate its undoing by Congress.

“I’m on a daily basis horrified by leaders at the Department of Health and Human Services who seem intent on taking healthcare away from the constituents they are supposed to serve,” former HHS Secretary Kathleen Sebelius said in an interview with The Daily Beast. “We always believed that delivering health and human services was the mission of the department. That seems to not be the mission of the current leadership.”

The Department of Health and Human Services (HHS) declined repeated attempts to discuss its PR efforts. But more than half-a-dozen sources at various agencies and on the Hill outlined the scope of the anti-Obamacare push in conversations with The Daily Beast.

Under Secretary Tom Price’s stewardship, HHS has filmed and produced a series of testimonial videos featuring individuals claiming to have been harmed by Obamacare. Those “viral” videos have had decidedly limited reach, often gathering somewhere between 100 and 200 views each. But the Department has made a heavy investment in them nonetheless. To date, it has released 23 videos. A source familiar with the video production says that there have been nearly 30 interviews conducted in total, from which more than 130 videos have been produced.

Each testimonial has the same look, feel, and setting, with the subjects sitting before a gray backdrop and speaking directly to camera about how Obamacare has harmed their lives. They were all shot at the Department’s internal studio, according to numerous sources who worked for or continue to work at HHS. Under the Obama administration, it was customary that such videos were recorded and edited by an outside contractor who then billed the department for its work. One former official said that the contractor would charge roughly $550 an hour.

Funding for those videos would come from the Department’s “consumer information and outreach” budget, which was previously used for the purposes of advertising the ACA and encouraging enrollment. The Trump administration has requested $574 million for this specific budget item, though HHS declined to detail how much it has devoted to specific line items. Two sources familiar with the videos say that HHS continues to draw money from the outreach fund, even though its objective has switched from promoting the ACA to highlighting the law’s critics and its shortcomings.

Getting the subjects to HHS’ studio also cost taxpayer money. In this case, the White House itself found individuals, often through local news stories and Republican Party connections, and flew them to Washington, D.C., to participate in roundtables to discuss Obamacare. From there, they were whisked across town to HHS headquarters.

“We had no clue [this was happening],” Tracie Sanchez of Lima, Ohio, told The Daily Beast. “That just popped up when we got there.”

A small business owner who kept her company at 49 employees for many years to avoid Obamacare’s mandate that larger employers cover workers’ health care, Sanchez said it was an “honor” to have been invited to the White House and to have appeared in an HHS video. But others who were filmed felt more ambivalent about their experience.

Dr. Ryan Stanton of Kentucky is critical of Obamacare but also acknowledges that the legislation has been beneficial in certain respects. He’s also uncertain about Republican-authored replacements. When he sat down for a recording at the HHS studio he said it “felt like they were pushing for a harder line against Obamacare” than he was delivering.

“I don’t think mine was the exact message they were looking for of, ‘Oh, let’s march against Obamacare,’” he recalled. “It was clearly an effort to push the repeal and replace.”

Sabotaging the Law From Within

Following the failure of Senate Republicans to pass an Obamacare repeal and replace package this week, President Trump said that he would allow the law to fall apart as a means of compelling congressional Democrats to the negotiating table.

It’s a strategy designed to test the opposition’s capacity to absorb human and political suffering. It’s also one Trump has the power to pursue.

Under the Affordable Care Act, both HHS and the Centers for Medicare and Medicaid Services (CMS) have broad authorities to administer the law—from implementing and relaxing penalties, to working with commissioners to shore up markets.

The Obama White House often used these administrative powers to circumvent efforts by congressional Republicans to undermine the ACA. Trump and company have gone in a diametrically different direction.

CMS has put out debatable numbers that make it appear that state health insurance exchanges are on less stable footing. The White House has wavered routinely on whether to pay cost-sharing reductions that insurers—and virtually every health economist—say are necessary to keep markets stable. And during the tail end of the 2017 enrollment period, HHS pulled television advertising and temporarily suspended social media efforts alerting consumers to the final sign up date.

Then there is Twitter. The official HHS account has become a clearinghouse for anti-Obamacare messaging. Since the Trump administration came into office, @HHSGov has mentioned “Obamacare” 13 specific times, 10 of which could be described as openly hostile of the law. Twice the account has re-tweeted Secretary Price’s own account when it has explicitly encouraged legislative efforts to undo Obamacare. The first was on May 4, when Price applauded the house for passing its bill, the American Health Care Act. The second came on June 5, when Price used the hashtag #RepealAndReplace.

Perhaps the most glaring efforts to publicly undermine the ACA, has come on the Department of Health and Human Service’s own website. In the Obama administration, this piece of online real estate featured direct links for consumers to apply for coverage and infographic breakdowns of the ACA’s benefits and critical dates. Since Trump was inaugurated, it has been retrofitted into an bulletin board for information critical of the law.

Currently, for example, the banner image on the site leads to a page explaining the ways in which the ACA “has done damage to this market and created great burdens for many Americans.” The “Health Care Home” section no longer contains a page on “Delivery System Reform” and “Facts & Figures.” And instead of a readily available link for visitors to access the main sign-up portal for obtaining health care coverage, the site has a post criticizing the now infamous healthcare.gov and encouraging people to use private sector web brokers.

Subtle changes have been made to the “About the ACA” section of the website as well that reflect the current administration’s hostility toward to the law.

  • * The “Plain Language Benefits” section has been scrapped as has the section on “ER Access & Doctor Choice.”
  • * Under the “pre-existing conditions” section, the Trump version has removed any mention of women no longer being able to be charged more than men for coverage.
  • * Under the “Young Adult Coverage” section, the Trump HHS site no longer notes that before the ACA insurance companies could have removed enrolled children at the age of 19.
  • * Mentions of the “Affordable Care Act” have been replaced with “current law.”
  • * And while the Obama HHS site had a section noting that the ACA forced insurance companies to provide “easy-to-understand” summaries of benefit and coverage packages, the Trump site has no such page.

Ultimately, the HHS website is a place to obtain information on Obamacare but not a vehicle of obtaining coverage under the law. But changes have been made to healthcare.gov as well, and they’re directly related to consumer education. Under the “Get Answers” section of the site, there no longer is a “Cost & Savings” tab that allows visitors to find out where to find prices, if they have to pay penalties, or if they qualify for savings.

How much damage these alterations have had on Obamacare is ultimately unknowable. But those whose job it once was to encourage enrollment insist that the burying of information, the pausing of advertising, and creation of policy confusion has collectively had a profound effect.

“I think uncertainty causes people to freeze,” said Andy Slavitt, the former acting administrator at CMS. “So I think it is quite impactful. And look, you’re not hired into the administration to decide whether you agree with the law you’re asked to execute. That’s not your job... Congress appropriates funds for you to carry out laws that they passed, not to spend those funds on activities that counteract those laws.”

Brushing Up Against the Letter of the Law

On Feb. 17, 2017, Sens. Patty Murray (D-WA) and Ron Wyden (D-OR) wrote Price a letter raising their concerns with the changes HHS had made to healthcare.gov and its decision to pull enrollment-deadline advertising (PDF). On June 6, 2017, Sens. Elizabeth Warren (D-MA) and Murray wrote the HHS’ inspector general requesting an investigation of the agency’s “actions to undermine the ongoing implementation” of the ACA (PDF). A week later, four leading congressional Democrats wrote a letter to the comptroller general of the Government Accountability Office (GAO) requesting an investigation into the various ways in which HHS used its public relations resources to help promote repeal of Obamacare (PDF).

Their offices tell The Daily Beast that they have not yet received responses from the administration. As for GAO, however, there is ample precedent to suggest that it will look into the matter. In 2010, the office examined HHS’ decision to pay contractors for help producing television advertisement concerning changes Obamacare made to the Medicare. It concluded that HHS had operated within the law because the ads did not constitute “a purely partisan activity”—which it defined as “completely devoid of any connection with official functions” and “completely political in nature.”

Years later, the GAO came down differently on another Obama agency. In December 2015, the office ruled that the Obama administration’s Environmental Protection Agency had engaged in “covert propaganda” in its use of social media to encourage public support for its clean-water regulations.

Both Murray and Wyden’s office said that they are waiting to hear back from the GAO on whether the Trump administration has engaged in similarly out-of-bounds conduct. But administrative law experts say that the department is coming close to, if not fully crossing, the line of legality. HHS is allowed to use funds for purposes of educating the public but it is prohibited under its appropriations statute from engaging in overt advocacy—such as encourage the passage or defeat of legislation.

The testimonial videos venture into the realm of political influencing, said Cary Coglianese, the Edward B. Shils professor of law and professor of political science at the University of Pennsylvania. But it was the tweets from Price and the HHS account—the ones encouraging and applauding passage of legislation—that drifted into legally troublesome areas.

“It certainly all sounds highly problematic and inappropriate,” said Coglianese. “It does seem very much akin to the kind of propaganda that the GAO faulted EPA for engaging in. The tweets by the Secretary are clearly seeking to shape public attitudes about Obamacare and whether it should be repealed and replaced. He is explicit about that. And it is highly unusual and, I think, problematic when government officials engage in that kind of public outreach.”

—with additional reporting by Joanna Purpich

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