The Department of Health and Human Services has a trillion-dollar operating budget, a staff of close to eighty thousand, and more than a hundred programs under its watch, including Medicare, Medicaid, the Food and Drug Administration, and the Centers for Disease Control and Prevention. It also oversees the Office of Refugee Resettlement, a relatively small program tasked with caring for recently arrived refugees. During the past month, O.R.R., in defiance of state and federal court orders, tried to keep a seventeen-year-old girl in its custody from having an abortion. Identified only as “Jane Doe,” she was living in an O.R.R.-funded shelter in Texas, where state law prohibits abortions after twenty weeks. At issue wasn’t the use of federal money (a nonprofit raised the funds necessary for the abortion) or logistics (the girl’s legal guardian had offered to transport her to and from a medical facility). The matter was political. Justice Department lawyers argued, in court, that O.R.R. has “strong and constitutionally legitimate interests in promoting childbirth, in refusing to facilitate abortion, and in not providing incentives for pregnant minors to illegally cross the border to obtain elective abortions while in federal custody.” Earlier this week, a federal appeals court ordered O.R.R. to stand down. Blocking the girl’s abortion, the judges wrote, was a “grave constitutional wrong.” On Wednesday morning, Jane Doe, who was nearly sixteen weeks pregnant, had the abortion before the government could further interfere.
The fact that O.R.R. was at the center of the controversy—and the object of such a dramatic judicial rebuke—shocked many who worked there in the past. “I have seen this office in Republican and Democratic Administrations, and the position it’s taken here doesn’t track with either,” Robert Carey, who served as the head of O.R.R. during the last two years of the Obama Administration, told me recently. “The decision-making looks uniquely ideologically driven.” The program is staffed by public-health professionals, N.G.O. veterans, and immigrants’-rights advocates. “It’s always been a mission-driven office,” Carey said. O.R.R.’s main responsibilities are finding homes and providing health care for foreigners who have refugee status in the U.S. In recent years, it also has housed and supported a population of more than a hundred and seventy-five thousand immigrants known as unaccompanied minors—children, mostly from Central America, who have arrived in the U.S. without their parents and whose legal cases are pending. “Jane Doe” is one of them. O.R.R. places these children in shelters administered by different aid organizations, where they’re supposed to have access to a full range of medical procedures, including abortions. In the past, some shelters operated by religious groups refused to facilitate abortions, but, in 2011, O.R.R. modified its policy to support the shelters that promised to offer complete medical care. “Absolutely everything in the lives of these kids is controlled by the shelters where they’re placed,” Maria Cancian, a professor at the University of Wisconsin who worked at H.H.S. in the Obama Administration, told me. “They generally don’t leave. Food, medical care, talking to their parents are all controlled by the shelter. If we place girls in shelters where providers have a strong ideology opposed to providing services, we’re putting them in an impossible position.” It has been estimated that sixty per cent of girls who make the trip alone to the United States from Central America are raped or sexually assaulted on their journey.
O.R.R. and H.H.S. leaders installed by the Trump Administration are responsible for the office’s new lurch into abortion politics. In late March, E. Scott Lloyd, who once served as a lawyer for the Catholic advocacy organization Knights of Columbus and who has a long and well-documented history of outspoken anti-abortion views, became the director of O.R.R. He came to the program with limited experience in refugee-related issues, and many attributed his appointment to his conservative credentials. A member of the Republican National Lawyers Association, he served as an attorney for H.H.S. during the Bush Administration, where he co-wrote a controversial policy called the medical “conscience rule,” to defend health-care providers that opposed abortion on moral or religious grounds. “It does seem that maybe ideology or perceived loyalty to a particular set of values is being valued more highly than experience running an agency, or organizational skills, or experience with refugees,” one immigration lawyer told the Daily Beast after Lloyd was officially tapped. Lloyd flew to Texas to meet with a pregnant girl living in an O.R.R. shelter, to try to persuade her not to have an abortion. On March 30th, two days after he became the head of O.R.R., Lloyd sent an e-mail to his staff with an explicit directive. “Grantees”—meaning shelters that receive O.R.R. grants—“should not be supporting abortion services pre or post-release,” he wrote. “Only pregnancy services and life-affirming options counseling.”
A trove of internal O.R.R. documents was made public during the litigation over Jane Doe’s abortion, and they show that the program was generating new policies concerning abortions even before Lloyd took over. One memo, dated March 4th, declared that, in situations where an unaccompanied minor “may be involved in an abortion,” shelters were “prohibited from taking any action that facilitates an abortion without direction and approval from the Director of ORR.” The same memo described an incident that took place the day before, when a girl at a shelter in San Antonio, who had already received a judge’s permission for an abortion, took an initial dose of mifepristone, a drug used to terminate early-stage pregnancies. Before she could take the next dose, O.R.R. intervened. Officials drove her to a nearby emergency room to assess her and her fetus’s “health status.” After legal pressure, O.R.R. relented, and she was allowed to take a dose of a second drug, called misoprostol, to complete the procedure.
Another official behind O.R.R.’s renewed interest in abortion issues is Margaret Wynne, an H.H.S. veteran who worked under Presidents George W. Bush and Barack Obama, and who now serves as counsellor for human-services policy at H.H.S. One H.H.S. veteran described Wynne’s job as “the main trouble-shooter for all the human-services activities at H.H.S.” and the point person for any policy issue before it reaches the head of the entire department.
Several of Wynne’s former colleagues described her to me as ardently pro-life. Like Lloyd, she once worked at the Knights of Columbus, and before joining H.H.S. she served as the director of the House of Representatives Pro-Life Caucus. Under Obama, Wynne ran O.R.R.’s anti-human-trafficking program, overseeing a team of social workers who assessed the eligibility of foreign-born trafficking victims to get temporary public-health benefits. “She did not trust the stories of these individuals anytime a lawyer was involved,” one former colleague told me. “She assumed the lawyers were coaching victims to get benefits. And any time a kid’s story changed, she acted like they were lying.” (Wynne, through an H.H.S. spokesperson, disputed this characterization.)
Wynne left H.H.S., in 2016, after years of clashing with other officials in the Obama Administration, but she returned to serve on the transition team at H.H.S. after last November’s election. Being one of the only political appointees at the department with extensive prior experience involving O.R.R. contributed to her clout. Until Lloyd took over, staffers at O.R.R. reported to her. “O.R.R.’s policies reflect her choices,” one former official, who still has close ties to the office, told me. (“O.R.R.’s policies reflect those of the Administration, and Maggie is in H.H.S to support them,” an H.H.S. spokesperson said.)
The A.C.L.U., which has represented Jane Doe, maintains that there are hundreds of other girls in O.R.R.’s care who are pregnant. It’s unclear how Wednesday’s ruling will affect them if they, like Jane Doe, seek to have abortions. “I don’t think the government is going to modify its policies until a court forces them,” Brigitte Amiri, Jane Doe’s lawyer, told me after the ruling. O.R.R., under Lloyd’s leadership, is currently directing unaccompanied minors who have requested abortions to so-called crisis pregnancy centers, where they are encouraged to carry their pregnancies to term. Carey, the former O.R.R. head, is concerned such practices will continue. “Policy is being issued by fiat over e-mails and through memos,” he told me. “Will girls be provided counselling about all their options? Will they have access to legal representation? These are all open questions.”
