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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.

  • The Trump-Pence administration’s refusal policies sought to empower 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

How We Got Here & Where We're Going


  • What to expect next
    The final rule for the Health Care Rights Law is scheduled to take effect on Aug. 18, and it is facing legal challenges
  • 6-12-2020
    Administration releases a final rule for the Health Care Rights Law, which scales back protections against discrimination for transgender people, people who have had abortions, and immigrants.

  • 1-16-2020
    Administration proposes "religious liberty" regulations that would eliminate protections for people who rely on federally funded programs and services, and make it easier for faith-based organizations to receive federal funds domestically and abroad

  • 8-14-2019
    Department of Labor proposes plan to let employers with federal contracts discriminate against workers based on the employer’s religious beliefs
  • 5-24-2019
    Administration proposes to roll back ACA
    non-discrimination protections in marketplace and other federally administered insurance plans
  • 5-2-2019

    Administration finalizes refusal rule to protect health workers who deny care based on personal belief. The rules are currently scheduled to take effect Nov. 22 if not blocked by the courts.

View more +
  • 1-19-2018
    HHS proposes a
    refusal policy that would empower medical workers to use their personal beliefs to deny care
  • 1-18-2018
    Roger Severino announces new office designed to protect providers who deny health care based on personal belief and focus less on individuals who experience discrimination in health care
  • 10-6-2017
    The U.S.
    Department of Justice encourages federal agencies and employers to discriminate in the name of religion




“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.”

How Refusal Policies Harm People

Refusal policies can be used to deny health care. 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 pregnant person'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

Final Affordable Care Act (ACA) Rule Nixes Discrimination Protections in Health Care

On June 12, the Department of Health and Human Services (HHS) issued a final rule that will roll back a regulation that prohibits health care providers and insurance companies from discriminating against LGTBQ individuals, people who need language access services, and people who have had abortions.

The Trump rule strips the Health Care Rights Law, which had ensured health equity for communities that have historically faced discrimination in access to health care services and coverage. The new rule stands to make it more difficult for transgender people, immigrants, and people seeking sexual and reproductive services to get care — and could even prevent people from getting the care they need entirely.

Administration’s Refusal Rule Emboldens Health Care Workers to Deny Care Based on Personal Belief

The refusal 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
Hurting Transgender Patients

The refusal rule 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 refusal rules 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
Background on ACA Protections Against Discrimination in Health Plans

In its June 12 final rule, the administration is changing the government’s interpretation of the ACA’s non-discrimination provision. Also known as Section 1557 and the Health Care Rights Law, the ACA’s non-discrimination provision prohibits discrimination on the basis of race, ethnicity, color, sex, national origin, disability status, and age.

Before the Trump-Pence administration came to power, the federal government interpreted this law in a way that protects people from discrimination based on gender identity, sex-stereotyping, termination of pregnancy, and more in marketplace plans and other health care programs that the government helps run. The current administration’s final ACA rule would interpret the law more narrowly. Now, HHS will enforce Section 1557 by interpreting "sex" discrimination as discrimination against someone for being a biological woman or a biological man, and nothing else. 

Attacking Health Care Access for Marginalized Communities

In January 2020, agencies including HHS and USAID proposed rules that could make it easier for faith-based groups to receive taxpayer funding while promoting their religion and not sharing secular alternatives with patients. This proposal could make it more likely that taxpayer dollars end up supporting culturally incompetent providers that deny services to marginalized communities — including LGBTQ people, women, and religious minorities. In turn, this policy could impact peoples' access to HIV and STI prevention programs, reproductive health services, youth homelessness services, and foster care and adoption services both domestically and abroad.

Expanding Denials of Care for Abortion

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

Providers Oppose Refusal Rules

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

American College of Obstetricians and Gynecologists
Lawsuits Mounting Against Refusal Rule

A slew of health care groups are suing the Trump administration over the refusal rule. They’re arguing that the rule puts providers’ religious views — on abortion and other services above patients’ constitutional rights guaranteed by the Fifth Amendment — which says that “no person shall be… deprived of life, liberty, or property without due process of law.”

Buzzfeed News

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