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in the Office of Science and Medicine to drive investigative review of literature fora variety of issues including the effect of abortion on prematurity and breast cancer; lack of evidence for so-called gender-affirming care; and physical and emotional damage following cross-sex treatments, especially on children. The OASH should withdraw all recommendations of and support for cross-sex medical interventions and “gender-affirming care.”

Title X. The Title X family planning program should be reframed with a focus on better education around fertility awareness and holistic family planning and a Deputy Assistant Secretary for Population Affairs that understands the program and is able to work within its legislative framework (ideally, an MD). In addition, the Office of Population Affairs should eliminate religious discrimination in grant selections and guarantee the right of conscience and religious freedom of health care workers and participants in the Title X program.

In 2021, HHS reversed a Trump Administration regulation that required grantees to maintain strict physical and financial separation between Title X activity and abortion-related activity.”° Under the Biden Administration’s regulation,” Title X activity can be conducted alongside abortion activity without strict physical and financial separation. The regulation also requires grantees to refer for abortions despite sincere moral or religious objections. This effectively bans otherwise qualified pro-life grantees from participating in the program.

HHS should rescind the Biden Administration’s regulation and reinstate the Trump Administration regulation for the program. It should also do this quickly (the Biden Administration completed its regulatory process and issued a final rule in less than nine months) and expand the potential grantee population beyond abortion providers like Planned Parenthood.

Congress should complement these efforts by passing legislation such as the Title X Abortion Provider Prohibition Act,”* which would prohibit family planning grants from going to entities that perform abortions or provide funding to other entities that perform abortions. This would help to protect the integrity of the Title X program even under an abortion-friendly Administration.

ADMINISTRATION FOR STRATEGIC PREPAREDNESS AND RESPONSE (ASPR)

ASPR vs. FEMA. When the President declares a national emergency (per the Stafford Act) related to a public health emergency declared by the HHS Secretary, FEMA is activated and controls instead of HHS/ASPR. While this arrangement has some benefits because of FEMA’s unique logistical capabilities, the arrangement should be reviewed—especially considering the COVID-19 pandemic—for improvements in efficiency according to expertise and available resources, reduced confusion for ASPR and among HHS agencies, and avoidance of duplicated efforts among agencies and personnel.

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Strategic National Stockpile. The President should invoke the Defense Production Act,” which is a form of temporary takeover of private enterprises, only in the gravest circumstances. The Strategic National Stockpile (SNS) should be reformed to consider the potential supply chain disruptions of pandemics or global conflicts. Also, during the COVID pandemic, many states received ventilators from the SNS and hoarded them in places where a rush of COVID patients needing ventilators never materialized. The SNS should clarify its mission as supplier of last resort to the federal government, state governments, or first responders and key medical staff and should not portray itself as serving the public as a whole.

OFFICE OF GENERAL COUNSEL (OGC)

The Office of General Counsel is essential to ensuring that HHS is operating within the bounds of its numerous governing statutes. However, legal caution can outweigh practical necessity and often slows processes and decisions when time is of the essence. Such problems were evident both before and during the COVID-19 pandemic. Internal processes should be reformed to streamline necessary legal determinations during crises, and general processes should be reviewed for efficiency. OGC should also:

• Rescind its PREP Act liability memo. OGC issued a PREP Acct liability memo that suspended application of civil rights and other laws in the context of the administration of covered countermeasures during the pandemic. It should be rescinded as contrary to law.

• Rescind efforts to curtail OCR authority over conscience and religious freedom. All OGC memos and Federal Register notices of organization or delegations of authority moving any OCR conscience and religious freedom enforcement to OGC, including RFRA, should be rescinded, and independent authority over these matters should be restored to OCR.

• Encourage DOJ to repeal OLC memos allowing abortion funding despite Hyde and memos allowing federal enclave immunity to perform abortions despite the Assimilative Crimes Act.°°

• Rescind legal analysis that authorized HHS to impose a moratorium on rental evictions during COVID.

• Rescind the OGC legal analysis saying that the injunction in Bowen

v. American Hospital Association* prevents any proposed HHS regulations or enforcement actions concerning the denial of care