By Christianna Silva
The Department of Health and Human Services issued a final rule on Thursday, May 2, that could limit care for an untold number of Americans by allowing health care institutions and workers to refuse to provide medical care and services like transition-related care, abortion, or assisted suicide for any religious or personally moral reason.
Included in the 440-page report is the ruling on the so-called “conscience rule,” which was first introduced in 2011, but the HHS found "inadequate" because it only covered three conscience statutes – this ruling covers 25. Basically, the “conscience rule” means that any health care professional – from the receptionist who schedules procedures to the doctor themself – can deny care to anyone for any reason as long as they object to that person or the care they are seeking on the basis of personal reasoning, or a conscience objection.
“This rule ensures that health care entities and professionals won’t be bullied out of the health care field because they decline to participate in actions that violate their conscience, including the taking of human life,” HHS Office of Civil Rights Director Roger Severino said in the rule. “Protecting conscience and religious freedom not only fosters greater diversity in health care, it’s the law."
There are plenty of issues to break down here, including that patients are far more likely to be afraid to seek medical care because of who they are than doctors are "bullied" out of the healthcare field. According to a study from Lambda Legal, 56 percent of lesbian, gay, and bisexual people and 70 percent of transgender and gender non-conforming people reported experiencing discrimination by health care providers. In a 2015 study, 23 percent of transgender respondents said they did not see a doctor when they needed medical care because they feared that they would be mistreated due to their gender identity. The same study found that 55 percent of transgender respondents who sought coverage for a transition-related surgery were denied.
The new HHS ruling, which is an edited version of a ruling first released in 2018, is set to take effect in just 60 days. It was one of the first actions taken by the HHS's new Conscience and Religious Freedom Division that Severino established in 2018. It also comes around the same time as some of the new Title X restrictions are set to go into place; according to Planned Parenthood president Dr. Leana Wen, such restrictions are unethical and illegal. “It violates the law as passed by Congress, which specifically states that doctors must provide the full range of options to our patients,” she told MTV News in April.
Here are some of the ways this new HHS ruling could affect you or someone you know.
- If you use birth control or need access to emergency contraceptive services
Many religious groups teach that it is intrinsically wrong to use contraception to prevent pregnancy. If your doctor or pharmacist believes that birth control is morally wrong, or if your hospital is owned by a religious group, they have the right to refuse to give it to you.
- If you are seeking an abortion for any reason
According to the Pew Research Center, many religions teach that, save for a few situations like rape or incest, abortion should not be permitted. That means, if your medical provider cites their religion as the basis for their conscience objection, they can deny providing you with an abortion. They can also refuse an abortion on moral grounds — that is, if prohibitive state legislation hasn't already made seeking an abortion all but impossible for you.
- If you’re not cisgender
If a healthcare provider has any religious or personally moral objection to caring for a transgender or gender non-conforming person, they can deny care for anything from giving a physical to providing transition-related care. A study out of the National LGBTQ Task Force shows that this is already rampant without the ruling: Nearly 1 in 5 trans patients reported being refused care because of their gender identity. Finding gender-affirming, affordable healthcare practitioners can be tough for many people, and can lead to people feeling distrustful of doctors or avoiding going altogether.
- If your family resembles anything other than a specific, heterosexual societal model
According to the Center for American Progress, LGBTQ people and their children already face high rates of health care discrimination. In 2015, an infant in Michigan was turned away from a pediatrician’s office because she had same-sex parents – that was illegal under the Affordable Care Act, but would be legal under the new HHS guidelines.
“The Trump-Pence administration’s latest attack threatens LGBTQ people by permitting medical providers to deny critical care based on personal beliefs,” the Human Rights Campaign Government Affairs Director David Stacy said in a statement about the rule. “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. Everyone deserves access to medically necessary care and should never be turned away because of who they are or who they love.”
- If you’re unmarried, LGBTQ+, or in an interfaith relationship and might like to access IVF
The ruling could allow any medical professional to refuse in vitro fertilization to anyone if they have any personal qualms with what that person’s family looks like, according to the American Civil Liberties Union. For instance, if a receptionist at a medical office does not believe that two women should be able to have a family together, she can refuse to schedule an IVF procedure on the basis of a moral objection.
- If you need HIV or AIDS-related care
In 2014, hospital staff refused to give a patient his HIV medication when he disclosed that he had sex with other men. The Affordable Care Act made that discrimination illegal – this new HHS ruling would make it legal again, despite Trump’s purported vow to end the HIV/AIDS epidemic during his tenure as president. This ruling would “pose a direct threat to the health of millions of Americans,” AIDS United said in a statement according to Politico, by allowing health care workers to refuse to provide the HIV prevention treatment PrEP. Advocate groups say this kind of discrimination is intrinsically homophobic, since HIV and AIDS are most commonly linked to the LGBTQ+ community. According to the Department of Health and Human Services, around 1.1 million Americans are living with HIV; the majority of those who test positive are gay and bisexual men.