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How Big A Problem Is Religious Objection In Health Care?


When a health care provider feels they have been forced to do something they disagree with on moral or religious grounds, they can file a complaint with the Department of Health and Human Services. Some high-profile cases have involved nurses who objected to abortion. For the last decade, HHS has gotten an average of one of those complaints per year. Last year, though, that number jumped to 343.

NPR's Selena Simmons-Duffin wanted to find out why.

SELENA SIMMONS-DUFFIN, BYLINE: Roger Severino runs the HHS Office for Civil Rights. And last week, he unveiled a new rule titled Protecting Statutory Conscience Rights In Health Care. He says this will cost $312 million to implement in the first year. And he says that increase in complaints demonstrates the need for this rule.

His office declined to provide details about the 343 complaints or an explanation for the sudden jump, but public outreach is certainly part of it.


ROGER SEVERINO: In January of 2018, we launched a new Conscience and Religious Freedom Division to make sure our existing conscience and religious freedom laws get the focused attention that they deserve.

SIMMONS-DUFFIN: He even made a video last year.


SEVERINO: If you believe that a covered entity has violated your civil rights, conscience and religious freedom or health information privacy, you may file a complaint through our website.

SIMMONS-DUFFIN: Dr. David Stevens thinks health care workers got Severino's message.

DAVID STEVENS: Now that it's well-publicized and it's available, people are contacting them.

SIMMONS-DUFFIN: Stevens is the CEO of the Christian Medical Associations based in Bristol, Tenn., which represents 19,000 members.

STEVENS: We're happy to provide compassionate and quality care for anybody that walks in the door as long as we don't become morally complicit in something that violates our conscience. That might be, for a transgender patient, being involved in a transition.

SIMMONS-DUFFIN: He also points to abortion and physician-assisted suicide as examples.

Stevens thinks complaints are rising because there's more antagonism now against people of faith. And he says there are pent-up complaints from before the Trump administration when providers felt like they had nowhere to go.

STEVENS: The big issue in the past has not been having laws. The big issue is having them enforced.

JOCELYN SAMUELS: It is wholly inaccurate to say that we in any way abdicated our responsibility to enforce these laws.

SIMMONS-DUFFIN: Jocelyn Samuels was Severino's predecessor as director of the Office for Civil Rights under President Obama. She agrees Severino's public outrage is probably part of the increase in conscience complaints. But she's concerned that that publicity will make providers think that there's blanket protection to refuse care based on religious or moral beliefs.

In reality, she says, the laws are quite narrow.

SAMUELS: So for example, a orthopedist cannot refuse to set the leg of an LGBT patient because the orthopedist disapproves of that person's sexual orientation or gender identity.

SIMMONS-DUFFIN: She says, of course, the number of complaints aren't a perfect metric for the scope of an issue. But...

SAMUELS: For at least a decade, before this administration, there were not very many allegations that this was a problem and even now is dwarfed by the number of complaints filed under other laws.

SIMMONS-DUFFIN: When she was in charge, she says they got around 20,000 complaints a year about privacy of health information and several more thousand complaints of civil rights violations. That puts 343 complaints of conscience rights violations into context.

Selena Simmons-Duffin, NPR News. Transcript provided by NPR, Copyright NPR.