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Debate erupts within HHS about ‘words to avoid’ such as ‘vulnerable,’ ‘diversity’ and ‘entitlement’

Health and Human Services Department officials confirmed Monday that they had singled out a handful of words that should be avoided in the upcoming budget process, but said they had not blocked employees from using them outright. A department spokesman further said that the guidance came from within HHS, not from the Office of Management and Budget.

HHS has been under fire for guidance its budget writers received last week, which identified certain words they should not use in narratives they are preparing for the Fiscal Year 2019 budget process. The style guide's written instructions, obtained by The Washington Post, listed three “words to avoid”: “vulnerable,” “diversity” and “entitlement.” It provided just one exception: the words could be used “when the terms are referenced within a legal citation or part of a title.”

At a budget meeting last week at the Centers for Disease Control and Prevention, employees were also told to avoid four other words not listed in the lengthy document: “fetus,” “transgender,” “evidence-based” and “science-based.” HHS officials gave different accounts of how that took place.

Budget narratives are descriptions of an agency's work and mission, and they reflect the administration's priorities and send a broader message about what may or may not be funded.

HHS spokesman Matt Lloyd said Monday that employees had misinterpreted the guidance. “HHS and its agencies have not banned, prohibited or forbidden employees from using certain words,” Lloyd said in an email to The Washington Post. “Recent media reports appear to be based on confusion that arose when employees misconstrued guidelines provided during routine discussions on the annual budget process. It was clearly stated to those involved in the discussions that the science should always drive the narrative.”

Officials who have been briefed on the budget guidance, however, said the message was clear. “It was interpreted as 'you are not to use these words in the budget narrative,'" said one person who received a briefing last week. “The idea that it's all a misunderstanding is laughable.”

The budget document distributed last week also instructs employees to use the term Republicans adopted to criticize the Affordable Care Act when referring to the 2010 law: "'ACA' and 'Affordable Care Act' should be called 'Obamacare' wherever those terms appear.”

Lloyd said the document originated within HHS. “This budget guidance is not official administration policy and did not come from OMB.”

Rep. Tom Cole (R-Okla.), who chairs the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies, said in a phone interview Monday that while he was “alarmed” by reports about the budget guidance, he speculated that “what we’re looking at is more silly than sinister.” HHS staffers may have crafted language aimed at courting favor with lawmakers, Cole said.

“I think this is more the bureaucracy trying to react to what they think the new administration wants to hear,” Cole said, adding that while he still plans to talk to CDC Director Brenda Fitzgerald about the matter, it appears to him that “this is not any effort to impose any effort to impose parameters on research or blinkers on science.”

Top Democrats on the Senate Health, Education, Labor and Pensions and the House Energy and Commerce Committee, Sen. Patty Murray (Wash.) and Rep. Frank Pallone Jr. (N.J.), pressed HHS Acting Secretary Eric Hargan to provide “information and documents regarding how and why the prohibition is being implemented across the Department.”

“The prohibition has the potential to freeze scientific advancement at the agency and across the Department, and it sends a clear message that the Trump Administration is yet again prioritizing ideology over science,” they wrote in their letter.

At the CDC, a senior career official in the office that oversees formulation of the agency’s budget told participants last week that certain words in budget narratives were being sent back to the agency because of problematic words that had been “flagged,” according to an analyst who took part in the meeting and whose job includes crafting budget-related documents. The senior budget official told the group that she had only seen three of these flagged words in writing. She said they were “vulnerable,” “diversity” and “entitlement.” She told the group there were other words too, but officials are avoiding writing them down, the analyst recalled her telling the group. The analyst requested anonymity because the person is not authorized to speak publicly about the meeting.

When participants pressed her for examples, the official said those words were “fetus” and “evidence-based” and “science-based.” Another senior budget official told the group that “evidence-based” and “science-based” had been used so often in budget documents that their meaning had been diluted. The officials suggested an alternative: “CDC bases its recommendations on science in consideration with community standards and wishes.” During that discussion, the word “transgender” also came up, and the senior official also told the group it was a word to be avoided.

The analyst took notes from the meeting to reflect the distinction the senior official drew between words to avoid for which there was written guidance, and the ones for which there was verbal guidance.

Another HHS official who was not present for the conversation gave a different account of the CDC meeting. He said the four other words were brought up by participants in the meeting, not by the senior official.

“You had people at the meeting, saying, 'Okay, if they want us to avoid “vulnerable,” what about “fetus",'" the official said. “These were words that were brought up by people in the meeting because of their prior experience in formulating the CDC budget.” The senior CDC budget official who was leading the discussion told the group they should find a way to avoid using the words, according to the HHS official who was not at the meeting. But the CDC budget official also said that if they could not find a good alternative, it was acceptable to use the word, according to the HHS official.

The budget analyst present at the meeting does not recall the conversation unfolding in that way.

At a second HHS agency, officials were also told to avoid using the words listed in the guidance document — “vulnerable,” “diversity” and “entitlement” — and to replace “ACA” and “Affordable Care Act” with  “Obamacare” wherever those terms appear.

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