A resolution honoring the life and legacy of the late George Foreman.

— 449 — 14 DEPARTMENT OF HEALTH AND HUMAN SERVICES Roger Severino If the U.S. Department of Health and Human Services (HHS) were a separate coun- try, its approximately $1.6 trillion budget would rank as the world’s fifth-largest national budget. For good or ill, HHS activities personally impact the lives of more Americans than do those of any other federal agency. Under President Trump, HHS was dedicated to serving “all Americans from conception to natural death, including those individuals and families who face…economic and social well-being challenges.”1 Under President Biden, the mission has shifted to “promoting equity in everything we do” for the sake of “populations sharing a particular characteristic” including race, sexuality, gender identification, ethnicity, and a host of other categories.2 As a result of HHS’s having lost its way, U.S. life expectancy, instead of return- ing to normal after the COVID-19 pandemic, continued to drop precipitously to levels not seen since 1996 with white populations alone losing 7 percent of their expected life span in just one year.3 Nothing less than America’s long-term survival is at stake. Accordingly, HHS must return to serving the health and well-being of all Americans at all stages of life instead of using social engineering that leaves us sicker, poorer, and more divided. OVERVIEW HHS consists of 11 operating divisions that have varying degrees of practical independence from the Secretary of Health and Human Services and 15 staff divisions that are directly under the Office of the Secretary. This chapter’s rec- ommendations are limited to those divisions that most need reform and address, wherever possible, five cross-cutting goals. — 450 — Mandate for Leadership: The Conservative Promise Goal #1: Protecting Life, Conscience, and Bodily Integrity. The Secretary should pursue a robust agenda to protect the fundamental right to life, protect con- science rights, and uphold bodily integrity rooted in biological realities, not ideology. From the moment of conception, every human being possesses inherent dignity and worth, and our humanity does not depend on our age, stage of development, race, or abilities. The Secretary must ensure that all HHS programs and activities are rooted in a deep respect for innocent human life from day one until natural death: Abortion and euthanasia are not health care. A robust respect for the sacred rights of conscience, both at HHS and among gov- ernments and institutions funded by it, increases choices for patients and program beneficiaries and furthers pluralism and tolerance. The Secretary must protect Americans’ civil rights by ensuring that HHS programs and activities follow the letter and spirit of religious freedom and conscience-protection laws. Radical actors inside and outside government are promoting harmful identity politics that replaces biological sex with subjective notions of “gender identity” and bases a person’s worth on his or her race, sex, or other identities. This destructive dogma, under the guise of “equity,” threatens American’s fundamental liberties as well as the health and well-being of children and adults alike. The next Secretary must ensure that HHS programs protect children’s minds and bodies and that HHS programs respect parents’ basic right to direct the upbringing, education, and care of their children. Goal #2: Empowering Patient Choices and Provider Autonomy. Basic eco- nomics holds that costs tend to decrease and quality and options tend to increase when there is robust and free competition in the provision of goods and services. Health care is no exception. Health care reform should be patient-centered and market-based and should empower individuals to control their health care–related dollars and decisions. Of course, providers who deliver health care also need the freedom to address the unique needs of their patients. States should be the primary regulators of the medical profession, and the federal government should not restrict providers’ abil- ity to discharge their responsibilities or limit their ability to innovate through government pricing controls or irrational Medicare and Medicaid reimburse- ment schemes. Finally, America’s broken insurance system, run largely through confusing pro- vider networks and third-party payers (employers), induces overconsumption of health care, limits consumer shopping, and hides true costs from patients. The federal government should focus reform on reducing burdens of regulatory compliance, unleashing innovation in health care delivery, ceasing interference in the daily lives of patients and providers, allowing alternative insurance coverage options, and returning control of health care dollars to patients making decisions with their providers about their health care treatments and services.

— 762 — Mandate for Leadership: The Conservative Promise 29. U.S. Small Business Administration, “Ensuring Equal Treatment for Faith-Based Organizations in SBA’s Loan and Disaster Assistance Programs,” Proposed Rule, Federal Register, Vol. 86, No. 11 (January 19, 2021), pp. 5036–5040, https://www.federalregister.gov/documents/2021/01/19/2021-00446/ensuring-equal-treatment- for-faith-based-organizations-in-sbas-loan-and-disaster-assistance-programs (accessed February 18, 2023). 30. President Joseph R. Biden Jr., Executive Order 14019, “Promoting Access to Voting,” March 7, 2021, in Federal Register, Vol. 86, No. 45 (March 10, 2021), pp. 13623–13627, https://www.govinfo.gov/content/pkg/ FR-2021-03-10/pdf/2021-05087.pdf (accessed February 19, 2023). See also press release, “Small Business Committee Republicans: The SBA Should Stay Out of Elections and Focus on Our Small Businesses,” Small Business Committee Republicans, Committee on Small Business, U.S. House of Representatives, April 4, 2022, https://republicans-smallbusiness.house.gov/news/documentsingle.aspx?DocumentID=404061 (accessed February 18, 2023). 31. Press release, “SBA Administrator Guzman, Biden–Harris Administration Announce Community Navigator Pilot Program Grantees,” U.S. Small Business Administration, October 28, 2021, https://www.sba.gov/ article/2021/oct/28/sba-administrator-guzman-biden-harris-administration-announce-community-navigator- pilot-program (accessed February 18, 2023). 32. John Reosti, “SBA Hasn’t Given Up on Direct Lending,” American Banker, May 2, 2022, https://www. americanbanker.com/creditunions/news/sba-hasnt-given-up-on-direct-lending (accessed February 18, 2023). 33. Goldman Sachs, 10,000 Small Businesses Voices, “22 Years Is Too Long: Support Small Businesses. Reauthorize the SBA,” Open Letter to Congress, November 16, 2022, https://www.goldmansachs.com/ citizenship/10000-small-businesses/US/voices/reauthorize-the-sba-letter/index.html (accessed February 18, 2023). According to Goldman Sachs, the letter “was published in Politico on Wednesday, November 16 to kick of a broader campaign to prioritize small businesses and modernize the SBA in the next Congress” and “was signed by over 3,000 small business owners from all 50 states.” Ibid. 34. See, for example, “Challenge 3: SBA Faces Significant Challenges in IT Investment, System Development, and Security Controls,” in U.S. Small Business Administration, Office of Inspector General, Top Management and Performance Challenges Facing the Small Business Administration in Fiscal Year 2023, Report 23-01, October 14, 2022, pp. 16–19, https://www.sba.gov/sites/default/files/2022-10/SBA%20OIG%20Report%2023-01_0.pdf (accessed February 18, 2023). 35. Ibid., p. iv. 36. Appendix M, “Office of Advocacy’s Legislative Priorities,” and Appendix Q, “Memorandum of Understanding Between the Small Business Administration and the Office of Advocacy,” in U.S. Small Business Administration, Office of Advocacy, Background Paper, Office of Advocacy, 2017–2020, January 2021, pp. 192 and 197, https://cdn.advocacy.sba.gov/wp-content/uploads/2021/02/09101916/Background-Paper-Office-of- Advocacy-2017-2020-web.pdf (accessed February 18, 2023). 37. President Donald J. Trump, Executive Order 13771, “Reducing Regulation and Controlling Regulatory Costs,” January 30, 2017, in Federal Register, Vol. 82, No. 22 (February 3, 2017), pp. 9339–9341, https://www.govinfo. gov/content/pkg/FR-2017-02-03/pdf/2017-02451.pdf (accessed February 19, 2023), and President Donald J. Trump, Executive Order 13777, “Enforcing the Regulatory Reform Agenda,” February 24, 2017, in Federal Register, Vol. 82, No. 39 (March 1, 2017), pp. 12285–12287, https://www.govinfo.gov/content/pkg/FR-2017-03- 01/pdf/2017-04107.pdf (accessed February 19, 2023). 38. U.S. Small Business Administration, Office of Advocacy, What Small Businesses Are Saying and What Advocacy Is Doing About It: Progress Report on the Office of Advocacy’s Regional Regulatory Reform Roundtables, June 2017–September 2018, December 2018, https://cdn.advocacy.sba.gov/wp-content/ uploads/2018/12/20091536/What-Small-Businesses-Are-Saying-What-Advocacy-Is-Doing.pdf April 2020, https://advocacy.sba.gov/regulatory-reform/ (accessed February 18, 2023December 10, 2022). See also U.S. Small Business Administration, Office of Advocacy, Reforming Regulations and Listening to Small Business: Second Progress Report on the Office of Advocacy’s Regional Regulatory Roundtables, June 2017–December 2019, https://cdn.advocacy.sba.gov/wp-content/uploads/2020/04/20141200/2nd-Progress-Report-on-Reg- Reform-Roundtables.pdf (accessed February 18, 2023). 39. U.S. Small Business Administration, Office of Advocacy, What Small Businesses Are Saying and What Advocacy Is Doing About It: Progress Report on the Office of Advocacy’s Regional Regulatory Reform Roundtables, June 2017–September 2018, pp. 32 and 43.

— 762 — Mandate for Leadership: The Conservative Promise 29. U.S. Small Business Administration, “Ensuring Equal Treatment for Faith-Based Organizations in SBA’s Loan and Disaster Assistance Programs,” Proposed Rule, Federal Register, Vol. 86, No. 11 (January 19, 2021), pp. 5036–5040, https://www.federalregister.gov/documents/2021/01/19/2021-00446/ensuring-equal-treatment- for-faith-based-organizations-in-sbas-loan-and-disaster-assistance-programs (accessed February 18, 2023). 30. President Joseph R. Biden Jr., Executive Order 14019, “Promoting Access to Voting,” March 7, 2021, in Federal Register, Vol. 86, No. 45 (March 10, 2021), pp. 13623–13627, https://www.govinfo.gov/content/pkg/ FR-2021-03-10/pdf/2021-05087.pdf (accessed February 19, 2023). See also press release, “Small Business Committee Republicans: The SBA Should Stay Out of Elections and Focus on Our Small Businesses,” Small Business Committee Republicans, Committee on Small Business, U.S. House of Representatives, April 4, 2022, https://republicans-smallbusiness.house.gov/news/documentsingle.aspx?DocumentID=404061 (accessed February 18, 2023). 31. Press release, “SBA Administrator Guzman, Biden–Harris Administration Announce Community Navigator Pilot Program Grantees,” U.S. Small Business Administration, October 28, 2021, https://www.sba.gov/ article/2021/oct/28/sba-administrator-guzman-biden-harris-administration-announce-community-navigator- pilot-program (accessed February 18, 2023). 32. John Reosti, “SBA Hasn’t Given Up on Direct Lending,” American Banker, May 2, 2022, https://www. americanbanker.com/creditunions/news/sba-hasnt-given-up-on-direct-lending (accessed February 18, 2023). 33. Goldman Sachs, 10,000 Small Businesses Voices, “22 Years Is Too Long: Support Small Businesses. Reauthorize the SBA,” Open Letter to Congress, November 16, 2022, https://www.goldmansachs.com/ citizenship/10000-small-businesses/US/voices/reauthorize-the-sba-letter/index.html (accessed February 18, 2023). According to Goldman Sachs, the letter “was published in Politico on Wednesday, November 16 to kick of a broader campaign to prioritize small businesses and modernize the SBA in the next Congress” and “was signed by over 3,000 small business owners from all 50 states.” Ibid. 34. See, for example, “Challenge 3: SBA Faces Significant Challenges in IT Investment, System Development, and Security Controls,” in U.S. Small Business Administration, Office of Inspector General, Top Management and Performance Challenges Facing the Small Business Administration in Fiscal Year 2023, Report 23-01, October 14, 2022, pp. 16–19, https://www.sba.gov/sites/default/files/2022-10/SBA%20OIG%20Report%2023-01_0.pdf (accessed February 18, 2023). 35. Ibid., p. iv. 36. Appendix M, “Office of Advocacy’s Legislative Priorities,” and Appendix Q, “Memorandum of Understanding Between the Small Business Administration and the Office of Advocacy,” in U.S. Small Business Administration, Office of Advocacy, Background Paper, Office of Advocacy, 2017–2020, January 2021, pp. 192 and 197, https://cdn.advocacy.sba.gov/wp-content/uploads/2021/02/09101916/Background-Paper-Office-of- Advocacy-2017-2020-web.pdf (accessed February 18, 2023). 37. President Donald J. Trump, Executive Order 13771, “Reducing Regulation and Controlling Regulatory Costs,” January 30, 2017, in Federal Register, Vol. 82, No. 22 (February 3, 2017), pp. 9339–9341, https://www.govinfo. gov/content/pkg/FR-2017-02-03/pdf/2017-02451.pdf (accessed February 19, 2023), and President Donald J. Trump, Executive Order 13777, “Enforcing the Regulatory Reform Agenda,” February 24, 2017, in Federal Register, Vol. 82, No. 39 (March 1, 2017), pp. 12285–12287, https://www.govinfo.gov/content/pkg/FR-2017-03- 01/pdf/2017-04107.pdf (accessed February 19, 2023). 38. U.S. Small Business Administration, Office of Advocacy, What Small Businesses Are Saying and What Advocacy Is Doing About It: Progress Report on the Office of Advocacy’s Regional Regulatory Reform Roundtables, June 2017–September 2018, December 2018, https://cdn.advocacy.sba.gov/wp-content/ uploads/2018/12/20091536/What-Small-Businesses-Are-Saying-What-Advocacy-Is-Doing.pdf April 2020, https://advocacy.sba.gov/regulatory-reform/ (accessed February 18, 2023December 10, 2022). See also U.S. Small Business Administration, Office of Advocacy, Reforming Regulations and Listening to Small Business: Second Progress Report on the Office of Advocacy’s Regional Regulatory Roundtables, June 2017–December 2019, https://cdn.advocacy.sba.gov/wp-content/uploads/2020/04/20141200/2nd-Progress-Report-on-Reg- Reform-Roundtables.pdf (accessed February 18, 2023). 39. U.S. Small Business Administration, Office of Advocacy, What Small Businesses Are Saying and What Advocacy Is Doing About It: Progress Report on the Office of Advocacy’s Regional Regulatory Reform Roundtables, June 2017–September 2018, pp. 32 and 43. — 763 — Small Business Administration 40. U.S. Small Business Administration, Office of Inspector General, Top Management and Performance Challenges Facing the Small Business Administration in Fiscal Year 2023, p. iv. 41. H.R. 748, CARES (Coronavirus Aid, Relief, and Economic Security) Act, Public Law No. 116-136, 116th Congress, March 27, 2020, https://www.congress.gov/116/plaws/publ136/PLAW-116publ136.pdf (accessed February 19, 2023). 42. Sarah McCammon, “Planned Parenthood Asked to Return Funds from Paycheck Protection Program,” NPR, May 21, 2020, https://www.npr.org/2020/05/21/859991359/planned-parenthood-asked-to-return-funds- from-paycheck-protection-program (accessed February 18, 2023). 43. Letter from William Manger, Associate Administrator, U.S. Small Business Administration, to Laura Meyers, Planned Parenthood of Metropolitan Washington, “Re: Notice of Investigation and Request for Records,” May 19, 2020, https://s3.documentcloud.org/documents/6922122/SBA-Letter-Planned-Parenthood-DC.pdf (accessed February 18, 2023). 44. Press release, “Lankford, HSGAC Republicans Demand Details on Illegal PPP Loans to Planned Parenthood Affiliates,” Office of U.S. Senator James Lankford, April 28, 2022, https://www.lankford.senate.gov/news/press- releases/lankford-hsgac-republicans-demand-details-on-illegal-ppp-loans-to-planned-parenthood-affiliates (accessed February 18, 2023). 45. Press release, “Romney, Colleagues Request Information from SBA Administrator Guzman on Illegal PPP Loans Given to Planned Parenthood Affiliates,” Office of U.S. Senator Mitt Romney, April 28, 2022, https:// www.romney.senate.gov/romney-colleagues-request-information-from-sba-administrator-guzman-on- illegal-ppp-loans-given-to-planned-parenthood-affiliates/ (accessed February 18, 2023). 46. 13 C.F.R. §§ 109.400(b)(11), https://www.law.cornell.edu/cfr/text/13/109.400; 123.301(g), https://www.law. cornell.edu/cfr/text/13/123.301; 123.502(n), https://www.law.cornell.edu/cfr/text/13/123.502; and 123.702(b)(6), https://www.law.cornell.edu/cfr/text/13/123.702 (all accessed February 19, 2023). 47. U.S. Small Business Administration, “Religious Eligibility Worksheet for all 7(a) and 504 Loan Programs” SBA Form 1971, http://www.sba.gov/sites/default/files/2020-11/sba-form-1971.pdf (accessed February 18, 2023). 48. U.S. Small Business Administration, “Ensuring Equal Treatment for Faith-Based Organizations in SBA’s Loan and Disaster Assistance Program.” 49. See, for example, Carson v. Makin, 596 U.S. ___ (2022), https://www.supremecourt.gov/ opinions/21pdf/20-1088_dbfi.pdf (accessed February 19, 2023). 50. 28 U.S. Code § 530d, https://www.law.cornell.edu/uscode/text/28/530D (accessed February 19, 2023). 51. U.S. Small Business Administration, “Ensuring Equal Treatment for Faith-Based Organizations in SBA’s Loan and Disaster Assistance Program.” 52. 13 CFR 120.110(k), https://www.law.cornell.edu/cfr/text/13/120.110 (accessed February 19, 2023). 53. U.S. Small Business Administration, “Regulatory Reform Initiative: Streamlining and Modernizing the 7(a), Microloan, and 504 Loan Programs to Reduce Regulatory Burden,” Final Rule, Federal Register, Vol. 87, No. 125 (June 30, 2022), pp. 38900–38910, https://www.federalregister.gov/documents/2022/06/30/2022-13483/ regulatory-reform-initiative-streamlining-and-modernizing-the-7a-microloan-and-504-loan-programs-to (accessed February 18, 2023). 54. Ibid. 55. U.S. Department of Justice, Office of Legal Counsel “Religious Restrictions on Capital Financing for Historically Black Colleges and Universities,” Memorandum Opinion for the Acting General Counsel, Department of Education, August 15, 2019, https://www.justice.gov/sites/default/files/opinions/ attachments/2021/01/01/2019-08-15-hbcu-capfin-2.pdf. (accessed February 18, 2023). 56. U.S. Small Business Administration, Office of Investment and Innovation, SBIR and STTR Annual Report, Fiscal Year 2019, p. 8, https://www.sbir.gov/sites/default/files/SBA_Final_FY19_SBIR_STTR_Annual_Report.pdf (accessed February 18, 2023). 57. S. 4900, SBIR and STTR Extension Act of 2022, Public Law No. 117–183, 117th Congress, September 30, 2022, https://www.congress.gov/117/plaws/publ183/PLAW-117publ183.pdf (accessed February 18, 2023). 58. U.S. Small Business Administration, Office of Investment and Innovation, SBIR and STTR Annual Report, Fiscal Year 2019, pp. 6, 40, and 108.