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 by Molly Bangs, an Equity Forward research associate. "However, because these same information gaps exist, accountability -- through calling out these correlations for what they are -- has never been more critical."
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 adviser 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.