The Trump administration is placing religious freedom at the center of its health policy agenda, a shift that critics argue will significantly impact reproductive health, LGBTQ+ healthcare, and vaccine mandates. The US Department of Health and Human Services (HHS) announced on Sunday a reorganization of its Office for Civil Rights, elevating conscience and religious freedom to top priorities. Concurrently, the US Department of Justice (DOJ) released a report on religious liberty on Friday that explicitly references abortion, vaccines, and gender-affirming care.
HHS Reorganization Emphasizes Religious Conscience
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 and the right to be free from coercion in HHS-conducted or funded programs," according to a public notice. Dorit Reiss, a professor at UC Law San Francisco, noted that this move "suggests they will use their funding authority to pressure states and local government and private groups." She added that the policy "tends to privilege a conservative form of Christianity and, for example, protect discrimination against LGBTQ people."
Critics Warn of Impact on Reproductive and LGBTQ+ Care
Liz Sepper, a professor of law at the University of Texas at Austin, argued that the framing of religious liberty masks a narrower agenda. "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," she said. Sepper highlighted that the most common violation of the Church Amendment, one of the laws cited 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," she asserted.
Sepper also noted that statutes allowing hospitals and individual providers to refuse certain healthcare could be interpreted broadly to cover politicized areas like vaccines and gender-affirming care. The DOJ report specifically targeted vaccine mandates, quoting anti-vaccine activists and parents opposing childhood vaccinations. Reiss commented that such federal intervention is unusual, as school vaccine requirements are typically state-level decisions.
Anticipated Religious Conscience Rule
The Trump administration is expected to release a new rule on religious conscience. Sepper described the recent moves as "at least preparing the administrative functions for when the rule comes out." She also referenced the US Supreme Court's opinion on the Emergency Medical Treatment and Labor Act (EMTALA), which "kind of punted" on the conflict between Idaho's abortion ban and federal emergency care requirements, suggesting providers could claim a conscience right to refuse emergency care. "I think we could see the administration take that perspective," she said.
Shift in Civil Rights Priorities
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 questioned the resource allocation: "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?" The Guardian has contacted HHS for comment.
