The Affordable Care Act remains on the books, but its opponents, guided by Trump administration policy at the Health and Human Services Department, are “censoring” practical website information on how to use the law, according to a new study by a nonprofit monitoring group.
In the largest report yet by researchers at the Web Integrity Project at the Sunlight Foundation, screen shot look-backs and tallies document removal of at least 85 pages of fact sheets, news releases and answers to frequently asked questions that HHS under the Obama administration posted to help users—particularly minorities—navigate the available health insurance benefits. The website monitors also documented 26 cases of what they deem censorship.
“The administration has censored a wide array of content aimed at a variety of audiences, including the general public, beneficiaries and those who serve beneficiaries,” the report said. “HHS has surgically removed the term ‘Affordable Care Act’ from many webpages; taken down information on rights guaranteed under the ACA; eliminated statistics and data on the ACA’s impact; and removed links to the federal government’s main platform for enrolling in ACA coverage, HealthCare.gov.”
The now-missing materials “read like a highlight reel of the law’s benefits, both actual and projected,” the report said.
In perhaps their most pointed policy criticism yet, the Web Integrity Project researchers warned that “if repeated on a wide scale, censorship of ACA information on federal websites has the potential to affect public support and awareness of the law. Ultimately, censorship that affects public opinion and awareness of the ACA may jeopardize Americans’ access to coverage and health services, and down the line, the ACA’s long-term viability.”
The main report, “Erasing the Affordable Care Act,” noted that “the federal government considers public federal agency websites to be the primary way the public learns about government functions, benefits and rules. Agencies are thus expected to maintain their websites to provide the public with accurate, objective, and nonpartisan information about their programs…But when the administration that leads those agencies vocally opposes the existence of a program, agency websites can be used as a tool to undermine that program.”
The 26 instances include “excised words, removed links, altered paragraphs, and removed pages” on HHS websites—tracked using the Internet’s way-back machine—since Trump took office. “They may represent only a small sample of the censorship that has occurred,” the analysts wrote, and “have also amplified and foreshadowed other executive actions taken by the administration to undermine enrollment and specific provisions of the law.”
Those include reduced funding for the ACA’s “navigators” program that helps people enroll and “limiting access” to Healthcare.gov and enrollment.
In a Monday conference call with reporters, the researchers said the Web changes—arrayed visually using an inventory and screen shots—foreshadow more formal tools for altering policy and are greater in scope than they expected. “Unlike rulemaking, non-enforcement, and fund reallocation, minimal guidance governs the use of information on government websites,” noted project Director Rachel Bergman and Research Director Sarah John. The changes targeted information and resources for underserved populations like women, the LGBTQ community, minority groups, and people with a mental health condition, they said. “These communities are already more likely to be uninsured or have less access to ACA health services than the rest of the population.”
The changes are often executed with little public notice or explanation, the group has long said. “Given the campaign about fake news and what is reliable,” John said, “a government source is considered a most reliable source.”
When the Centers for Medicare and Medicaid Services “added information about the law’s individual mandate, “there was no mention of the law,” Bergman said. “Policy and censorship are working in concert.”
HHS did not respond to requests for comment by publication time. In the past its spokesmen have stressed that the materials were “not removed, but rather reorganized” in keeping with federal records practices to “keep content relevant.”
The department is “always looking at ways to provide users content in a way they can find it and many changes that we make are based on usability testing and analytics,” a past statement said.
The Web Integrity Project, which has been monitoring 30,000 webpages at two-dozen agencies, recommended as a solution “a formal process of writing memos that review whether content should be moved to archives” as well as “notice when revising or publishing new information on the HealthCare.gov website during Open Enrollment.”
More ambitiously, the researchers called on Congress to subject agencies to rules on website changes using guidance crafted by the Government Accountability Office or Office of Management and Budget (already the source of guidance on agency website protocols). “With the presumption of quality and respectability afforded to content located on a .gov page, agencies should be required to follow formal processes to change their websites and adhere to standards of Web content that ensure its quality,” the researchers said.