Trump Administration Shuts Down Public Input, Undermining Transparency, Health Equity and Good Policy

HHS Must Reinstate the Richardson Waiver, A Critical Tool for Equitable and Transparent Health Policy

Earlier this year, the Trump Administration rescinded the “Richardson waiver,” ending over 50 years of precedent in seeking public comment for major policy decisions at the U.S. Department of Health and Human Services (HHS). In doing so, HHS Secretary Robert F. Kennedy, Jr. departed from his promise of “radical transparency,” and removed key tools that strengthen government accountability and transparency, encourage more responsive and inclusive policies, and bolster pathways for improved health access and care.

Public Comment is Essential for Good & Equitable Health Policy

Public comment on HHS’ proposed rules enables stakeholders to weigh in on how changes to policies and regulations impact the health of individuals and communities. Through the notice-and-comment process, individuals and organizations have an opportunity to highlight how proposed agency action could create or worsen health disparities and barriers to health care. In turn, policymakers can learn from public voices to better understand whether and how to revise proposed rules to prevent harm to individuals, families and communities.

Public comments are informed by the real experiences of Americans from red states and blue states, big cities and rural areas, and describe the true challenges our friends and family members have with gaining access to quality, affordable health care. Those most affected should have the ability to shape the policies and systems that govern their lives by telling government bureaucrats how proposed policies play out in the real world. The public notice-and-comment process ensures that policies are shaped not just by those in positions of authority, but by individuals, organizations, and all communities directly impacted by regulatory change. Through public comment, policymakers can avoid mistakes before they happen and get informed about intended and unintended consequences of how a policy may or may not be implemented.

HHS’ recission of the Richardson Waiver means that the almost 80 million Americans served by Medicaid and the Children’s Health Insurance Program (CHIP) — including children and low-wage working families, pregnant women, veterans, vulnerable seniors and people with disabilities— no longer have clear avenues in advance of rule-making to engage with HHS on regulatory changes that impact their health and daily lives. While the Medicare statute guarantees a public notice-and-comment period for most Medicare regulatory changes, Medicaid and CHIP do not have similar statutory protections. Given that nearly 42 million people of color use Medicaid to access health care — including 20.3 million Latinos, 13.3 million African Americans and millions of Asian Americans, Native Americans and Pacific Islanders — HHS’ policy reversal will serve to exclude communities who often do not have other channels to voice their perspectives.

While certain regulatory actions will still seek formal public comment as required under the APA, many other actions will go without public notice and input, since the Richardson Waiver had required these agencies to seek public comment on everything from organ transplant to health care delivery. The Richardson waiver is more than a procedural step, it is a tool that helps ensure policymaking is equitable — informed by the life experiences, needs, and priorities of diverse communities, especially those facing systemic barriers to care. This rollback represents a fundamental shift in how federal health regulations may be developed — without guaranteed public engagement in decisions that shape our health care, coverage and wellbeing.

A Call for Restoring the Richardson Waiver and Bringing Back Critical Transparency in Policymaking

The repeal of the Richardson Waiver undermines the legitimacy of our health policymaking process and our ability to build a better, more responsive, inclusive, and equitable health system. As such, Families USA calls on HHS to withdraw its policy statement rescinding the Richardson Waiver, and to embrace the value of public comment by reinstating notice-and-comment rulemaking for all programs and policies within its purview.

Families USA is not alone in this demand and has joined with partner organizations representing health care consumers, patients, workers, clinicians, and other stakeholders for months to keep the pressure on to restore the Richardson waiver. This week, we sent a letter to Senate leadership rejecting the repeal of the waiver by the Trump administration. More than 50 organizations have joined Families USA in supporting a resolution from Senators Wyden, Markey, and King, which calls on HHS to take action and reaffirm practices that involve public comment in the rulemaking process.

Read the Families USA letter in support of the May 1 Senate resolution (S. Res. 198S. Res. 198) introduced by Senators Wyden, Markey and King.