Tues 8/13: Comments on rule to allow religious prejudice to rule our healthcare system – comments due tonight.

Action – Write for our rights…Tonight by (Tuesday 11:59 pm EST)

Send your thoughts on this horrible rule here.

The Trump-Pence Administration is quietly erasing our rights, one by one. (planned parenthood) The proposed rule, which closes tonight affects the Health Care Rights Law, aka Section 1557 of the Affordable Care Act, which prohibited discrimination by certain entities against patients on the basis of sex, race, ethnicity, national origin, age, and disability status. The Obama administration ensured that the law:

• prohibits discrimination based on gender identity or sex stereotyping;
• prohibits discrimination on the basis of pregnancy, including termination of pregnancy;
• requires certain language access and interpretation services for people with limited English proficiency; and
• prohibits plans from discriminating against people with chronic illnesses.

This law was a HUGE step toward achieving health equity for communities nationwide, including women, people of color, immigrant communities, and LGBTQ people — but now, the Trump-Pence administration is trying to roll that progress back. (kff.org)  “The proposal cannot change Section 1557’s protections in the law enacted by Congress but would significantly narrow the scope of the existing HHS implementing regulations, if finalized, by:

• Eliminating the general prohibition on discrimination based on gender identity, as well as specific health insurance coverage protections for transgender individuals;
• Adopting blanket abortion and religious freedom exemptions for health care providers;
• Eliminating the provision preventing health insurers from varying benefits in ways that discriminate against certain groups, such as people with HIV or LGBTQ people;
• Weakening protections that provide access to interpretation and translation services for individuals with limited English proficiency;
• Eliminating provisions affirming the right of private individuals to challenge alleged violations of § 1557 in court and to obtain money damages, as well as requirements for covered entities to provide non-discrimination notices and grievance procedures;
• Narrowing the reach of the regulations by only covering specific activities that receive federal funding, but not other operations, of health insurers that are not “principally engaged in the business of providing health care,” and no longer applying the regulations to all HHS-administered programs;
• Update: (mother jones) “the proposal is particularly insidious as it would allow employers to use their religious beliefs to engage in hiring practices that would otherwise be banned as sex-based discrimination. This could be used to target pregnant women who are not married, as employers could claim sex out of wedlock violates their religion. The ACLU tells Mother Jones that there were four court cases pending as of March 2019 in which churches and Christian schools terminated workers who were pregnant and unmarried.
• The new rule would also expand what counts as a “religious organization,” according to Ashley Westby, program manager at the National Employment Lawyers Association. “It means that religious organizations aren’t necessarily just an organization that is a church or a Christian college or a mosque or things of that nature, but any kind of an organization that says on its face that they are doing what they are doing because of their religion,” Westby says. Essentially, any company that claims to espouse religious beliefs, even if they aren’t core to its business, would be covered by the new rule.”

HHS also requests comment on whether to change certain provisions intended to ensure equal access for people with disabilities. It also proposes eliminating prohibitions on discrimination based on gender identity and sexual orientation in 10 other Medicaid, private insurance, and education program regulations outside Section 1557. If finalized, HHS’s proposed changes would substantially narrow, and in many cases entirely eliminate, the regulations’ existing protections against discrimination in meaningful ways.”

Here is the document would allow discrimination against patients – 440 pages of steaming misogyny, transphobia  and homophobia.

In theory, it could allow…

• an ambulance driver to refuse to drive a woman with an ectopic pregnancy to a hospital because it would lead to an abortion.
• the anesthesiologist who thinks that an abortion to save the life of the pregnant woman shouldn’t be performed
• the ER staffer who refuses rape victims the morning-after-pill; or referrals to someone who will.
• the nurse who doesn’t want to run an IV line for a transgender patient
• a surgeon refusing to surgically sterilize a woman after giving birth, making her undergo a separate operation, with more risk, later. (Oh, wait, they were already doing that).
• or a medical worker to won’t adhere to a patient’s end-of-life directives
• A health worker objecting not only to performing an abortion, for example, but also to participating in anything “with a specific, reasonable and articulable connection” to an abortion procedure. That could include counseling, referrals, or even scheduling appointments for abortions.

What’s already happening now…

• What’s already happening to women:
  • women being forced to suffer near-fatal infections before their non-viable pregnancies can be terminated. (this is already happening in Catholic hospitals)
  • pharmacists to refuse to fill birth control prescriptions or drugs to induce a miscarriage. (Oh, wait, they were already doing that).
• What’s already happening to LGBTQ patients:
  • A Florida hospital informed a woman whose partner had collapsed that she was in an “antigay city and state” that did not recognize the same-sex relationship or permit her to visits. (This already happened – the patient died without seeing either her partner or their children.)
  • Fewer than half of medical schools and few hospitals  train their students or staff on LGBT issues.
  • In a survey, the Centers for Disease Control found that 34% of primary care doctors and nurses had never heard of a drug that, when taken regularly, can prevent HIV transmission.
  • Doctors assuming that all gay patients’ medical conditions must be was HIV related.
• What’s already happening to transgender patients:
  • Nearly 1 in 5 (19 percent) reported being refused care outright because they were transgender or gender non-conforming.
  • Survey participants reported very high levels of postponing medical care when sick or injured due to discrimination and disrespect (28 percent).
  • Harassment: 28 percent of respondents were subjected to harassment in medical settings.
  • significant lack of provider knowledge: 50 percent of the sample reported having to teach their medical providers about transgender care.
  • Despite barriers, the majority has accessed some form of transition-related medical care, but only a minority has had any surgery, despite the fact that a strong majority stated wanting to have it someday.
  • Respondents reported more than four times the national average of HIV infection, 2.64 percent in our sample compared to 0.6 percent in the general population, with rates for transgender women at 3.76 percent, and with those who are unemployed (4.67 percent) or who have engaged in sex work (15.32 percent) even higher.
  • Over a quarter of the respondents reported misusing drugs or alcohol specifically to cope with the discrimination they faced due to their gender identity or expression.
  • A staggering 41 percent of respondents reported attempting suicide compared to 1.6 percent of the general population.

• Andrew Seidel of the Freedom from Religion Foundation (ffrf.org): “This rule does not protect the religious liberty of doctors and patients, it instead imposes religious dogma on patients. The right to practice your religion ends where my rights begin; you don’t get to use your medical license to impose your dogma on anyone else.” (More information on what goes on at Catholic hospitals here.)

Really, why stop there?
The administration, in the guise of the Department of Health and Human Services, has put the religious beliefs of providers over the needs of patients. The rule allows adherents of religions to discriminate against the legal medical needs of women, the LGBTQ community and the dying based solely on their “religious and deeply held personal beliefs”. Those in powerful positions of medical care-giving and decision-making would legally be allowed to refrain from having to provide, participate in, pay for, provide coverage of, or refer for, services such as abortion, sterilization, assisted suicide, gender reassignment issues and advance directives.

Really, why stop there?
Focusing all their big guns on thwarting women’s reproductive needs and harassing the LGBTQ community ignores all those who want to discriminate against people of color, which, until the civil rights era, was openly espoused as “religious freedom“. It discriminates against the doctors, nurses, pharmacists, ambulance drivers, etc…who would cheerfully refuse treatment to atheists, Jews, Hindus and Muslims if they could. Or those who would refuse to treat Christians. In fact, it prioritizes the prejudices of those most concerned with misogyny and homophobia over the discrimination desires of others. Not only is this blatantly unfair to those other potential discriminators, but it puts far more pressure on a smaller group of victims, instead of spreading hate out more evenly throughout the population. 

Really, why stop there?
Why are the religionists in medical-adjacent professions allowed to easily opt out of dealing with the sick and vulnerable public members they find distasteful, when those in the commercial sphere – who sell food, or clothing or rent apartments, are held to tougher standards? Why don’t we return to the ugly era of redlining, separate-but-equal everything, “whites-only” country clubs and “gentleman’s agreements“, when Americans were free to discriminate at will based on nothing but their “strongly-held beliefs”? Inconceivable in 2019? A survey in 2014 found that 10% of Americans believe business owners should be able to refuse to serve black people if they see that as a violation of their religious beliefs. 16% of Americans say that small business owners could use religious grounds to deny service to gay or lesbian people, 15% would be ok with not serving atheists and 12% would use religion to prevent service to Jewish people.

Are we making ourselves “Great” yet?
The administration’s current fiction is that the implementation and enforcement of federal conscience and anti‐discrimination laws for medical and medical-adjacent personnel (pharmacist, ambulance drivers, paramedics, medical students, people who prep patients for the operating rooms, and charitable groups) would help alleviate the country’s shortage of health care providers by encouraging undereducated religious landmines to clutter up our clinics and hospitals. (Yes, doctors are now allowed to graduate without learning how to do a safe medical abortion!) Maybe they will next ask to be excused from learning about evolutionary medicine, or refusing to use any treatment based on fetal tissue research. 

Or maybe people whose religious beliefs prohibit them from dealing with women’s reproductive needs, LGBTQ needs, the dying, etc, can do what they’ve done before. Go into a branch of medicine where their deeply held personal beliefs cause no harm, or join a different profession entirely.