But inside HHS, staff say that those leaders are steering their offices to support evangelicals at the expense of other voices, such as a recent decision to selectively post public comments that were overwhelmingly anti-abortion. “It’s supposed to be the faith-based partnership center, not the Christian-based partnership center,” said a longtime HHS staffer, referencing the HHS Center for Faith-Based and Neighborhood Partnerships led by Royce.

More than a dozen current and former HHS staffers, who requested anonymity to speak freely, spoke with POLITICO for this story. HHS declined to make top officials available for interviews.

Short-term victories fuel long-term plan

The agency’s devout Christian leaders have set in motion changes with short-term symbolism and long-term significance. One of those moves — a vast outreach initiative to religious groups spearheaded by Royce, asking how to serve them better — came in October 2017 while the health department reeled from the resignation of former Secretary Tom Price and congressional Republicans struggled to repeal the Affordable Care Act.

That outreach initiative began a rulemaking process that could culminate in a rollback of Obama-era protections for transgender patients and allowing health providers more protections to deny procedures like abortion. It worried abortion rights and LGBT advocates, who acknowledge that while abortion laws and other regulations remain mostly intact, the groundwork is steadily being laid to revise them.

“This administration is focused on recognizing one set of religious beliefs,” said Gretchen Borchelt of the National Women’s Law Center. “It’s going to do whatever it can to reshape or violate the law to do that.”

The October effort surprised Royce’s own staff, many of whom weren’t aware that the center’s request for information — a key tool in rulemaking that lets agencies solicit comments that they can use to revise or introduce regulations — was even being developed until it was publicly posted. The reason: Royce, the center’s director, didn’t tell them.

“Shannon put it together with Roger Severino and jammed it out the door,” said one staffer, who noted that the center had never issued a request for information before. “We were messaging each other — ‘did our office just put out an RFI?’”

It wasn’t the first time that Royce, Severino and their allies pushed their HHS offices to pull off groundbreaking maneuvers. That’s helped raise their stature with evangelical groups, as well as with anti-abortion Republican lawmakers, a powerful bloc that includes Vice President Mike Pence.

“You’re over at HHS, a true bright spot in this administration when it comes to protection of life and protection of conscience,” a moderator at the Evangelicals for Life conference said when introducing Royce last Thursday. “It’s no exaggeration to say that you guys have just had a monster year over at HHS.”

But those same actions have alarmed the ACLU and other groups, which warn that the health department’s leaders are blurring the lines between church and state. “Time and time again, we have seen this administration radically redefine religious freedom to impose one set of ultraconservative beliefs on all Americans,” said Sara Hutchinson Ratcliffe of Catholics for Choice.

Shifts in process and priorities

The political leaders’ moves also worry career agency staff, who say that important decisions about controversial issues like abortion, contraception and transgender care are increasingly being kept secret at the nation’s largest government agency. “The American people deserve to know and deserve to weigh in,” said one staffer, referencing the agency’s decision to withhold thousands of critical comments on the RFI. “This shouldn’t be sprung on them as a finished product.”

Anti-abortion, devoutly Christian leaders now shape HHS’ daily communications and overarching legal strategy — a major departure from the Obama administration and arguably leaving them more empowered than under previous Republican administrations. Charmaine Yoest, the former head of Americans United for Life, is the department’s top spokesperson and steers the agency’s messaging. Matthew Bowman is now the HHS deputy general counsel, a post in which he advises the secretary and helped roll back the same birth control protections that he once fought before the Supreme Court.

The roster of anti-abortion leaders at HHS is deep enough to adjust to sudden departures. Teresa Manning had been overseeing Title X programs at the agency, which included funding contraception care — a striking appointment, given that Manning publicly had said that contraception didn’t work. After Manning’s abrupt departure last week after less than nine months, she was replaced by Valerie Huber, an advocate for abstinence education who also joined the department last year.

“One of the axioms of politics is that personnel is policy,” Royce said last Thursday, appearing at the anti-abortion conference. “We have such an amazing team at HHS that is absolutely a pro-life team across the spectrum.”

That team has found new ways to expand HHS’ powers and engage evangelicals, most recently by setting up a “Conscience and Religious Freedom” division of its civil rights office on Thursday. The newly created division, which POLITICO first reported on Tuesday, will work to strengthen health workers’ ability to opt out of procedures when they have religious or moral objections. It’s a dramatic broadening of conscience protections that have long been on the books.

“These protections have been under-enforced in the past,” Severino reportedly said on a media call with mostly conservative and Christian publications last week. “We are back in business.” (POLITICO and other national media outlets were not invited to the call, and HHS declined to make Severino available for an interview.)

But longtime HHS officials say that the existing civil rights office was more than capable of handling these issues and that creating an entire division to focus on religious liberty sends the wrong message.

“This is a classic solution in search of a problem,” said one official who’s handled civil rights issues at HHS. “And it’s a problem that doesn’t really exist, because hospitals tend to be really compliant on this kind of stuff.”

During the Obama administration, Christian conservative groups had even hailed HHS for its efforts to enforce religious freedom, such as intervening in a lawsuit filed by an anti-abortion nurse against Mount Sinai Health System in New York. “Pro-life medical personnel should not be forced to assist abortions, and Mount Sinai’s new policy reflects that, thankfully, after Alliance Defending Freedom brought lawsuits and complaints to HHS,” Bowman said at the time, four years before he would join HHS himself.

Royce’s partnership center has sparked controversy with how it handled its request for information. POLITICO in December reported that the center was deliberately withholding thousands of critical comments of its plan while posting just 80 comments, overwhelmingly from anti-abortion and evangelical respondents who called on HHS to roll back protections related to abortion and transgender care. (The center released the missing 12,000-plus comments four days after POLITICO’s story.)

After adjustment, leaders look ahead

Some of the anti-abortion leaders have also had occasionally bumpy transitions, particularly because many of them had little, if any previous experience in the federal government or in relevant positions and often don’t consult the career staff.

Yoest was criticized for the agency’s handling of questions about Price’s controversial use of charter jets. HHS seemed unconcerned by the stories at first and felt there was little need to respond, according to White House officials, who griped about the agency’s crisis-management strategy last year. The communications office has seen a steady stream of departures and remains under-staffed.

Jane Norton, an anti-abortion activist tapped to be HHS’ top liaison, was pushed out after less than seven months in the job, as she struggled to communicate the department’s work to governors, business associations and other groups. She was also the plaintiff in a long-running lawsuit against Planned Parenthood of the Rocky Mountains, which created an eye-catching legal situation: one of HHS’ top leaders actively suing one of HHS’ grantees. Oral arguments in the case were held in November 2017, while Norton was still at seat in HHS.

But staff acknowledge that the political leaders are starting to achieve a steady stream of symbolic, anti-abortion goals, led by Royce and Severino. “She’s a force of nature,” said one staffer who’s worked with Royce inside HHS. “She just goes after and goes after it.”

“I think he’s very sincere,” said a civil rights lawyer who’s worked with Severino. “He tries to be principled — we just have different principles.”

The agency’s political leaders understand that a future Democratic administration could reverse some of their own regulations, raising the stakes for future legal battles. According to an individual familiar with their thinking, leaders like Severino and Yoest have celebrated Trump’s record number of appellate judges confirmed last year, which have stocked the judiciary with jurists who favor their causes. Severino’s wife, Carrie Severino, is a judicial activist who’s worked to get Trump’s nominees confirmed.

HHS’ leaders also are waiting on the arrival of HHS Secretary-designate Alex Azar, a George W. Bush administration veteran who’s likely to get confirmed. In his testimony, Azar has praised the need for conscience protections, comments that strengthened his support among evangelicals.

“Praying for Alex Azar II this morning,” Royce posted last Wednesday, ahead of a committee vote to advance Azar’s nomination. “Please join me.”

The health department is poised to keep playing an outsize role on issues important to Christian conservatives, with a series of decisions looming related to enforcing transgender protections, funding contraception and paying for programs related to family planning. Meanwhile, the agency’s four-year strategic plan is being finalized and is expected to include policy positions sought by evangelicals, such as stating that life begins at conception.

“You will see exciting things in the coming days, and that’s all I can say right now. But good stuff is coming,” Royce promised attendees at last Thursday’s anti-abortion conference. She then urged the audience — with hundreds of attendees in town for the March for Life, the nation’s largest anti-abortion rally — to play a part in helping HHS achieve its strategy.

“I’m a goal-setter for every new year,” Royce said. “My challenge to you this year … ask the Lord to show you one thing you can do consistently that is pro-life.”