Unlike some traditional Republicans, many religious conservatives eagerly sought jobs in the administration and the chance to shape policy after eight years of a Democratic president. This was especially true at H.H.S., where the senior ranks are staffed with former activists who have built careers advancing socially conservative causes.
Some of those hires at H.H.S. include a deputy general counsel who was a lawyer with the Alliance Defending Freedom, a well-funded conservative legal group that opposes gay rights and abortion and fought the Obama administration’s contraception coverage requirements; the chief of staff to the assistant secretary for health, who used to lead an abstinence advocacy group; and the head of the department’s Office for Civil Rights, whose work at the Heritage Foundation involved promoting religious freedom initiatives.
After a relatively slow start as key personnel were put in place, the department has been responsible for a flurry of new policies. It has told states that they no longer have to follow Obama-era rules that made it difficult to withhold Medicaid funding from Planned Parenthood. It has announced the creation of an entity inside its Office for Civil Rights called the Conscience and Religious Freedom Division, which will respond to alleged violations of conscience and religious protections. And its new strategic plan commits the department to “protecting Americans at every stage of life, from conception.”
The result, activists on both sides of the fight say, is that no White House has been as aggressive in shaping policy in a way that hews so closely to the priorities of the religious right.
“Times are changing,” said Roger Severino, the head of the Office for Civil Rights, as he announced the Conscience and Religious Freedom Division this year. “And we are institutionalizing a change in the culture of government, beginning with H.H.S.”
Unlike previous Republican administrations, when it was Congress or the Supreme Court that initiated the biggest changes to abortion law, many of the most significant developments today are occurring at the agency level, largely out of public view. And that troubles liberal advocates like the American Civil Liberties Union, which has sued Mr. Lloyd and won several times.
“There’s much more action at the federal level under Trump than there has been with other administrations,” said Jennifer Dalven, the director of the A.C.L.U.’s Reproductive Freedom Project.
And when that action occurs mostly under the radar, she added, “you don’t provoke the same level of outrage from the public. It’s quiet. People don’t see it. And unlike if you were to overturn Roe v. Wade, you don’t have people marching in the streets.”
Since the week he took office, Mr. Trump has issued several orders that have thrown up roadblocks to access to abortion and reproductive health care.
Just three days after his inauguration, he reinstated a policy first implemented by President Ronald Reagan in 1984 that prohibits foreign nongovernmental organizations from performing or discussing abortions as a family planning option if they want to receive American funding.
While this decision was something Presidents George H.W. Bush and George W. Bush also implemented, the Trump administration went further and expanded its order to say that if these nongovernmental organizations did offer or suggest abortion as an option, they would be ineligible not just for family planning assistance but for funding for a host of other unrelated health concerns — like HIV awareness, malaria and nutrition. That put billions of dollars of American aid in jeopardy.
“Trump being Trump, he didn’t just reinstate,” said Ilyse Hogue, the president of Naral Pro-Choice America. “He applied it to a much larger pot of money.”
But the administration’s most sweeping changes yet could come with proposed rules it announced in January. The proposals would expand protections for doctors, nurses and possibly a much wider pool of workers more loosely connected to health services who say that assisting with procedures like abortion and gender reassignment surgery would violate their religious beliefs. The administration is reviewing more than 55,000 comments on the proposals and could issue final rules later this year.
Critics say the language is so broad it could apply to virtually anyone, no matter how tangentially connected to the health care procedure or service they consider immoral.
“If you are the contractor who empties the waste baskets at a health plan and that health plan covers abortion, you can refuse without being fired,” said Clare Coleman, the president of the National Family Planning and Reproductive Health Association.
Like his colleagues in other parts of H.H.S., Mr. Lloyd, who declined requests for comment, has a history in the anti-abortion movement. Before he joined the Trump administration, he worked as a policy coordinator for the Knights of Columbus, the Catholic fraternal order, and served on the board of a crisis pregnancy center in Virginia. On the résumé and cover letter he submitted to the department, he listed his work experience as the “architect” of a late-term abortion ban that is now law in six states.
While anti-abortion work has been his passion, Mr. Lloyd’s job as director of the Office of Refugee Resettlement entails broad responsibilities for helping people of all ages who are trying to resettle in the United States with financial, medical and other assistance. That undocumented minors have been caught up in his personal quest to fight abortion is something of a bureaucratic quirk. Minors are under the care of his office; the placement of adult refugees is overseen by the Department of Homeland Security.
The Administration for Children and Families at H.H.S., which oversees the Office of Refugee Resettlement, said in a statement that as the legal guardian for the minors, Mr. Lloyd’s office is required by law to act with the girls’ interests in mind. And the Trump administration has determined, the statement added, that “the best interests of illegal immigrant children in our care include the protection of mothers and their babies in our facilities, and we will defend human dignity for all in our care.”
Mr. Lloyd has taken the position that as unauthorized immigrants, the girls are not entitled to the same constitutional protections as citizens. Under questioning from an A.C.L.U. lawyer during a deposition, he said he did not know of any set of circumstances that would cause him to grant an abortion request, though he said that if a girl’s life were in danger that could “potentially” sway him. He has denied at least one request for an abortion from a girl who said she had been raped.
Anti-abortion groups have welcomed his defiance as a hopeful sign. And they echo what H.H.S. officials have said themselves: A new culture is taking hold inside the Trump administration.
“If you think this is just an appendectomy, you rush that person to the hospital,” said Marjorie Dannenfelser, the president of the anti-abortion Susan B. Anthony List. “But if you think that an abortion is actually taking another person’s life, you pause, you think, you consider and figure out other options. And I think that’s where the Trump administration is coming from.”