Some of its employees have described an environment allowing mistreatment of minority and LGBTQ employees.

A legal aid organization leading the fight against several Trump administration policies, including health care for LGBTQ and low-income people, is facing its own internal allegations of discrimination.

The National Health Law Program, or NHeLP, was founded in 1969 to advocate for health care rights of underserved people. It has grown more prominent in the Trump era, taking on causes like fighting Medicaid work requirements. But some of its employees have described an environment allowing mistreatment of minority and LGBTQ employees, including instances of bullying black women; employees telling “off-color jokes” about women and Jewish people; and a “sense of not belonging among LGBTQ staff,” according to a 2018 assessment on its workplace culture obtained by POLITICO.

Elizabeth Taylor, a former Justice Department attorney who became the group’s executive director in 2014, said leadership has worked, and continues to work, to fix problems flagged by the 53-pageassessment, which the organization commissioned amid high staff turnover and concern about workplace culture.

“We appreciate the urgency of addressing racism both internally and in our outward facing work,” said Taylor. She said remedies include diversifying leadership, bringing in a human resources company to do management training, convening all-staff retreats focused on equity issues and establishing ground rules for conduct during meetings and other workplace interactions.

But a half dozen individuals who work or have worked for the social justice nonprofit claimed workplace inequities persist. All of them worked there after the January 2018 report.

NHeLP employs roughly three dozen attorneys, policy experts and administrative staff across its three offices in Washington, Los Angeles and Carrboro, N.C.

“They say we hear you and we understand you but then don’t see results,” said one employee who called the pace of change too slow. “Things have to change.” That employee, as well as other current and former employees who spoke to POLITICO, asked to remain unidentified.

Taylor acknowledged that improvements may not occur quickly enough for certain employees — but that the changes can’t be rushed if they are to be done correctly and sustainably.

The January 2018 report, in addition to interviews with several former and current employees, depict an organization struggling to create an equitable workplace even as it battles the Trump administration over policies it says are discriminatory or punitive to low-income people and other marginalized groups.

The legal group is not alone in grappling with these issues; many sectors of society including Hollywood, Congress, the media and both the corporate and nonprofit worlds are uncovering mistreatment, abuse andemployee discrimination.

Since 2016, 14 people have left NHeLP, including eight people of color, according to figures the organization provided to POLITICO. Four of them left this year, including two individuals who are ethnic minorities.

It is unclear whether all these departures were related to the issues raised in the report. POLITICO was unable to reach some of the people who left in recent years; others did not respond to queries.

One employee who left after the 2018 assessment told POLITICO there were challenges around the retention of minority staff and lack of leadership opportunities.

“I think that there are situations that they are trying to improve. I just think it’s a long road ahead,” said the individual who left after concluding there was no opportunity for advancement.

NHeLP for decades has fought in court for patient access to a range of health care services, such as medications for severe chronic illness, children’s mental health benefits and abortion. It has also advocated for legislation expanding health insurance coverage. The group’s profile — along with its fundraising — has grown in the Trump era, its work seen as indispensable among health care advocates who oppose a range of Trump policies they believe will weaken the health care safety net for millions of people.

The organization has led successful lawsuits blocking the Trump administration from allowing the first-ever Medicaid work requirements in three states, though the Justice Department has appealed and other states are still planning on adding work rules. NHeLP is also likely to challenge the administration’s looming rollback of civil rights protections for LGBTQ patients, which the nonprofit helped shape as part of the Affordable Care Act.

The organization raised $8.3 million in 2017, more than triple the $2.6 million it raised in 2014, according to tax documents (though below the nearly $11 million that came in during 2013.) In 2017, as Republicans in Washington sought to repeal the Affordable Care Act, the group hired 11 people, about three times as many as the year before. Despite staff turnover, the organization grew.

NHeLP has stood out as a rare legal organization that is primarily led by women. Yet it has struggled with retaining a diverse staff, even as it expanded.

“We know that we still have work to do and we’re doing it,” Taylor said.

Many nonprofits as well as for-profit entities struggle with boosting diversity and installing leadership that is more representative of the populations they serve.

“This is something that’s urgent and most every nonprofit in the country is struggling with,” said one individual in the nonprofit sphere who has worked with NHeLP for years. “Figuring out a way to address it is vital.”

Taylor said the departures in 2016 of three employees of color who worked on policy issues was one reason NHeLP stepped up its diversity and equity efforts, including hiring an outside firm to examine its workplace culture. That review by the Management Assistance Group produced the January 2018 assessment.

“There were certainly things in it that resonated with me,” said Wayne Turner, a senior attorney based in Washington, declining to give specifics. But he added, “I think for people who have been here for a while, it’s kind of history and we’ve moved beyond that.”

The group’s board in 2017 also adopted a strategic plan that included priorities to boost equity internally as well as in other areas, including partnering with organizations that represent the interests of people of color.

Then the January 2018 report came. The report, which is based on interviews and observations provided by current and former staff as well as board members, detailed management styles that alienated staff of color and LGBTQ workers.

The report noted the perception among some employees that “there were instances where women of color had more experience but white staff were identified as more capable.” It also relayed descriptions of instances when individuals acted “surprised when a person of color is a good writer.”

“Management issues are so bad and pervasive,” the report quotes one employee saying. “While I’ve benefited from being a white woman, it is hard to see it because it is such a challenge. It is worse for people of color.”

The report said people observed “bullying” of black female employees, but it did not provide details or indicate how many individuals witnessed it. Nor did it provide more details about off-color jokes.

“There were things in there that were shocking as leaders of the organization to read,” Taylor said.

The report said NHeLP’s emphasis on maintaining a workplace culture of “niceness” and avoiding conflict can prevent employees from raising concerns related to treating workers equally. Managers also “often” meant to create an inclusive atmosphere, but those efforts backfired at times, the report said.

“We learned that managers often have the best intentions to make staff feel included and welcome, however due to miscommunication, disparate management styles, and assumptions about what people want, are skilled at, and need, their actions do not land as intended, and too often create an atmosphere of unintended hostility,” the report reads.

Not all employees perceived that hostility; the report found most staff believed NHeLP’s offices were pleasant and knew their colleagues had “the best intentions in mind.” Many of the current and former employees interviewed by POLITICO, who represented a diverse group, also had a positive impression.

“It was a pretty decent organization,” said one former employee who nonetheless witnessed staff turnover and people of color voicing concern about the workplace environment. This individual said that managers attributed staff departures to millennial “job hop,” rather than looking at deeper issues.

“There was definitely that brush off — ‘oh, that age group,’” the former employee said.

Taylor said she had never heard anyone on the management team make such a remark.

She said the organization views the effort to improve workplace culture as a “long-term commitment.” Employees said NHeLP set up committees to address various issues, from improving partnerships with organizations led by people of color to hiring, retention and office culture.

“I feel like staff was given a lot of leeway from management to come up with a staff-driven process on how to address these issues that were going on,” said one employee who had not personally witnessed bullying but did occasionally hear off-putting jokes at work. This individual was concerned that co-workers might be impatient and “lose faith.”

“It’s not a short-term process,” the person said. “Doing something on a consensus basis, staff-led process is going to be slower.”

Two individuals who work or have worked at the organization viewed some of the remedies as inadequate. “We have all of these committees and I honestly just don’t know why,” said one.

NHeLP’s director of health policy Leonardo Cuello said the organization is making changes deliberately and doesn’t view improving diversity and equity as “a check the box thing.”

“You have to do things in the right order and you have to do it with professional support, and you have to do it thoughtfully and kind of in accordance with the model practices. And that takes time,” he said.

“We’ve been working on it for two years and there’s a reason for that.”

This article was originally published by Politico on August 16, 2019. Reprinted with permission. 

About the Author: Rachana Pradhan is a health care reporter for POLITICO Pro. Before coming to POLITICO, she spent more than three years at Inside Health Policy focusing on implementation of the Affordable Care Act. Prior to that, Pradhan worked at The Daily Progress in Charlottesville, Va., and spent most of her time covering city government (with the occasional foray into stories on urban chicken-keeping and the closure of neighborhood pools).

Pradhan is a rare local of the Washington, D.C., area and graduated from James Madison University. She was also news editor of JMU’s student newspaper, The Breeze.