New report analyzes how the administration is undermining the Affordable Care Act using web censorship
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 non-partisan information about their programs, such as the Affordable Care Act (ACA). 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.
Our new trend report, “Erasing the Affordable Care Act: Using Government Web Censorship to Undermine the Law,” explores the current administration’s censorship of ACA-related web content to show that loose regulation of federal government websites allows an administration to use them to weaken laws it opposes. The Web Integrity Project has documented 26 instances of ACA censorship — including excised words, removed links, altered paragraphs, and removed pages — on HHS websites. These examples of censorship are unlikely to be all of the instances of ACA-related censorship on federal websites, and may represent only a small sample of the censorship that has occurred since President Trump took office.
HHS offices have censored a wide array of content aimed at a variety of audiences, including the general public, beneficiaries, and those who serve beneficiaries. They’ve 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. If repeated on a wide scale, these forms of censorship of ACA information on federal websites have 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.
A side-by-side comparison of a portion of the July 11, 2017 and March 30, 2018 versions of HHS’s “Who is eligible for Medicaid?” page, as captured by the Internet Archive’s Wayback Machine. This is one of the 26 findings documented in the report.
The examples of ACA censorship we have found have also amplified and foreshadowed other executive actions taken by the administration to undermine enrollment and specific provisions of the law. In effect, the Trump administration has used government websites, a modern unregulated tool, to complement — and sometimes even foreshadow — formal, regulated tools for changing policy. Unlike rulemaking, non-enforcement, and fund reallocation, minimal guidance governs the use of information on government websites. We show how website changes have reflected or enhanced the impact various policy actions that have been implemented to undercut the ACA, like defunding navigator programs that reduce their outreach capacity and limiting access to HealthCare.gov and ACA enrollment.
What’s more, censoring online information about rights, benefits, and services under the ACA may have an outsized negative impact on the most vulnerable in our society. Many instances of web censorship we have seen have targeted information and resources for underserved populations like women, the LGBTQ community, minority groups, and people with a mental health condition, and in some cases may deepen the negative impacts of policy changes that de-emphasize and de-prioritize their rights to affordable coverage. These communities are already more likely to be uninsured or have less access to ACA health services than the rest of the population.
Given the negative impact on the public that can result from agencies altering their websites, especially websites with information about healthcare, the report includes recommendations for HHS that will help avoid harmful loss of ACA- and healthcare-related information. These recommendations range from suggestions on how to maintain archives and provide notice of large-scale removals of information, to creating an inter-office portal for healthcare-related information found across HHS offices’ websites on HHS.gov.
By examining examples of the Trump administration’s censorship of online public information about the ACA, we can begin to understand the different ways the federal government can more widely use agency websites as a tool to undercut public access to quality information about laws, and in turn undermine the effectiveness of those laws.