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Thursday, December 13, 2018

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Federal religious freedom office could affect rural Texans’ health care


Medical practitioners can now choose not to perform procedures, such as abortion, that interfere with their religious beliefs. | Dana C. Jones/The Cougar

The Trump administration’s Thursday push to protect the rights of healthcare professionals who object to performing medical treatments or procedures due to religious or moral obligations could prevent women in rural communities from receiving adequate reproductive care, according to a UH Law professor.

On Thursday the Department of Health and Human Services created the Conscience and Religious Freedom Division in its Office of Civil Rights to ensure medical professionals, including doctors and nurses, have protection when they refuse to perform certain medical procedures, like abortions, on religious or moral grounds.

“What the agency does is it provides an additional vehicle for making sure those protections exist on more than just paper,” said Seth Chandler, a UH law professor who specializes in insurance and health law. “There are a number of protections that Congress has enacted, for better or worse, that give employees — or people working for agencies that receive federal funding — these rights of conscious. In theory, the rights of conscious are broad, but 95 percent of the time it’s about reproduction and abortion.”

Reviving old norms

Rural areas with religious communities could experience a drought of reproductive care if all doctors in the area refused to perform certain treatments and procedures, he said.

“In those areas, it can make it considerably more difficult for poorer women to receive those services,” Chandler said.

These protections have been law for two decades or more, Chandler said. Lawmakers today just made different interpretations of what they mean and how heavily they will be enforced.

“What the Trump regulations do is to push things back away from the way the Obama Administration had interpreted them,” Chandler said, “and go back, at least as far back, as the way the Bush Administration had interpreted them.”

The Bush Administration had enacted a rule in its last year, Chandler said, that discussed how a number of the conscious statutes were interpreted. He said they were more on the side of religious conscious and less concerned with reproductive rights than many would prefer.

The Obama Administration, Chandler said, undid most of that work and basically required employees of federally funded programs to be willing to perform abortions or provide contraception.

“The pendulum has swung again, and now we have the Trump Administration doing, I would say, two things,” Chandler said. “One is undoing what the Obama Administration did, which in turn undid what the Bush Administration did, but then it’s actually gone farther and created this new division…that’s going to be staffed up with people whose job it’s going to be to find institutions that purportedly violate these rights of conscious.”

Not only does this protect doctors and others who refuse to perform certain procedures, it will also fine institutions found to be pressuring staff to perform procedures against their religious obligations, Chandler explained.

Far-reaching effects

Devan Ford-McCartney, the director of the Women and Gender Resource Center at UH, said these new regulations could have other impacts on women’s health.

“As an example, many women use birth control for a variety of health conditions including irregular or heavy menstrual periods, menstrual cramps, PMS, Primary Ovarian Insufficiency, Endometriosis and hormone replacement therapy,” Ford-McCartney said in an email. “Lack of access to get such medication may have a negative impact on their care as well as their health.”

Lorraine Schroeder, the director of the UH LGBTQ Resorce Center, explained that these regulations could potentially have a negative impact on the LGBTQ community as well.

Many in the LGBTQ community are already denied treatment, mistreated, or just don’t seek out healthcare due to discrimination,” Schroeder said in an email. “Health care professionals that perform gender affirming procedures do this because that is their specialty, but it may influence LGBTQ people having equal access to insurance benefits.”

Schroeder said the new division could worsen discrimination that already exists for transgender people.

“According to the 2011 ‘Injustice at Every Turn’ Report, 19 percent of transgender people have been denied healthcare, and 50 percent have had to educate their doctors about transgender care,” Schroeder said.

‘A noose around Planned Parenthood’

The same day the Trump Administration issued the regulations that created the Conscience and Religious Freedom Division, Chandler said, it also sent a letter to every Medicaid director in every state.

That letter rescinded an Obama Administration letter from 2016 that disallowed states from de-funding entities like Planned Parenthood that have affiliates that perform abortions.

The Obama Administration’s reasoning was that the Medicaid statute required funding for any medically qualified institution, Chandler said.

“I suspect what that will do is reinvigorate the efforts of states like Texas to tighten a noose around Planned Parenthood in which pieces of that organization provide abortion or services that some people think are abortion,” Chandler said.

The argument here, according to Chandler, is between religious conscious concerns and reproductive rights concerns. He said neither party completely ignores one value in favor of the other.

“I think a lot of Republicans here are saying, ‘Look, we’re not saying you can’t have an abortion, we’re just saying that people who find it religiously offensive to participate in that shouldn’t feel pressured to be complicit in what they regard as murder,’” Chandler said. “Similarly, the Democrats are saying, ‘Yeah, but if enough people say that, then that really makes it difficult for people that need family planning services to get them.’”

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