THE PROGNOSIS

Scott Lloyd heads the federal agency that’s become central in the political maelstrom over the Trump administration’s now-reverted policy separating migrant children from their families at the southern border. Yet Lloyd has said nothing publicly about the matter, even as it has consumed the headlines for days.

It’s unclear the exact role played by Lloyd, who directs the Office of Refugee Resettlement under the Department of Health and Human Services that has had more than 2,000 migrant children in its care since they were separated from their parents under Trump's "zero tolerance" policy (those children, and tens of thousands more, may now be transferred to the Pentagon). Lloyd hasn't been heard from publicly since he spoke on a United Nations panel in April about his desire to create stricter standards for accepting unaccompanied minors who cross the border into the federally run shelters. 

When we asked about the scope of LLoyd's involvement, a spokeswoman for HHS offered this statement:

“The Office of Refugee Resettlement (ORR) at HHS’ Administration for Children and Families is responsible and required to ensure the care of all minors who are in the country illegally without a parent or guardian, until they can be reunified safely with an appropriate sponsor. As director of ORR, Mr. Lloyd is responsible for ensuring the office is effectively carrying out that mission.”

(We also asked how the department planned to reunite parents and children who were separated, but the spokeswoman did not respond. HHS is embroiled in an increasingly confusing controversy over exactly how the children in its custody are to be reunited with parents who are separately being detained after being charged with the crime of crossing the border illegally: 'It's just a total labyrinth," one attorney working on reunification told The Post's Kevin Sieff.)

 

Lloyd’s silence may not be that surprising, according to Bob Carey, who served as ORR director under President Obama. Carey said weighing in on such controversial issues is usually reserved for more high-profile figures like the HHS secretary, adding that there are probably a lot of interagency meetings about coordination that Lloyd is participating in.

But Carey said he’s doubtful there was much preparation or thought given to the challenges of housing so many young people separated from their detained parents in what seems like a haphazard policy process. And he said the Trump administration’s previous 
"zero tolerance" policy put Lloyd in an incredibly hard position – one in which the ORR is handling the ramifications of the administration’s decision to separate children and their parents.

“It would be hard for me if I was there. The ORR is dealing with the trauma caused by your government," Carey said. "It's arguably amoral and abusive and not what a human services agency normally does.”

There’s no doubt the White House's prior separation policy has complicated ORR’s duties. But abortion rights advocates had already been slamming Lloyd over other issues for months, most notably his efforts to stop pregnant immigrant women from getting abortions. 

They’ve noted his resume does not include any child welfare or refugee resettlement history, unlike many of his predecessors who made careers in that work. Lloyd's most relevant work was on behalf of Christians persecuted by ISIS during his time as an attorney in the Knights of Columbus public policy office in Washington.

Lloyd is currently embroiled in a lawsuit over a policy he unilaterally implemented when he first took over the agency in March 2017 that requires his signature to release immigrant children who are detained by ORR because they're considered a risk to others. The New York Civil Liberties Union, which brought the suit, contends that Lloyd's reasons for holding the kids are often baseless and subjective, and that his lack of background in child welfare makes him unqualified to make such decisions.

In a deposition in the case, Lloyd said he implemented the policy “so that if something went wrong, then there wouldn't be the appearance that it wasn't something that I didn't own personally,” adding it “was in an effort to gain accountability for myself and visibility." When asked what effort he took in trying to determine how many children would be affected by his policy, he responded, "We didn't make an effort."

Donna Lieberman, executive director of NYCLU, said she is "deeply" concerned about Lloyd running the agency that is now caring for the children separated from their parents. "The bottom line is from the minute he got to his position, the amount of suffering has increased dramatically," she said. 

Democrats called for Lloyd's firing last year after it was revealed that he tried to personally persuade immigrant girls in ORR custody not to terminate their pregnancies. But HHS Secretary Alex Azar has rejected those calls. 

Mary Alice Carter, executive director of Equity Forward, a nonprofit that describes itself as a watchdog for reproductive rights, filed a Freedom of Information Act request with HHS for any emails between Lloyd and officials regarding the dozen immigrant women he wanted to stop from getting abortions. HHS informed her there were 166,000 pages. At the rate it was willing to release them it would have taken 28 years, Carter said.

"Scott Lloyd has no relevant experience," she said. "He’s almost exclusively an antiabortion activist. He’s using it as a position to push his personal beliefs on the people under his care. The fact that he was getting oversight over more vulnerable children really concerns us."

Correction: An earlier version misstated exactly what was FOIAed. It's for correspondence between Lloyd and other officials, not Lloyd and the immigrant women.

AHH, OOF and OUCH

AAH: Health insurer Cigna announced yesterday it aims to reduce opioid overdoses among its customers 25 percent by 2021. The company said it will focus efforts in places where it has the most customers, including in Connecticut, Maryland, New Jersey and Virginia as well as in New York, Chicago, Philadelphia and D.C., Fierce Healthcare’s Tina Reed reports. Cigna said it will track claims made with an opioid-overdose diagnosis code in order to measure its progress.

“The continued increase in people suffering from overdoses is alarming, and immediate action is needed to help disrupt this trend,” Doug Nemecek, the company's chief medical officer for behavioral health said in a statement. “We know we can’t do it alone and are collaborating with partners on local efforts to curb this preventable disease by improving care for people with chronic pain and substance use disorders.”

OOF: Insurers are proposing premiums for next year's Obamacare marketplaces that are 15 percent higher, on average, than this year's final premiums, per a new analysis from the firm Avalere. If the proposed premiums are finalized, mid-grade "silver" plans will cost an average of $98 more per month in the 10 states Avalere looked at. The average silver plan premium will cost $740, up from $642 this year, the firm found.

But don't forget the majority of the marketplace enrollees are eligible for subsidies, which help disguise the premium hikes and make coverage more affordable. And there's another silver lining -- several smaller insurers have recently announced they're joining or re-entering some state marketplaces. Centene Corp. and Molina Healthcare Inc. say they're submitting filings to sell plans in North Carolina, Wisconsin and Utah, per the Wall Street Journal. Oscar Health says it will sell plans in nine states next year, up from six this year.

OUCH: Yesterday, U.N. ambassador Nikki Haley blasted a U.N. report condemning poverty in the United States as a "misleading and politically motivated" document about "the wealthiest and freest country in the world." Criticizing the report for critiquing the U.S.'s treatment of its poor, Haley argued the U.N. should instead focus on poverty in developing countries such as Burundi and Congo Republic. 

"It is patently ridiculous for the United Nations to examine poverty in America," Haley wrote in a letter to Sen. Bernie Sanders (I-Vt.). "In our country, the President, Members of Congress, Governors, Mayors, and City Council members actively engage on poverty issues every day. Compare that to the many countries around the world, whose governments knowingly abuse human rights and cause pain and suffering."

"Last month, U.N. special rapporteur on extreme poverty and human rights Philip Alston released a report saying the U.S. has the highest rates of youth poverty, infant mortality, incarceration, income inequality and obesity among all countries in the developed world, as well as 40 million people living in poverty," The Post's Jeff Stein reports. "Alston accused President Trump and the Republican Congress of deepening poverty and inequality in the country, citing the Republican tax law passed last fall."

Haley pushed back in Thursday's letter, arguing that the administration had created a strong economy that would lift people out of poverty and that Alston's report was premised on misleading statistics. "I am deeply disappointed that the Special Rapporteur used his platform to make misleading and politically motivated statements about American domestic policy issues," Haley said. "Regrettably, his report is an all too common example of the misplaced priorities [of the U.N.]."

TRUMP TEMPERATURE

— First lady Melania Trump made a surprise visit to detained, immigrant children yesterday. She met for more than an hour with children at the Upbring New Hope Children’s Shelter in McAllen, Tex. She “met with dozens of children as well as the people who are educating them and supervising their care,” the New York Times’s Katie Rogers reports. “She asked officials questions about children’s well-being. She told the children to value friendship over all else.”

The visit came one day after the president’s executive order that pledged to halt the practice of separating families. The first lady asked her advisers to schedule the trip after she saw images of separated families and heard audio of children crying at such centers, Katie reports.

But Melania Trump also made headlines for what she was wearing during the trip. A photo was taken of the first lady wearing an olive green coat that read: “I really don’t care. Do U?” Her communication’s director, Stephanie Grisham, denied Melania was trying to send any messages. “It’s a jacket,” Grisham said in a statement to reporters. “There was no hidden message. After today’s important visit to Texas, I hope this isn’t what the media is going to choose to focus on.”

Grisham's statement via Twitter: 

The president weighed in as well: 

But her husband quickly undercut her:

CNN's Kate Bennet pointed out she wore it again once she returned to Washington: 

From Rep. Dina Titus (D-Nev.): 

The first lady tweeted about her visit later Thursday: 

AGENCY ALERT

— The White House apparently didn't take our recommendation to rename HHS the "Department of Be Best." In the federal overhaul proposal the administration released yesterday, HHS would instead be renamed the "Department of Health and Public Welfare" and would be given jurisdiction over nutrition assistance programs. The new title would “better capture the nature of its programs,” the White House said.

Most parts of the proposal -- which also calls for merging the Labor and Education departments into a new Department of Education and the Workforce -- would require congressional approval and are expected to face significant opposition from both Democrats and some Republicans, The Post's Lisa Rein reports.

"The sweeping plan builds on Trump’s pledge to shrink the size and scope of the federal government, a long-sought goal of conservatives," Lisa writes. "The shifts, if enacted, would likely reduce the number of employees in some offices, which would draw opposition from federal employee unions, which the administration took aim at in May with a series of executive orders that curtail their power."

The White House’s move to consolidate federal safety-net programs in a revamped and renamed health department could also help fulfill a conservative goal of building standardized requirements that people must work or prepare for jobs to qualify for government help, The Post's Amy Goldstein and Caitlin Dewey write.

"The blueprint does not itself contain funding cuts for food stamps, cash assistance, Medicaid or other longtime pillars of the government’s safety net," Amy and Caitlin write. "But it runs alongside President Trump’s efforts in his budgets to slash funding for such programs. And it would buttress a case for reductions by pulling together programs in ways that make clearer how much the government is spending."

— Moving the $70 billion Supplemental Nutrition Assistance Program (better known as "SNAP" that covers food stamps) out of the Department of Agriculture and into HHS would make it easier to revamp the program and help administrators better track how much money low-income families receive in benefits, conservatives say.

“There’s no integration between these programs, and they need to be brought together so that they can be understood and analyzed holistically,” said Robert Rector, a senior research fellow at the Heritage Foundation who is widely credited with crafting the ideas in the Trump proposal. “Our current system, both in the executive branch and in Congress, is completely incapable of doing that. … No one sees the full picture.”

"The Agriculture Department...has run food stamps for decades, a legacy of a time when the program existed in large part to redistribute surplus commodities," The Post's Caitlin Dewey reports. "But HHS oversees many of the others programs that SNAP recipients also rely on, such as Medicaid, subsidized child care and Temporary Assistance for Needy Families...Under the Trump administration’s plan, those programs...would be consolidated under a rebranded HHS."

— Speaking of food stamps, the House narrowly passed a farm bill yesterday afternoon that includes new work rules for most adult food-stamp recipients — provisions that are dead on arrival in the Senate. "The massive legislative package overseeing more than $430 billion of food and agriculture programs over five years contains a host of measures aimed at strengthening farm subsidies, expanding foreign trade and bolstering rural development," Caitlin and Erica Werner report.

React from the president:

— Virginia Gov. Ralph Northam, a Democrat, has ordered state officials to investigate claims of abuse by children at an immigration detention facility in the state. Immigrant children as young as 14 that were being housed at the Shenandoah Valley Juvenile Center were allegedly handcuffed, beaten and left naked in solitary confinement for long periods of time, the Associated Press’s Michael Biesecker, Jake Pearson and Garance Burke report.

Shortly after the AP's initial report, Northam announced on Twitter his intention to review the allegations. The claims are included in a federal court filing that “include a half-dozen sworn statements from Latino teens jailed there for months or years,” Michael, Jake and Garance report. “Multiple detainees say the guards stripped them of their clothes and strapped them to chairs with bags placed over their heads.”

“Whenever they used to restrain me and put me in the chair, they would handcuff me,” said one Honduran immigrant, who told the AP he was sent to the facility when he was 15. “Strapped me down all the way, from your feet all the way to your chest, you couldn’t really move. ... They have total control over you. They also put a bag over your head. It has little holes; you can see through it. But you feel suffocated with the bag on.”

Attorneys for the juvenile center deny the allegations, which span from 2015 to 2018.

— Virginia’s two Democratic senators asked the Trump administration this morning for answers on the facility. Sens. Mark Warner and Tim Kaine sent questions to HHS’s U.S. Office of Refugee Resettlement about the Shenandoah Valley Juvenile Center. “The senators asked whether regulators had received any past complaints involving the facility located near Staunton, Virginia,” the AP’s Michael Biesecker writes. “The Democrats also want to know whether there is a system in place to discipline staff members who abuse children in federal custody.”

— A few more good reads from The Post and beyond:

HEALTH ON THE HILL
MEDICAL MISSIVES
To Your Health
A new website, PreventEpidemics.org, scores countries on their ability to prevent, detect and stop deadly infectious diseases.
Lena H. Sun
STATE SCAN
DAYBOOK

Today

  • The AHIP Institute and Expo continues in San Diego, Calif.
  • The FDA holds a blood products advisory committee meeting.

Coming Up

  • The Senate Finance Committee holds a hearing on drug affordability and innovation on June 26.
  • The House Appropriations Subcommittee on Labor, Health and Human Services and related agencies holds a markup on the 2019 fiscal year appropriations on June 26.
  • The House Veterans Affairs Committee holds a hearing on ““VA Electronic Health Record Modernization” on June 26.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on health care costs on June 27.
  • The Senate Veterans Affairs Committee holds a hearing on the nomination of Robert Wilkie to be the Veterans Affairs Secretary on June 27.
SUGAR RUSH

From The Post's Fact Checker: One rally, one hour, almost 30 Trumpian claims

House narrowly passes divisive farm bill

Stephen Colbert responds to Melania's controversial jacket choice: