Whatever Republicans like Sen. Kevin Cramer of North Dakota may claim, Donald Trump was not “being funny” about governing as a dictator (only on “Day 1,” he promises). We know he meant it because we saw what he did in his first term, including after his 2020 loss. We also know he’s not joking because he has an army of right-wing activists who are bent on carrying out their own authoritarian agenda for the Christianization of the federal government, especially at the Department of Health and Human Services.
That agenda is all laid out in the Heritage Foundation’s “Mandate for Leadership 2025: The Conservative Promise,” the nearly thousand-page document cited in recent media coverage as the blueprint for a possible Trump second term. As it was in Trump’s first term, HHS will be the epicenter of imposing the Christian right’s agenda on all Americans, under the guise of protecting the “conscience” and “religious freedom” of people who oppose abortion and LGBTQ rights.
Severino makes clear that punishing blue states remains a key goal.
As Heritage’s blueprint has sparked a raft of unfavorable stories, the Trump campaign has sought to distance itself. But the author of the mandate’s section on the department is a former Trump appointee: Roger Severino, director of the HHS Office of Civil Rights under Trump.
Now at Heritage, Severino is a lawyer and longtime anti-abortion and anti-LGBTQ rights activist who, in 2018, used his political appointment and coordinated support from outside organizations to create a new enforcement structure in the agency, the Conscience and Religious Freedom Division. “We’re institutionalizing a change in the culture of government, beginning with HHS,” Severino said at a launch event at HHS headquarters, “to never forget that religious freedom is primary freedom, that it is a civil right that deserves complete enforcement and respect.”
Bragging that the division was “open for business,” Severino urged Christian right organizations to encourage followers to file administrative complaints with the agency, charging that a hospital policy or a blue state law protecting abortion access violated their religious convictions. Many complied, and Severino and his allies used the uptick in complaints as evidence that the creation of the new division filled a vital need.
If the agency had found liability in these cases, the possible — and unprecedented — penalty could have been denial of federal funding to individual health care institutions, and even, in the hopes of Christian right activists, entire states. Though the agency failed at this the first time around, in the Heritage document Severino makes clear that punishing blue states remains a key goal. He proposes cutting off Medicaid funding to states (like California) that require coverage for abortion services in health insurance.
Severino also promotes the right-wing trope that protection of LGBTQ rights is a malevolent ideology deployed by soulless bureaucrats to crush the freedom of religious Americans. During his tenure at HHS, Severino tried to undo an HHS regulation protecting transgender people from discrimination in health care. When the Biden administration restored the rule, Severino responded with transphobic lies.
The think tank has worked hand in glove with the increasing radicalization of the Republican Party, including on the Christian right’s core issues.
In the Heritage document, Severino writes that the agency should instead “pursue a robust agenda to protect the fundamental right to life, protect conscience rights, and uphold bodily integrity rooted in biological realities, not ideology.” He puts gender identity in scare quotes, calling it a “destructive dogma.” He resurrects old conservative “pro-family” cliches, claiming that the pro-LGBTQ policies of the Biden administration are “fraught” with “subsidizing single-motherhood, disincentivizing work, and penalizing marriage.” Severino adds, “These policies should be repealed and replaced by policies that support the formation of stable, married, nuclear families.”
Other Trump political appointees at HHS opened the door, contrary to existing law, for Christian adoption and foster care placement agencies to discriminate against same-sex and non-Christian parents. In this vein, Severino proposes “adoption reform,” arguing that faith-based adoption placement organizations are the ones experiencing discrimination. He complains that they “are under threat from lawsuits, or else their licenses and contracts have been halted because they cannot in good conscience place children in every household due to their religious belief that a child should have a married mother and father.” The Heritage “Mandate” is not a new exercise. The think tank has worked hand in glove with the increasing radicalization of the Republican Party, including on the Christian right’s core issues. The group created its inaugural “Mandate” to guide Ronald Reagan’s presidency. But Heritage staffers were disappointed that Reagan’s first year in office was, in their view, insufficiently right wing. In Trump, the organization found a more willing partner — something it hopes to replicate if he occupies the White House again. Trump’s political team may worry that “dictator” is not the best campaign slogan. But his ambitions are obvious, and there’s no reason to doubt Trump would permit, like he did in his first term, the Christianization of HHS — especially as acolytes continue to praise him as a divinely anointed defender of the Christian nation. Trump would interpret such praise as loyalty to him, which he reportedly plans to require for anyone serving in his administration. And even if he is never president again, the Heritage Foundation will continually try, in 2028 and beyond, to turn an agency meant to promote the health and welfare of all Americans into a tool of the Christian nationalist agenda.
Sarah Posner
Sarah Posner is the author of "Unholy: How White Christian Nationalists Powered the Trump Presidency, and the Devastating Legacy They Left Behind." 
