During a speech Thursday before faith leaders gathered for the National Day of Prayer, President Trump announced a new rule allowing health providers, insurers and employers to refuse to provide or pay for services such as abortion, sterilization or assisted suicide that they say violate their religious beliefs.
Conservative groups welcomed what they said were needed “protections” for health care workers, while LGBT and women’s groups warned the rule would lead to discrimination and drastically reduce services for already marginalized groups since providers might decline to offer certain treatments, or refuse to treat gay and transgender people.
“Religious liberty is a fundamental right, but it doesn’t include the right to discriminate or harm others,” said Louise Melling, deputy legal director at the American Civil Liberties Union. “This rule threatens to prevent people from accessing critical medical care and may endanger people’s lives. … Medical standards, not religious belief, should guide medical care.”
Religious conservatives contend that such protections are needed in the face of increasing state and federal mandates and ineffectual enforcement
“Though these laws were passed on a bipartisan basis and have been policy for years, the previous administration did not fully enforce them, and now they are increasingly being violated,” said Archbishops Joseph F. Naumann of Kansas City, Kans. and Joseph E. Kurtz of Louisville, both chairmen of the U.S. Conference of Catholic Bishops. “Health care providers like New York nurse Cathy DeCarlo and medical trainees have been coerced into participating in the brutal act of abortion against their core beliefs, while churches and others who oppose abortion are being compelled by states like California to cover elective abortion—including late-term abortion—in their health plans.”
Trump’s remarks on the National Day of Prayer were the third time he has used the 77-year-old annual multifaith observance to make announcements addressing the concerns of Christian conservatives, who are a large part of his base. During his first year in office, he promised to make it easier for religious leaders to speak openly about politics. On Thursday, he said the Johnson Amendment, which prevents churches from endorsing political candidates, has been effectively eliminated, though it would take an act of Congress to officially strike it.
At the White House Rose Garden ceremony, Trump also noted the three black churches set aflame in Louisiana, along with the bombings of churches in Sri Lanka, the attack on a mosque in New Zealand and the attack on a synagogue in Pittsburgh last year.
“We will fight with all our strength and everything that we have in our bodies to defeat anti-Semitism, to end the attacks on the Jewish people and to conquer all forms of persecution, intolerance and hate,” he said. Rabbi Yisroel Goldstein, who lost his finger during a shooting at his synagogue last week in Poway, Calif., thanked Trump for “being, as they say in Yiddish, ‘a mensch par excellence.’ ”
The final rule regarding health care — issued at 440 pages by the Department of Health and Human Services — broadly defines, or in some cases redefines, key terms in the law such as discrimination, referrals and what it means to assist in a procedure. It also meticulously lays out religious exemptions in detail, both in terms of the types of workers that are covered and specific situations that might arise.
It explicitly mentions abortion, sterilization, assisted suicide and advance directives as issues, and says that individuals and entities would be allowed to refrain from having to provide, participate in, pay for, provide coverage of or refer for, such services. It includes protections for medical students, people who prep patients for the operating rooms, and charitable groups alike.
Such “conscience protections,” as conservatives describe them, have become a flash point in culture war debates. In a high-profile battle with the Obama administration, several religious institutions objected to HHS’s mandate that employers must cover employees’ contraception.
Office of Civil Rights Director Roger Severino said that under the Obama administration, the office received an average of 125 conscience-related complaints each year. However, in the last fiscal year, there were 343, reflecting what he said is a greater need for protections.
The rule expands the powers of HHS’s Office for Civil Rights — requiring health-care entities to maintain records and report and cooperate with OCR requests. These new mechanisms, Severino said, will make sure “Congress’ protections are not just empty words on paper.”
Health-care providers and civil rights groups, however, expressed worry the rule could compromise patients’ well-being in ways large and small. On page 80, for instance, HHS appears to allow for the possibility that ambulance drivers, or EMT personnel, could refuse care in certain situations.
“It appears that a paramedic could refuse to drive a woman having an emergency – such as an ectopic pregnancy – because they object to the treatment she will receive at the hospital,” Heather Shumaker, senior counsel at the National Women’s Law Center.
Likewise, the rule appears to allow a pharmacist to refuse to fill a prescription for miscarriage management medication to a woman who is experiencing pregnancy loss and to refuse to tell her why.
Others contended that the rule would be used as cover for discrimination.
“The administration’s decision puts LGBTQ people at greater risk of being denied necessary and appropriate health care solely based on their sexual orientation or gender identity,” said David Stacy, government affairs director for Human Rights Campaign, the nation’s largest LGBTQ advocacy group. “Everyone deserves access to medically necessary care and should never be turned away because of who they are or who they love.”
Social conservatives said that the rule was needed at a time when many health care workers feel intimidated and fearful about standing up to do what they believe is right.
“There are over 20 federal laws protecting against this, and many more at the state level,” tweeted Montse Alvarado, executive director of the Becket Fund for Religious Liberty, one of the leading legal groups that tackle religious liberty cases. “But these laws often go unenforced. So today’s regulation makes clear that HHS can enforce them—mainly by showing violators how to improve, but also by cutting off federal funds for those who refuse to follow the law.”
Travis Weber, vice president for policy for the Family Research Council, a conservative Christian think tank, said he was pleased with how “broadly and comprehensively they address the conscience issue here.”
Under President Barack Obama, HHS replaced a rule passed during the administration of George W. Bush that was interpreted as allowing medical workers to opt out of a broad range of medical services. Obama’s narrower version left in place long-standing federal protections for workers who object to performing abortions or sterilizations, and it kept the ability for workers to file complaints.