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Trump aims to expand religious and philosophical exemptions for health workers

President Trump intends to expand rules that allow health care workers to opt out of participating in certain services on religious or moral grounds. While conservatives celebrated what they call “conscience protections,” LGBTQ and women’s advocates warned the change would reduce services and cause patients harm. Amna Nawaz talks to The New York Times' Margot Sanger-Katz for analysis.

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  • Judy Woodruff:

    For many years, both political parties have agreed to exempt some health care workers from providing care and performing certain procedures they object to on religious or moral grounds. That can include abortions and sterilizations.

    But, as Amna Nawaz tells us, President Trump has gone further than his predecessors by issuing a complex and more comprehensive rule allowing for these exemptions.

  • Amna Nawaz:

    Judy, the president announced the new rule tied to the National Day of Prayer. Conservative groups welcomed what they call conscience protections.

    But women's groups, LGBTQ advocates and others are warning the rule could reduce services and lead to discrimination against transgender patients and others, if providers refuse to deliver certain care or treat people.

    Under the new rule, hospitals, clinics and other institutions must comply with 25 laws that are part of this in order to receive funding from federal programs such as Medicare and Medicaid.

    Margot Sanger-Katz writes about health care for The New York Times. And she joins me here.

    Welcome to the "NewsHour."

    So you have described this to my colleagues as an expansion of existing rules, both the category of workers, but also the ways in which they can object. Explain that to me.

  • Margot Sanger-Katz:

    Yes, so, there have always been roles that have protected health care practitioners from having to participate in certain kinds of services that they might have religious or conscience objections to.

    And I think the classic example is a health care provider who objects to performing an abortion, say. But what this rule does is, it really widens the category of person who could have this kind of objection, to include even, say, the scheduler in a medical office who might not want to schedule a patient for a certain procedure, all the way up through the board of directors of a hospital that might say, this hospital will not perform certain services, will not offer them to our patients.

    So, the kind of groups of people who can object to things on conscience basis have grown. And the other thing that this rule does is that it provides more enforcement kind of processes and more punishment.

    So, if a hospital fails to protect the rights of its religious worker, then it could be punished pretty substantially, potentially losing a lot of its federal funding.

  • Amna Nawaz:

    So, obviously, critics of the rule, opponents to it say that this just means there's a lot of ways that people can actually discriminate against certain categories of communities.

    What are some of those examples that they cite as places where people can come in contact with the health care system and be denied services they should get?

  • Margot Sanger-Katz:

    So, I think there are a lot of concerns.

    We don't know exactly how this is going to play out on the ground. But the worry is that certain kind of patients may be denied care because there are — the health care workers who are treating them have religious conditions that disagree with certain aspects of their lifestyle.

    So, there's a concern, for example, that perhaps a doctor wouldn't want to treat the child of a gay couple because they have a religious objection to gay marriage, for example. Or there are a lot of concerns that transgender patients may have difficulties accessing services.

    The rule itself makes reference to some very old laws from the 1970s that protect workers who don't want to participate in sterilization. It seems to suggest that certain services that transgender patients receive might be treated as sterilization, which transgender rights advocates say is really a stretch of what that law was originally intended to do.

  • Amna Nawaz:

    You mentioned the enforcement, though. What if there's a conflict? What if protecting someone's religious freedom, if they don't want to perform a certain service, means that then they're discriminating against another group? How do you resolve that conflict?

  • Margot Sanger-Katz:

    I think it's a really interesting question that's raised by this rule, because these are both civil rights questions, right? There are civil rights that are supposed to protect patients and prevent them from being the subjects of discrimination because of their status, because of their sex or their — other aspects of their person.

    But then there's also this concern about the civil rights of these health care workers, who shouldn't be forced to do things that interfere with their religious convictions.

    And I think the Trump administration through this action and through a series of other actions has really signaled that they're much more worried about the civil rights of the religious person in a health care setting than they are about the civil rights of the patient being denied care.

    The details of how this would work out in any individual case, I think we are going to have to see. And you could imagine, for example, a situation in which both parties might have a legal case to bring forward about the way that their health care institution resolves this.

  • Amna Nawaz:

    Speaking of legal cases, we should note that San Francisco immediately sued the Trump administration. The rule is scheduled to go into effect 60 days after it's published in the federal register.

    Less than a minute left.

    What do we expect to happen next? Does this just get caught up in a legal battle and never actually implemented?

  • Margot Sanger-Katz:

    I think it's very possible that it will.

    There are a number of health care institutions and also states and municipalities, like San Francisco, that are worried about this rule potentially interfering with some of their practices. And it could be stopped before it even goes into effect.

    We have seen that with other related Trump administration actions, including one having to do with family planning grants, where they were trying to prevent certain health care providers that provide abortion from getting these family planning grants.

    So this is all part of the regulatory agenda that may well get caught up in the courts before we really see it happening on the ground.

  • Amna Nawaz:

    One to follow, for sure.

    Margot Sanger-Katz of The New York Times, thanks for being here.

  • Margot Sanger-Katz:

    Thank you for having me.

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