By Stephanie Armour
KFF Health News

From his perch in the Trump administration’s Department of Health and Human Services, Roger Severino made a controversial name for himself, working to shield health workers who declined to perform medical procedures including abortion on religious grounds.

After President Donald Trump left office, Severino helped the conservative Heritage Foundation develop a plan to expand that conservative stamp to the broader department, recasting HHS with a focus on traditional marriage and family.

The vision is outlined in the Project 2025 “Mandate for Leadership,” a blueprint by the foundation and allied groups intended to guide the next presidential administration. It has emerged as a political flash point, as Democrats portray the 900-page document as promoting an authoritarian power grab by extreme conservatives.

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Severino, the lead architect of the project’s section on HHS, has won praise from conservatives and criticism from LGBTQ+ and other liberal advocacy groups who say he poses a threat to reproductive rights and gender-affirming care.

His proposals smack of some of the most heated culture war conflicts shaping the election, from gay rights to gender identity to contraception. They would likely find support under a conservative administration.

Under Severino’s vision for HHS, federal approval of one commonly used abortion drug, mifepristone, could be revisited and potentially withdrawn. Health agencies would promote “fertility awareness” as an “unsurpassed” method of contraception. Medicaid, the public health insurance program that covers more than 75 million low-income and disabled people, could be converted into block grants that Democrats say would result in far lower funding and enrollment.

HHS itself would be known as the Department of Life, underscoring a new focus on opposing abortion.

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Severino declined to comment extensively on Project 2025, but he pushed back in an interview on assertions that it would ban access to medication abortion.

“When the Biden-Harris administration says [the document] would ban all chemical abortion nationally, it’s a lie, plain and simple,” he said.

Trump, again the GOP’s presidential nominee, has taken increasingly aggressive steps to distance himself from Project 2025 as it has become central to his opponents’ attacks. Heritage on July 30 said that Paul Dans, who directed the initiative, would step down from his role. The same day, Trump’s campaign managers, Susie Wiles and Chris LaCivita, denounced the document.

“Project 2025 had nothing to do with the campaign, did not speak for the campaign, and should not be associated with the campaign or the President in any way,” Wiles and LaCivita said in a statement.

But the campaign’s message is undermined by the document’s authorship; its contributors include a number of high-ranking officials from Trump’s first administration, including former White House adviser Peter Navarro; Christopher Miller, whose positions included acting secretary of defense; and Trump’s secretary of Housing and Urban Development, Ben Carson.

Project 2025’s passages on abortion, in particular, depart significantly from what Trump has said about the issue on the campaign trail. He has said he wants abortion policy made in states, not at the federal level, and that he wouldn’t support a national ban or taking mifepristone off the market. He refashioned the official GOP platform to make scant mention of abortion, recognizing the political peril the issue posed for his campaign.

Support for abortion access is growing. Sixty-one percent of adults want their state to allow legal abortion for any reason, according to a poll conducted in June by The Associated Press and the University of Chicago’s NORC, which conducts social research.

The Heritage Foundation’s policy proposals, published roughly every four years since the 1980s, have had considerable sway on GOP presidents. Former presidents Ronald Reagan and Trump each adopted about 60% or more of the recommendations produced in earlier Heritage guides, the group says.

Severino was a trial attorney for seven years in the U.S. Department of Justice’s Civil Rights Division under former presidents George W. Bush and Barack Obama. He joined Heritage in 2015 and garnered acclaim from conservatives in part because of articles he published while he was there.

In one, for example, he said a proposal by Obama to include gender identity in Affordable Care Act provisions prohibiting discrimination would penalize medical professionals and health care organizations that, as a matter of faith, believe “maleness and femaleness are biological realities” to be “affirmed” rather than “treated as diseases.”

He was tapped to run the HHS Office for Civil Rights in 2017.

There, he created a new Division of Conscience and Religious Freedom because, he said, protections for people with deeply held religious beliefs had been underenforced.

The proposals for HHS laid out in Project 2025 have alarmed LGBTQ+ advocacy groups as well as some researchers.

“It could promote stigma and discrimination,” said Lindsey Dawson, director of LGBTQ Health Policy at KFF, a health information nonprofit that includes KFF Health News.

President Joe Biden and the Democratic Party’s new presumptive presidential nominee, Vice President Kamala Harris, have repeatedly urged voters to read the document themselves.

In one of her first speeches after taking over the top spot on the Democratic ticket, Harris said Project 2025 would “treat health care as only a privilege for the wealthy instead of what we all know it should be, which is a right for every American.”

Conservatives say Democrats are lying about what Project 2025’s proposals would do and are incorrectly attributing the ideas to Trump for political gain.

Spokespeople for the Trump and Harris campaigns didn’t respond to requests for comment.

The blueprint’s foreword espouses what it calls an anti-“woke” mentality, proposing to delete from every federal regulation words such as diversity, equity, inclusion, “and any other term used to deprive Americans of their First Amendment rights.”

HHS would revisit a rule that prohibits discrimination in health programs and extends those protections to people based on their sexual orientation and gender identity. The document says that definition “created special privileges for new classes of people, defined in ways that are highly ideological and unscientific,” and should be reversed.

The Centers for Disease Control and Prevention would cease collecting data on gender identity because, the Project 2025 report says, it “legitimizes the unscientific notion that men can become women (and vice versa),” and health agencies would study the “negative effects of cross-sex interventions” such as puberty blockers.

“Families comprised of a married mother, father, and their children are the foundation of a well-ordered nation and healthy society,” according to the document.

The road map would roll back years of hard-fought gains for people who are LGBTQ+, their advocates say.

“This is a fantasy reality, like watching ‘Leave it to Beaver,’” said David Stacy, vice president of government affairs at the Human Rights Campaign, an LGBTQ+ advocacy group.

The concepts may appeal to many in Trump’s conservative base, however. Nine in 10 U.S. adults say a husband and wife raising children together is completely acceptable, according to a 2023 poll by the Pew Research Center. Fewer than half say the same about a married gay or lesbian couple raising children together.

Nine in 10 Trump supporters and about 4 in 10 Biden supporters say sex at birth determines if someone is a man or a woman, according to an April Pew poll.

Project 2025 risks GOP voter support over its anti-abortion stance, according to some political analysts. Its foreword also calls for removing from grants, regulations, and legislation words such as abortion, reproductive health, reproductive rights, and any other term “used to deprive Americans of their First Amendment rights.”

The proposal urges that the CDC fund research into abortion risks and complications and that HHS cut federal funding for states that don’t provide data such as the number of abortions performed within their borders.

Project 2025 calls for revisiting approval of the abortion pill mifepristone. It could potentially lose FDA authorization and be subject to new dispensing requirements — such as barring distribution by mail, based on an 1873 law known as the Comstock Act— before that step.

The proposal’s authors say misoprostol, a medication approved to treat ulcers but also used for abortion, would not be affected.

“If the FDA were to reconsider mifepristone because of legal or safety concerns, at most, it would put doctors back in the process without limiting their ability to prescribe other chemical abortion drugs off-label,” Severino said.

Stephanie Armour: sarmour@kff.org, @StephArmour1