Trump Administration Shuts Down Public Input, Undermining Transparency, Health Equity and Good Policy – Families USA

Report on the Rescission of the Richardson Waiver and its Implications for Sustainable Development Goals

Executive Summary

A recent policy change by the U.S. Department of Health and Human Services (HHS), which rescinded the long-standing “Richardson Waiver,” has significant negative implications for the advancement of several Sustainable Development Goals (SDGs). This action eliminates the established 50-year precedent of public consultation for major health policy decisions, thereby undermining principles of transparent governance, equity, and public well-being. This report analyzes the impact of this policy reversal through the lens of SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice, and Strong Institutions).

Undermining SDG 16: Peace, Justice, and Strong Institutions

Erosion of Institutional Transparency and Accountability

The decision to end the mandatory public comment period directly conflicts with the objectives of SDG 16, which calls for effective, accountable, and transparent institutions.

• Target 16.6 (Accountable and transparent institutions): The Richardson Waiver served as a critical mechanism for government accountability by requiring HHS to seek public input on regulatory changes. Its rescission removes a key tool for ensuring that health policy is developed transparently.
• Target 16.7 (Inclusive and participatory decision-making): The notice-and-comment process is a cornerstone of participatory governance. It ensures that policy is not only shaped by authorities but also by the communities directly impacted, fostering a more responsive and inclusive system.

Exclusion from Policy-Making Processes

By removing guaranteed avenues for public engagement, HHS has weakened the democratic process in health policy formulation. This procedural shift means many regulatory actions, from organ transplant rules to healthcare delivery models, may be implemented without public input, fundamentally altering how federal health regulations are developed.

Exacerbating Inequities in Conflict with SDG 10

Disproportionate Impact on Vulnerable Populations

The policy reversal disproportionately affects marginalized and vulnerable groups, directly contravening the core principle of SDG 10 to reduce inequality within and among countries.

• Target 10.2 (Promote universal social, economic and political inclusion): The populations most impacted are those served by Medicaid and the Children’s Health Insurance Program (CHIP), which include:
  1. Nearly 80 million Americans
  2. Low-wage working families and children
  3. Pregnant women
  4. Veterans and vulnerable seniors
  5. People with disabilities
• Target 10.3 (Ensure equal opportunity): Unlike Medicare, which has statutory protections for public comment, Medicaid and CHIP lack similar safeguards. This creates a significant equity gap in the policy-making process.

Heightened Barriers for Racial and Ethnic Minorities

The decision will particularly silence communities of color, who rely heavily on public health programs and often lack alternative channels to voice their perspectives.

• An estimated 42 million people of color utilize Medicaid for healthcare access, including 20.3 million Latinos and 13.3 million African Americans.
• Eliminating the public comment requirement serves to exclude these communities from shaping policies that are critical to their health and well-being, thereby worsening systemic health disparities.

Jeopardizing Progress on SDG 3: Good Health and Well-being

Threats to Universal Health Coverage and Equitable Access

The absence of public consultation threatens the development of effective health policies aimed at achieving universal health coverage, a key target of SDG 3.

• Target 3.8 (Achieve universal health coverage): Public comment allows policymakers to understand the real-world challenges individuals face in accessing quality, affordable healthcare. This feedback is essential for designing regulations that prevent harm and reduce barriers to care.
• Without this input, policies may be implemented with unintended consequences that undermine health outcomes for millions, particularly those in the Medicaid and CHIP programs.

Call to Action: Reinstating SDG-Aligned Governance

Multi-Stakeholder Advocacy for Policy Reversal

In alignment with SDG 17 (Partnerships for the Goals), a coalition of civil society organizations is advocating for the reinstatement of the Richardson Waiver.

• Families USA, along with over 50 partner organizations representing consumers, patients, and clinicians, has urged HHS to reverse its decision.
• This coalition supports Senate Resolution 198, which calls on HHS to reaffirm its commitment to public comment in the rulemaking process.

Recommendations

To realign U.S. health policy with the principles of the Sustainable Development Goals, the following actions are recommended:

1. HHS should immediately withdraw its policy statement rescinding the Richardson Waiver.
2. HHS must reinstate mandatory notice-and-comment rulemaking for all programs and policies to ensure that policymaking is equitable, inclusive, and transparent.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The article’s central theme is health policy and its impact on access to quality, affordable health care. It specifically discusses the 80 million Americans served by Medicaid and CHIP, whose health and well-being are directly affected by regulatory changes made by the Department of Health and Human Services (HHS). The removal of the public comment process could lead to policies that create or worsen barriers to health care for these individuals.
2. SDG 10: Reduced Inequalities
   • The article explicitly states that the rescission of the Richardson Waiver will disproportionately harm vulnerable and marginalized communities. It notes that “nearly 42 million people of color use Medicaid to access health care” and that the policy reversal will “exclude communities who often do not have other channels to voice their perspectives.” This directly addresses the goal of reducing inequalities by highlighting how a procedural change can deepen systemic barriers for specific racial and economic groups.
3. SDG 16: Peace, Justice and Strong Institutions
   • This is the most prominent SDG in the article. The entire text is a critique of a policy change that undermines the principles of transparent, accountable, and inclusive institutions. The Richardson Waiver is presented as a “critical tool for equitable and transparent health policy” that strengthens “government accountability and transparency” and ensures “responsive, inclusive, participatory and representative decision-making.” Its removal is framed as a step away from these principles.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Under SDG 3: Good Health and Well-being
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
     • The article discusses the health care access of “almost 80 million Americans served by Medicaid and the Children’s Health Insurance Program (CHIP).” The public comment process is described as a mechanism to ensure that regulatory changes do not create “barriers to health care,” thereby protecting access to essential health services for this large population.
2. Under SDG 10: Reduced Inequalities
   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
     • The article argues that the public notice-and-comment process empowers individuals and communities, especially those “facing systemic barriers to care,” to “shape the policies and systems that govern their lives.” Rescinding the waiver disempowers these groups and undermines their political inclusion in the policymaking process.
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.
     • The Richardson Waiver is presented as a practice that promotes equal opportunity in policymaking. Its repeal is seen as a policy reversal that could lead to inequitable outcomes, as it removes a key channel for highlighting how proposed rules “could create or worsen health disparities.”
3. Under SDG 16: Peace, Justice and Strong Institutions
   • Target 16.6: Develop effective, accountable and transparent institutions at all levels.
     • The article directly criticizes the HHS for departing from its promise of “radical transparency” and removing “key tools that strengthen government accountability and transparency.” The call to reinstate the waiver is a call to restore a mechanism for institutional accountability.
   • Target 16.7: Ensure responsive, inclusive, participatory and representative decision-making at all levels.
     • This target is at the core of the article’s argument. The text champions the public comment process as a way to “encourage more responsive and inclusive policies” and ensure that policies are shaped “by individuals, organizations, and all communities directly impacted by regulatory change.” The repeal of the waiver is described as a “rollback” that removes “guaranteed public engagement in decisions.”

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Implied Indicators for SDG 3 & 10
   • Proportion of the population affected by health policy changes without public consultation: The article provides specific numbers that can serve as a basis for an indicator. It mentions “almost 80 million Americans served by Medicaid and the Children’s Health Insurance Program (CHIP)” and “nearly 42 million people of color” who use Medicaid. These figures quantify the population whose health access could be impacted by non-participatory policymaking, serving as a measure of the scale of the issue.
2. Direct and Implied Indicators for SDG 16
   • Existence of policies requiring public consultation: The central indicator is the status of the Richardson Waiver itself. Whether this waiver is in effect or rescinded is a direct, binary indicator of the government’s commitment to participatory decision-making in health policy.
   • Level of stakeholder engagement in advocacy for transparent policymaking: The article provides quantifiable evidence of stakeholder engagement. It mentions that “More than 50 organizations have joined Families USA in supporting a resolution” and references a specific letter and Senate resolution (S. Res. 198). The number of organizations and legislative actions can be used as an indicator of civil society’s efforts to ensure accountable institutions.

4. Summary Table of SDGs, Targets, and Indicators

Source: familiesusa.org