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Reporter Says Anti-Abortion, Anti-LGBTQ Activists Are Shaping Federal Policy


This is FRESH AIR. I'm Terry Gross. President Trump has had trouble getting some of his legislation through Congress, but he's been able to make a lot of significant policy changes through agencies, including at the Department of Health and Human Services. My guest Dan Diamond reports in Politico that religious activists are on the rise inside HHS. He writes that several high-level positions have been filled by Christian conservatives who have spent months quietly planning how to weaken federal protections for abortion and transgender care, a strategy that's taking shape in a series of policy moves that took even their own staff by surprise.

Diamond covers Health and Human Services for Politico and writes "Politico Pulse," a daily morning briefing on health care politics and policy. Along with another Politico reporter, he broke the story that forced out Tom Price, President Trump's first appointee to head HHS. These reporters uncovered how Price frequently used private jets at great taxpayer expense. Yesterday, Price's replacement, Alex Azar, was confirmed by the Senate.

Dan Diamond, welcome to FRESH AIR. So would it be an overstatement to say that most of the leadership of Health and Human Services now is people who were leaders of the anti-abortion movement or the anti-LGBTQ movement?

DAN DIAMOND: I think that would be an overstatement, but there's certainly much more representation in this administration of those views than in previous Republican administrations and certainly a major departure from the Obama team. There are a significant cohort of folks who work together as advocates in the anti-abortion, anti-LGBT movements before coming into government. And that's unusual and notable.

GROSS: President Trump isn't very religious, as far as we know. He doesn't appear to be ideologically opposed to abortion or didn't appear to be that way before the election, anyways. And, of course, last week, he spoke at an anti-abortion march. But why has HHS tilted in that direction of Christians and Catholics who are ideologically opposed to abortion and LGBTQ rights?

DIAMOND: There's a political story and a policy story behind why Trump and Christian conservatives are so tightly aligned, both in his campaign and now in the administration. I think the political story is that evangelicals, Christian conservatives flocked to Trump during the primaries and have largely stayed with him. And there's a persuasive case, that's why he won. About 80 percent of white evangelicals supported Trump on Election Day. Evangelicals represented a record number of voters in 2016, more than one-quarter of the electorate.

And the policy story side of this is that Trump's policy positions were malleable, to be generous. Your listeners might remember, Terry, he took five different positions on abortion in three days at one point during the campaign. He was talking about abortion, if it's illegal, women should be punished - and then walked back from that and then said the doctor should be punished - and then said the states should have right here - but then said maybe we should just let the law stay as it is.

So Trump, never a guy to sweat the policy details as a candidate and now as an administrator, he didn't have much of a policy shop around him too in the way that Hillary Clinton had dozens of internal staff and external advisers. So the Trump administration ended up relying on, first, staff associated with Mike Pence, who had deep ties to the anti-abortion movement - and then also think tanks like the Heritage Foundation, this very conservative group in Washington, D.C., that had fallen out of some favor and really got a big break by attaching to the Trump campaign as kind of the dark horse candidate. And that really started to manifest the representation of anti-abortion views, the Christian conservatives.

Right after the election, I remember just two or three days into the Trump transition, there was a change on the transition website that included language about imposing new conscience protections or making sure that life begins at conception, that that was a element that needed to be protected. Those weren't issues that Trump as a candidate ran on, but those are issues that have influenced what his health department has pursued.

GROSS: Do you know how active Vice President Pence has been in getting anti-abortion people and anti-LGBTQ rights people appointed to HHS and, perhaps, other agencies as well?

DIAMOND: Vice President Pence has been a major player here. He's the one in the White House with the conduit to this movement, his staff as well. He spoke at the March for Life last year, that's the big anti-abortion rally that's held every year in Washington, D.C. This is a signature issue for him. And the agency, which had been for many months this year without a full-time secretary, has taken a lot of cues from the White House. And those are coming from the Mike Pence wing of this administration.

GROSS: And you're saying that the Heritage Foundation had sway over HHS because they endorsed Donald Trump when others were not endorsing him, when he was a dark horse candidate during the primary.

DIAMOND: I think the Heritage Foundation emerged as this policy shop that the Trump administration, first as a campaign and now as a White House, was really able to draw on. There was kind of a purity test after the election. Not a religious purity test but an ideological and loyalty purity test that ended up weeding out Republicans who had criticized Trump. And there were quite a few of them. There were also moderate Republicans who decided early, they didn't want to work for Trump leading up to the election and right after.

I talked with prominent policy leaders who had worked for the George W. Bush administration or they'd worked for the Romney campaign in 2012. And I asked them again and again, would you work for this president? And as unpopular as Trump is today, he's been our president for a year. He oversees a big staff. And I think we're starting to forget just how many people he had alienated during that exceptionally brutal campaign. He insulted the bravery of John McCain. He went after the Gold Star family - the Khizr Khan incident. He'd seemingly mocked a disabled reporter, the list went on and on.

So I would ask these Republican thinkers, would you work for this president? And they would tell me over and over again, no, no, we can't work for a guy like that. And that's where Heritage Foundation came into play because they had these policy experts with a very deliberate policy view that were able to be plucked - not just that at HHS but in other areas on immigration, on legal rights across the administration.

GROSS: So how have the anti-abortion, anti-LGBTQ rights views of the new leadership of HHS been reflected in new policy?

DIAMOND: There are so many different ways, both very big and visible to small and kind of hidden away. This administration's policies are being shaped by the views of leaders who are anti-abortion and who have expressed, before joining the administration, some very strong anti-LGBT views too. For instance, there's a corner of HHS called the Office of Refugee Resettlement. It takes custody of more than 100,000 refugees every year. It also handles unaccompanied minors.

Historically, Terry, this has been a nonpolitical office that does a lot of coordination with foreign policy groups. It's located inside HHS for a variety of reasons, one being that refugees often have health concerns. They have mental health issues from the challenge of migrating to the United States. They may have had a harrowing trip and have health issues because of that. Sometimes the women who have come through the refugee program have been assaulted - sexually assaulted on their way to the United States.

The Office of Refugee Resettlement - I've been covering HHS just for more than a decade, this is the first time I can remember that the office has been at the center in the abortion fight. Last year, the political head of that office appointed by the Trump administration, a guy named Scott Lloyd, began blocking teenage girls in his custody from seeking or obtaining abortions even when they alleged rape. And Scott Lloyd even went so far as to personally visit some of these undocumented teenagers and try and convince them to change their mind.

That's a real question of what is within bounds for an official. That's led to repeated legal challenges from the ACLU and others who went all the way to the Supreme Court. My colleague based in Texas, Renuka Rayasam, has covered this very closely. It's an area where there was no expectation that this would be one of the places where abortion would be hashed out and fought over. But the Trump administration has been looking for ways to pull back the government's role. And where patients who maybe in the past had been able to seek abortions, now they're running into new barriers.

GROSS: So let me ask you about Scott Lloyd, who heads the Office of Refugee Resettlement. What's his background politically and ideologically?

DIAMOND: Scott Lloyd had been in HHS years ago, but then he went to the Knights of Columbus, this group that some folks may know because of their ties in local communities. But they also had been very major players in advancing the pregnancy crisis centers, the idea that instead of getting an abortion, women are steered towards these centers where they will be told of the risks of an abortion, and maybe they'll be given an ultrasound of the fetus in an attempt to convince them not to abort their child.

Lloyd has opposed contraception. He's been involved in broader issues related to ending life. He had worked with Terri Schiavo's parents, if your listeners remember that case - Terri Schiavo, who was essentially brain dead and the issue of whether or not to end her life. But Lloyd had gotten involved in that fight too. What is interesting, Terry, is he's running this office about refugee resettlement, but up until this point, he had no expertise in refugee resettlement. He was really more known for his cultural beliefs and work in health care around what advocates would say are pro-life issues.

GROSS: If you're just joining us, my guest is Dan Diamond, who reports on Health and Human Services for Politico. We're going to take a short break and then talk some more about HHS in the era of the Trump administration. This is FRESH AIR.


GROSS: This is FRESH AIR. And if you're just joining us, my guest is Dan Diamond. And he covers Health and Human Services for Politico. And he's been writing about how Health and Human Services is changing under the Trump administration and how the leadership - how a lot of people in the leadership in HHS are evangelical Christians and Catholics who oppose abortion and oppose LGBTQ rights. So there's a new division within Health and Human Services called the Division of Conscience and Religious Freedom. What is this division supposed to be doing?

DIAMOND: This is essentially an entire team dedicated to ensuring religious liberty in health care and punishing doctors and hospitals that don't allow workers to express their religious objections. This creation of the team, which we scooped last week, was clearly politically choreographed. There was the March for Life in Washington where tens of thousands of anti-abortion supporters came to the city. The announcement of this new division was scheduled for a day ahead of that. And then religious leaders at the events were able to tout it and celebrate and say, look what the Trump administration is doing to protect religious liberty.

The question, Terry, is, was this new division necessary? I talked to folks inside HHS. And one lawyer who's worked on civil rights issues told me this was essentially a solution in search of a problem. There really hadn't been that many objections about religious liberty in health care, that workers weren't able to express their religious liberty which is protected. That has not been controversial that there should be protections if someone wants to opt out of an abortion because of his or her moral religious beliefs, that had been OK.

The Obama administration had supported some of those fights. And there really had only been about one complaint per year during the Obama administration. But since Donald Trump's election, there have been 34 complaints alleging religious discrimination. There are real questions as to why there would be such a massive spike in a little over a year. And folks that I talked to suggested that perhaps HHS was looking for those cases to come forward, that there was some encouragement to help create an environment where they would be able to justify this new office.

And some defenders say that HHS is right to establish a new division. It's not really a change in policy, it's just strengthening the policy in place. There's some truth to that, but I think it lacks context. The Office of Civil Rights at HHS already had a team devoted to protecting all civil rights which included religious freedom. What this move is essentially doing is carving out an entire new team just focused on religious freedom that is co-equal to the team devoted to all other civil rights issues like age, disability, race, gender. And historically, there have been so many more complaints about those kinds of issues and discrimination than just religious freedom.

GROSS: So it sounds like the people whose religious rights this office is protecting are the people who have religious or moral objections to abortion or to LGBTQ people and don't want to treat them or don't want to perform abortions or don't want to treat LGBTQ people for certain procedures or medications. I mean, it's a select group of religious people whose rights they seem to be most interested in.

DIAMOND: Historically, that has been where most of these objections have fallen, and the comments coming in have reflected that too. I will say that the history of these conscience protections dates back to Roe v. Wade. They are kind of born out of the controversial abortion fight. And to make it more palatable, there was some bipartisan consensus among lawmakers that, OK, abortion is now a mandated right. But if there are doctors and workers who maybe don't want to perform these procedures, these conscience protections will help lessen the impact.

And over the years, I've talked to some law professors about this how these conscience protections have evolved to be a kind of counterweight to whatever controversial issue there might be in health care, which historically is centered around these Christian beliefs. Earlier, it was abortion. Increasingly, there is some concern about assisted suicide and physicians who want to work with patients who maybe want to end their lives because of a terminal disease. And the conscience protections can kind of extend out as far as that.

GROSS: What about protection for people seeking a legal abortion or for trans people seeking hormonal treatment that they need? Are there any protections for them?

DIAMOND: Well, it's interesting you bring that up because the theme that has been raised over and over again is that this administration has focused so much on the objections of doctors and workers who say we have religious objections to treating these patients, whereas the vulnerable patients who maybe haven't been able to access an abortion because the patient lives in a rural community and there's only one provider in that community who performs abortions and maybe this provider doesn't want to - has moral objections. So the patient is further locked out. Or trans patients who historically were discriminated against and now are looking at the possibility of a rollback in regulations put by the Obama administration.

There are procedures that trans patients might be seeking that aren't necessarily emergency care - hormonal therapy, fertility treatment, whatever it might be that could be seen as more elective. And those are things that advocacy groups had fought very hard to win and protect. And the Trump administration is already backing away from those protections, which is a major blow for trans folks.

GROSS: Are there examples of how this new Division of Conscience and Religious Freedom has used its power?

DIAMOND: The division is so new, and the rule that came out to accompany it is a proposed rule. So we're still in the early days. I do think it's illustrative, though, to look back at what the George W. Bush administration did. In one of its final acts the, administration expanded conscience protections and made them broader. So pharmacists, other employees - not traditionally just doctors and nurses, as you said, that maybe didn't want to prescribe medicine related to contraception or work with gay or lesbian Americans on fertility treatments. There were a number of examples of those folks being unable to access the care that they wanted. And that's why the Obama administration, fairly early on, started working to roll back and narrow what religious objections could actually be be filed.

The Trump administration is looking to, again, broaden the ability of pharmacists, of others to object to care. There's still - I want to be clear - there's still a law on the books that if I show up to an emergency room and I've got an emergency condition, the doctor has to treat me no matter what - or the hospital has to treat me no matter what, based on just the need to be stabilized as an emergency patient.

But if you get into the gray zone of if a person is seeking Plan B emergency contraception, under this conscience division, it certainly seems like a pharmacist could just decide - I don't want to prescribe this to you. And again, there are big, rural parts of this country where there aren't a lot of health care providers. And a single pharmacist, a single doctor might be the only conduit to getting the care that some of these patients want.

GROSS: So who is the head of this new Conscience and Religious Freedom Division?

DIAMOND: The Office of Civil Rights, overall, is run by a gentleman named Roger Severino. He did come from the Heritage Foundation. He ran the religious liberty center there. And Roger Severino has been praised for his intellect, and he's a principled person. But his principles are around Christian beliefs. He's spoken out against the push for same-sex marriage. He said that was an assault on religious liberty. He's criticized the transgender condition. He's obviously anti-abortion. And that makes for quite a puzzle that someone in charge of protecting civil rights for all Americans in health care is someone who has said things that some vulnerable groups are deeply concerned about.

And now, so far, he has acted in a way that is above board. But I think what I've heard, Terry, is that these are still the early days of the Trump administration. We're just one year in. And in many cases, the administrators over at HHS needed some time to kind of find their footing. And now they are starting to release a series of rules, building divisions - whatever it might be - that are laying the groundwork for future efforts down the line.

GROSS: Yeah. Well, the - HHS has a four-year strategic plan that's being finalized. And that's expected to include a statement about life beginning at conception. If that statement is in the four-year strategic plan, what are the implications for policy?

DIAMOND: It's still unclear what the strategic plan will have. And if it does say that life begins at conception, that's a big win symbolically for Christian conservatives, evangelical groups who firmly believe that and will be able to tout it and say, look - the Trump administration, the government now agree with our position. And there are possible implications down the road because if that's the HHS position, they'll be able to use that to defend different policy outcomes.

I think what's tricky, Terry, is historically, the strategic plan was more of a symbolic document than a practical one. But we are watching as this administration is finding new ways, whether it's the Office of Refugee Resettlement, the Office of Civil Rights, some other things that have happened around the agency - finding new ways to use the regulatory structure to support this agenda of anti-abortion moves.

GROSS: My guest is Dan Diamond, a reporter for Politico who covers the Department of Health and Human Services. After a break, we'll talk more about Christian conservative activists in the department. And we'll talk about how a stakeout helped Diamond and a colleague break the story that led Tom Price to resign from his position as secretary of HHS last September. And Justin Chang will review the film "Lover For A Day." I'm Terry Gross, and this is FRESH AIR.


GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with Dan Diamond about how Christian conservative activists now hold several leadership positions at the Department of Health and Human Services and how that's affecting policies related to abortion, contraception and LGBTQ health care issues. Diamond covers HHS for Politico. He's one of two political reporters who broke the story that led to the resignation last September of HHS Secretary Tom Price. Yesterday, the Senate confirmed his replacement, Alex Azar.

Let's look at some more of the leadership within HHS. Charmaine Yoest - so what's her position now, and what did she do before?

DIAMOND: Charmaine Yoest is the head of public affairs, essentially, at HHS. She's the top spokesperson. Any messaging that the agency does, any communications - it all flows through her. And before joining HHS, Charmaine was a very prominent anti-abortion advocate. She had suggested that there's a link between having abortions and breast cancer, which the American Cancer Society and other researchers have said there is no link, at least not scientifically proven. She had questioned whether transgender folks were mentally ill. And now she is running a $1 trillion agency with 80,000 employees, many of whom are career staff who have been there for years and work in health and science fields and may not agree with her policies. When we see the documents coming out of us that do have these subtle cues to the anti-abortion movement, the anti-LGBT folks, it's interesting to look and see how Charmaine, someone who hadn't really been in a government public affairs job before, is now the person who gets to sign off on those messages.

GROSS: So Matthew Bowman is the new HHS Deputy General Counsel. Has he been an activist before, and what was his role?

DIAMOND: Matthew had been a major player in the legal fight to weaken or overturn the birth control protections in the Affordable Care Act. The Obama administration had included birth control as one of the preventive measures that insurers had to cover as part of the ACA that immediately produced legal fights. Religious groups said, we don't want to provide contraception to our employees. It went all the way to the Supreme Court. There was a compromise hashed out that some groups could decide to object to allowing birth control for religious reasons. With Matthew Bowman and some of the other HHS leaders in charge now, the Trump administration a few months ago dramatically broadened that exception, allowing virtually any employer or organization to say, we don't want to provide contraception to our employees. So it's an interesting flip. The guy who fought this policy all the way to the Supreme Court is now on the inside working to roll it back.

GROSS: So let me ask you about one other person, Valerie Huber, who oversees the Title X programs at HHS, and that includes funding for contraception care. And Title X was put into effect during the Nixon era. It provides grants that provide comprehensive family planning, including contraception for low-income and uninsured individuals at reduced cost or no cost. So what's Valerie Huber's background?

DIAMOND: Valerie Huber is someone who believes in abstinence, which is an interesting role for someone now in charge of family planning and contraception awards. She is the new leader of this office. She replaced someone named Teresa Manning who abruptly left in the past 10 days. And Teresa Manning had said that contraception didn't work. So even though there has been some turnover, it's a sign of just how deep now the bench goes among anti-abortion folks and anti-contraception folks at HHS. And there's a lot of scrutiny right now, Terry, on that office. It's running well behind when it normally would issue applications. There is a sense that there might be an effort to steer money away from Planned Parenthood, which has historically been a very big grantee providing not just abortion help but also sexual education, contraception, other emergency care, and instead steer that money towards federally qualified health centers around the country. So that's one reason why Valerie Huber and that office, again, another office in this giant administration, may have a very significant role depending on the regulations that she's shaping.

GROSS: And now we have a new head of HHS, Alex Azar, who has replaced Tom Price, who, as a result of a story that you broke was forced out because he used private jets for official travel. So tell us about Alex Azar.

DIAMOND: Alex Azar is a more traditional choice for the job than Tom Price. Azar's a George W. Bush administration veteran. He was a high-level HHS leader. He was also in the private sector, a pharmaceutical executive at Eli Lilly. So he has lots of administrative expertise. He's someone that Democrats feel they can work with. Tom Price, his predecessor, who left the agency after the reporting of me and my colleague Rachana Pradhan, hadn't been a high-level agency official, and he was much more partisan. He had really been an attack dog for the Republican Party on the Affordable Care Act. So Azar is seen, interestingly, as a more moderate choice who's inheriting an agency that has had more partisan bend. He did telegraph in his hearings that he believes, though, in conscience protections. That issue came up. And after he said that, that was seen by the evangelical community, the Christian conservative community as a sign that he will continue some of these pushes, if not all of them.

GROSS: He's also said that the mission of Health and Human Services is to enhance the health and well-being of all Americans, and this includes the unborn.

DIAMOND: It's certainly more in line with what we would see from any Republican administration. I do want to clarify, Terry, anytime there's a political handoff - and in this case we're coming off the Obama administration which had spent eight years advancing abortion rights, changing the definition of protections for transgender patients and other more liberal policies - there was going to be a course correction under a Republican president. Any Republican president would have instituted more of a focus against abortion. I think the question here is are these new leaders plucked by Trump from non-traditional roles doing things that are substantively different than their predecessors under previous Republican administrations? And there's a lot of evidence that suggests, yes, they are.

GROSS: So if some of the new regulations from HHS are appealed, would they likely go before judges who were appointed by President Trump?

DIAMOND: You're hitting on another major victory for this administration, which is the president has appointed a Supreme Court justice. That was one reason why Christian conservatives flocked to support him in the run up to the 2016 election. They were terrified that Hillary Clinton would almost surely appoint a Supreme Court justice who would be in favor of abortion rights, in favor of some other policies that Republicans and conservatives really did not want to see. And then on the appellate level, Trump had a historic year. He appointed 12 judges, more than any president has appointed in a single year. And that has led to the expectation that when these challenges come - because they will - there will be that much more support for the Trump administration because the judiciary is being filled out with more judges who are sympathetic to these positions.

GROSS: So from what you know, are evangelical leaders satisfied with Trump appointees such as the appointees, you know, in the Department of Health and Human Services?

DIAMOND: Evangelicals haven't supported Trump at quite the level that they did during the election. Some of the polling has fallen off. But overall, Christian conservatives are very happy. There was an interview that Tony Perkins, the head of the Family Research Council, just did with my colleague at Politico, Isaac Dovere, where he said, and I quote, "from a policy standpoint, he has delivered more than any other president in my lifetime." He's talking about Donald Trump. And Tony Perkins is 54, so you can do the math. He is saying that Donald Trump has done more for religious leaders than both Bushes, than Reagan, than Nixon and Ford.

And I think the challenge for Christian conservatives and evangelicals is, how do you judge Donald Trump the president versus Donald Trump the leader, who has this track record of being involved in lots of things that aren't very Christian? Trump spoke to the March for Life just hours after last week's very seamy interview with Stormy Daniels, the adult film star, published. And yet he's treated as a hero by evangelicals for what he is doing as president after, they felt, an assault on their positions for eight years by the Obama administration.

GROSS: I've heard this question posed this week to Tony Perkins from the Family Research Council. You know, how do you square Trump's behavior with your own evangelical views? And he said, basically, the relationship he had with Stormy Daniels was before he became president. And then the interviewer pointed out, but the payoff he made to her as part of the nondisclosure agreement was right before the election. It was during the presidential campaign. And he sounds like - Perkins sounds like he's willing to give the president a pass because it didn't happen during the presidency.

DIAMOND: He basically said that Trump should get a mulligan on his previous 70 years or so. And it's a fascinating interview to listen to because the question comes up again and again - how to judge this man who has done things that - things that aren't very Christian, who has used language that isn't very Christian. As my colleague Isaac pointed out, so much for turning the other cheek. And Tony Perkins said, yeah, but we only have two cheeks; it's good to see someone fighting back and standing up for our kind of beliefs, and whether that means attacking his critics in a way that would not be very biblical - Christian conservatives kind of like that he is rallying to their cause.

And I think there's also an important point in that interview from Tony Perkins - and other evangelical leaders have made the same issue - which is that Christianity is about forgiveness. It's about improving yourself. And in their view, Trump - this is a process. He is a better person today than he was during the campaign. He will continue to get better and better because behind closed doors when they meet with him, they find a Donald Trump who, they say, is very compassionate, who cares about the right issues and is doing things that reflect a Christian faith even if five years ago, 10 years ago, two years ago, he was not the same person.

GROSS: My guest is Politico reporter Dan Diamond. We'll be back after a break. This is FRESH AIR.


GROSS: This is FRESH AIR. My guest is Dan Diamond, who covers the Department of Health and Human Services for Politico. Yesterday, Alex Azar was confirmed as the new head of the department.

So the reason why we have a new head of Health and Human Services is that you and your colleague broke a story about the former head of HHS, Tom Price, and how he spent at least $400,000 of taxpayer money for private jets for official travel in instances when they should not have been authorized because private jets are only supposed to be used if it's, like, the last option and it's essential. And it was not essential in these instances. Did you get a tipoff about this?

DIAMOND: That was a very long-germinating story. My colleague Rachana had got the first tip back in May of last year. We didn't actually write the story until September because one tip unfortunately can't get you all the way to proving that a cabinet official is engaging in that kind of behavior. So yes, there was an early tip, but there was also a lot of groundwork of camping out at airports and building a database of...

GROSS: Oh, no, you have to tell us a little bit about that because you actually - you literally did camp out in an airport. And you had all this great technology to help you monitor what was going on because you needed to see Tom Price actually get on this plane.

DIAMOND: That's true. That's true. I mean, and great technology is my iPhone as I was staring at it while also...

GROSS: (Laughter) Is that what it was?

DIAMOND: ...While also watching Price's plane come in for a landing at Dulles. But I guess the backstory is at Politico, we believe in covering every agency like it's a mini-White House. I'm a health care reporter, so that means digging into key leaders of the Health Department - HHS - just like White House reporters dug into Michael Flynn or Steve Bannon or Gary Cohn. So Tom Price, obviously, someone that we're going to track and follow - it was actually very hard to track him in his early months because his staff did not put out his schedule and often wouldn't tell people where he was or what he was doing until a few days after it happened.

And when Rachana got the first tip and she brought it to me a few days later, we quickly realized that one challenge was going to be, how can we prove this if we didn't even know where he was going until three or four days later? And that's what led to the airport stakeouts. Once we started to get a little bit more information about where he was going, we needed to see for ourselves Price and his staff getting on and off the plane. And Dulles turned out to be a good vantage point to do that, though we had had some failures up until that moment.

GROSS: So you write that you and, I guess, Rachana spent a thousand hours reporting this story.

DIAMOND: It got to the point where I knew Tom Price's schedule much better than I knew my own. The...

GROSS: Probably better than he knew it - he probably had staff to tell him when to go someplace. But that's a lot of hours. So what was your reaction when he was actually forced out of HHS?

DIAMOND: It was a surreal moment. I think it came at the end of about 10 days of our stories publishing. We'd published five big stories and a bunch of smaller updates in between. So I don't think we really processed it in the moment. And really, the story that we immediately started writing was, what's next? The thousand hours came from not just the source-building, not just camping out at airports and the building of databases about his trips. But we were calling around. I remember we figured out he'd gone to Nashville - couldn't figure out what he was doing in Nashville. He was only on the ground there for a few hours.

It seemed like a odd use of tens of thousands of dollars in private jet funds, so I called around to all these different health care leaders in Nashville - did you meet with Tom Price? - just trying to kind of reconstruct his schedule in reverse. And that's how we were able to figure out that he was in Nashville in part to have lunch with his son. He was only on the ground for a few hours there, and having the lunch was one of the big focuses of that trip. So that kind of effort was necessary to just build out Price's schedule, get the contracts involved, get the dollars, and get to this point where we were able to say, over five months in office, he spent more than a million dollars on charter jet travel, about half of that in the United States and then, you know, a little more than that when he was traveling abroad to events where he brought his wife, which is a little less unusual. Cabinet officials will take these charter jets, these Gulfstreams that the U.S. Air Force owns, when they're traveling abroad. But it was notable given that that's what Tom Price was spending his time on at a moment when Republicans were trying to achieve priorities like repeal the ACA.

GROSS: So here's a logistical question. How do you camp out at the airport without getting chased away by security?

DIAMOND: We spent a lot of time trying to figure out what the best vantage points would be. I remember calling the hotline for reporters who have legal questions about what was allowed and where. I talked to a lawyer. Where could we be? Could we take photos? Is it within our right if we approached Tom Price if we saw him walking? And Dulles turned out to be an interesting vantage point because the charter jet terminal is kind of off to the side - for listeners who maybe have been to the main Dulles terminal, it's kind of this big retro-future building. The charter jet terminal's a few hundred feet to the side of it, and there's a side road that kind of leads up to it.

We had, in the morning - Rachana and I had kind of camped out, standing separately on our cell phones to each other, a couple hundred feet apart from each other, trying not to look too conspicuous. Trying to get visual confirmation of Tom Price as he was getting on the plane didn't quite work. We thought we saw him, but it had attracted enough attention, these two people standing around near the charter jet terminal, that we knew we needed a better strategy in the afternoon.

That's when we came up with the plan where Rachana would be driving, and then there was kind of a gap in the fence where she could look through and see the landing area. And I was going to be monitoring from the main terminal, and that's when I was looking at my iPhone. And we had kind of been tracking Tom Price's flight. We figured out of plane he was on. There's a way to track, sometimes, those planes. It was a very visually distinctive plane. So in addition to looking on my iPhone, I was looking up in the sky for this plane with this golden belly. And as it was coming in for landing, I was counting down to Rachana, you know, it looks like it will be two minutes, one minute.

She got ready to drive past the charter jet terminal at the right moment. And I kind of darted out from the main terminal, and there was a little patch of concrete that we had scouted out earlier where I ran over and it gave me a view of the charter jet field. So as Rachana was driving by and able to see Tom Price getting out of the plane - his distinctive shock of white hair - I was able to see the kind of backup view of the overall staff. And then I ran down and saw Kellyanne Conway, who he was traveling with, and others appeared to be getting into black SUVs escorted by Secret Service. So that was a pretty pivotal moment because we had been working for months and months to confirm it, and we saw it with our own eyes.

GROSS: So looking ahead, what are some of the big questions you have about how HHS is going to operate?

DIAMOND: Terry, I think there are three or four big questions that we'll be looking to see. One would be this continued administration over the Affordable Care Act, a law that Republicans have fiercely fought. It's mostly intact. What will they do to keep it running or look for ways to weaken it? A second issue is the opioid crisis. This is something that Donald Trump ran on. He promised effects. One year later, there's been very little done. And that is striking when we compare it to the efforts done around birth control, around establishing the new conscience office. It's interesting that there is funding and effort behind establishing a new team devoted to religious conscience, but there have been problems getting funding for the opioid epidemic.

And I think there's a broader question of what is happening in the United States with life expectancy, which has been going down. There has been a rise in suicides. A lot of that is tied to the opioid epidemic. But it is a historic change, and the Health Department is on the front lines of trying to arrest that. Is the Trump administration up to that challenge? What will they be doing? Who will they be putting into office? And Alex Azar, as the looming leader, is going to have that challenge on his plate, too.

GROSS: Well, Dan Diamond, thank you so much for talking with us.

DIAMOND: Terry, it was a pleasure. Thank you for having me.

GROSS: Dan Diamond covers the Department of Health and Human Services for Politico. After a break, Justin Chang will review the new film "Lover For A Day." This is FRESH AIR. Transcript provided by NPR, Copyright NPR.