WASHINGTON D.C. — The US Department of Health and Human Services (HHS) reorganized its office for civil rights to prioritize conscience and religious freedom. Concurrently, the US Department of Justice (DOJ) issued a report on religious liberty that included references to abortion, vaccines, and gender-affirming care.

According to a public notice, the reorganized HHS office will require federal agencies, state and local governments, healthcare providers, and health plans to focus on protecting the free exercise of religion and conscience in HHS-conducted or funded programs. Liz Sepper, a professor of law at the University of Texas at Austin, said: "This is, of course, being framed in terms of religious liberty, but it's not really about that."

"Most of the religious conscience statutes the office says it is planning to enforce are laws about refusing reproductive healthcare to patients and to beneficiaries of insurance," Sepper said. "I think it's a really clear signal to the right to life movement that some of their priorities are going to be coming to the top at the agency." She added: "The most common violation of the church amendment, one of the laws mentioned in the HHS reorganization, is discrimination against abortion providers. I would guarantee that we will not see the Trump administration's HHS go to work to stop that kind of discrimination."

"Statutes allowing hospitals and individual health providers to refuse certain kinds of healthcare could also be interpreted broadly to healthcare that has been politicized, like vaccines or gender-affirming care," Sepper said. The DOJ report quoted anti-vaccine activists and parents who do not want their children vaccinated. The HHS civil rights office has downplayed areas of discrimination that were previously top priorities, such as discrimination against disabled people and transgender patients.

Sepper said: "The US supreme court in its opinion on the Emergency Medical Treatment and Labor Act (Emtala) kind of punted on Idaho's abortion ban and the conflict with Emtala, suggesting that providers would have a conscience right to refuse emergency medical care under Emtala. I think we could see the administration take that perspective." She added: "The conscience laws HHS enforces are usually focused on providers, not patients."

"That really means they're focused on the rights of a very small segment of the population, and the rights of those providers to refuse medical care come into conflict with the rights and interests of the American people to receive medical care that's nondiscriminatory or that doesn't impose someone else's religion on them," Sepper said. "The question becomes: Are you dedicating lots of resources to enforcement of religious refusal laws in the place of enforcement of national origin discrimination protections, for instance, or translation services or accommodations for disability?"