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Refusal Policies

let providers refuse to give health services they object to — such as abortion, birth control, and transgender health services — and potentially refuse to give care to certain people

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Why It Matters

  • So-called “refusal” laws — or “conscience protections,” or “religious refusals” — allow health care workers, including pharmacists and volunteers, to deny patients access to services the health care worker deems contrary to their personal beliefs.

  • In many cases, refusal policies have no protections for patients, not even in emergencies.

  • Under the Trump-Pence administration’s refusal policies, health care workers in the United States and around the globe would be able to deny patients services like birth control, abortion, and sterilization — and potentially even hormone therapy, HIV treatment, and HPV vaccines.

Related Players

Donald Trump

President of the United States

Elected to Office: 11-8-2016
Alex Azar

Secretary of Health and Human Services (HHS)

Nominated by Trump: 11-13-2017
Roger Severino

Director of the Office of Civil Rights (HHS)

Appointed: March 2017

“My life was saved by an abortion. I live in a hugely religious town. [If] the nurses treating me had refused care to me, I would have died.”

Refusals Can Be Used to Deny Care to Anyone Across the Country and Around the World

Under refusal policies, a patient might not learn that their provider has personal objections to certain health care services until after they've been denied care, placing their health at risk. A patient could be denied birth control simply because their pharmacist believes birth control is wrong.

Examples of refusal provisions include: A pharmacist could refuse to fill a prescription for birth control or antidepressants, or not administer a vaccine simply because of their own personal beliefs. A hospital administrator could cancel a woman’s life-saving treatment for cancer because it might harm her pregnancy. A transgender patient could be denied hormone therapy or emergency medical care, because their provider refuses to treat transgender people.

Background on Refusal Policies

Administration’s New Rule Allows Health Care Workers to Refuse Care Based on Personal Belief

The rule goes well beyond current law. It requires hospitals, universities, clinics and other institutions that get federal funding from programs such as Medicaid to certify they comply with over two dozen federal laws protecting health care workers who deny care they oppose (like abortion) and who deny care to patients whose identities they oppose (like LGBTQ patients).

Rewire News
Expanding Denials of Care for Abortion

Already, federal law and nearly every state also allows health care providers to refuse to perform abortions. The rule would embolden and expand these denials of care.

Providers Oppose Refusal Rules

Mainstream medical groups have recognized the negative effects that refusal laws can have on patients and have called for patient protections.

American College of Obstetricians and Gynecologists
Hurting Transgender Patients

The refusal measure could compound existing barriers to health care faced by transgender patients — 29% of whom already report having been refused care due to their gender identity.

Center for American Progress
Catholic Hospitals and Restrictions on Reproductive Care

Ten of the nation’s top 25 health systems are Catholic-sponsored, which means they’re subject to religious restrictions on a patient’s access to health services including, abortion, birth control, and miscarriage management services.

ACLU and MergerWatch Project
Hurting Women of Color

Health care refusals disproportionately impact Black women, namely because Black women are more likely than white women to seek health care in Catholic hospitals with religious restrictions on care.

Columbia Law School

Related Issues

The Health Agenda

Federal Judges

LGBTQ Rights