The Trump administration Thursday finalized new rules making it easier for health care workers to refuse to provide care that violates their religious or moral beliefs, advancing a policy favored by anti-abortion groups and Christian conservatives closely allied with the Trump administration.
The rules will protect “physicians, pharmacists, nurses, teachers, students and faith-based charities,” President Donald Trump said during Rose Garden remarks noting the National Day of Prayer. “Together, we are building a culture that cherishes the dignity and worth of human life.”
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The administration said the new rules will bolster enforcement of more than two dozen existing federal laws protecting conscience rights. However, patient advocates have warned the rules, which were first proposed over a year ago, could make it harder for women to receive emergency abortions or access contraception, and they say providers may be able to refuse care to gay and transgender patients. HHS is also expected to soon pare back nondiscrimination protections extended to transgender patients under an Obama-era policy that has been blocked in the courts.
“We are giving these laws life with this regulation,” said Roger Severino, director of the HHS Office for Civil Rights, which is overseeing the new rules.
Gretchen Borchelt of the National Women’s Law Center called Thursday’s announcement “an enormous expansion” of longstanding conscience protections.
“It would mean a woman seeking birth control at a pharmacy could be turned away,” Borchelt said. “A woman facing an unintended pregnancy could be denied information about her options.”
The first conscience protections were passed 46 years ago, as lawmakers sought to accommodate health care workers who had objections to theRoe v. Wade Supreme Court decision that legalized abortion nationwide. Those measures and subsequent laws have been at the center of political battles in recent years — George W. Bush’s administration pushed to expand conscience protections for religious workers, and the Obama administration rolled them back.
Advocates worried that LGBTQ patients, who have had trouble accessing routine care, could face new hurdles. For instance, the National Center for Transgender Equality warned that providers will be able to deny sterilization care often sought by people making a gender transition. The group’s spokesperson, Gillian Branstetter, pointed to a provision in the rule that says workers’ complaints related to sterilization will be considered on a case-by-case basis.
“We’re confident this rule will make the lives of transgender people across this country harder,” Branstetter said.
Advocates for other marginalized patients worried the new rules would make it tougher to get care — and could undercut the Trump administration’s efforts to reduce HIV transmission and the opioid epidemic. AIDS United warned that the rules give broad leeway for health care workers to refuse providing the HIV prevention treatment PrEP or the opioid overdose reversal drug naloxone.
“This rule is the latest in a series of attacks on health care in the United States and pose a direct threat to the health of millions of Americans — especially those in marginalized communities including LGBTQ people, people living with HIV, women, and youth,” AIDS United said in a statement.
Conservative groups and religious rights organizations hailed the announcement.
“No one should be forced to participate in life-ending procedures like abortion or similar activities that go against their religious beliefs or moral convictions,” said Jeanne Mancini, the president of March for Life.
Some Republican lawmakers have called for Congress to go further and codify the rules into law, though they would face opposition from a Democratic-controlled House.
The HHS civil rights office last year created a new conscience division to safeguard health workers’ religious rights. The office has historically focused on responding to thousands of annual complaints about discrimination and privacy violations in health care. It received just one complaint about conscience rights per year, on average, during the Obama administration.
However, the office last week changed its mission statement to reflect it is now an “HHS law enforcement agency” that will more aggressively investigate potential violations of religious freedom. Office leaders have said more than 300 complaints about conscience rights were received in fiscal year 2018.
California Attorney General Xavier Becerra, who has led numerous legal challenges to the Trump administration’s health care agenda, hinted his state could sue over the new rules.
“We’re prepared to do whatever it takes to challenge the rule,” a spokesperson for Becerra said.