The Trump administration has launched investigations into health care organizations in an effort to allow providers to refuse care for transgender patients on religious or moral grounds. <\/p>\n
One of the most recent actions<\/a> by the Department of Health and Human Services, launched in mid-June, targets the University of Michigan Health system over a former employee\u2019s claims that she was fired for requesting a religious exemption from providing gender-affirming care.<\/p>\n An administration release announcing the probe says the Michigan case is the third investigation in \u201ca larger effort to strengthen enforcement of laws protecting conscience and religious exercise\u201d for medical providers, citing federal laws known as the Church Amendments<\/a>.<\/p>\n The probes are the first time HHS has explicitly claimed the amendments \u201callow providers to refuse gender-affirming care or to misgender patients,\u201d said Elizabeth Sepper<\/a>, a professor at the University of Texas who studies conscience laws. Those laws, Sepper said, primarily allow objections to performing abortions or sterilizations but \u201cdon\u2019t apply to gender-affirming care, by their very own text.\u201d<\/p>\n But religious freedom groups that supported the health worker in the Michigan case, Valerie Kloosterman, say the investigation is a welcome recognition of existing protections for medical professionals to refuse to provide some types of care that conflict with their beliefs.<\/p>\n \n\t\tSubscribe to KFF Health News’ free weekly newsletter, “The Week in Brief”\t<\/p>\n<\/div>\n \u201cWe are pleased to learn that the Department of Health and Human Services is taking its responsibility seriously to enforce the federal statutes protecting religious health care providers,\u201d said Kloosterman\u2019s attorney Kayla Toney, of the First Liberty Institute, which advocates for religious liberty plaintiffs.<\/p>\n The two other cases HHS announced in recent months involve ultrasound technicians<\/a> who didn\u2019t want to be involved in \u201cabortion procedures contrary to their religious beliefs or moral convictions,\u201d and a nurse<\/a> who asked for a religious exemption to \u201cavoid administering puberty blockers and cross-sex hormones to children,\u201d according to HHS. The department did not disclose the locations for those investigations.<\/p>\n Sepper said opening investigations into gender-affirming care cases is a new tactic for HHS after federal courts<\/a> blocked a 2019 effort<\/a> by the previous Trump administration to broaden conscience rules.<\/p>\n And it sends a message that this administration will \u201cinvestigate or otherwise harass providers of gender-affirming care, even when that provision is legal in the states where they operate,\u201d said Sam Bagenstos, a general counsel at HHS during the Biden administration and a professor at the University of Michigan.<\/p>\n HHS spokesperson Andrew Nixon declined to comment, citing the ongoing investigation.<\/p>\n HHS launched its investigation years after Kloosterman filed a lawsuit against her former employer. She started working for Metropolitan Hospital in Caledonia, Michigan, as a physician assistant in 2004. When the hospital merged to become part of University of Michigan Health-West in 2021, Kloosterman took part in a \u201cmandatory diversity training,\u201d according to a federal lawsuit filed in 2022.<\/p>\n In that training and follow-up discussions, the health system \u201cattempted to compel Ms. Kloosterman to pledge, against her sincerely held religious convictions and her medical conscience, that she would speak biology-obscuring pronouns and make referrals for \u2018gender transition\u2019 drugs and procedures,\u201d according to the lawsuit by Kloosterman\u2019s attorneys.<\/p>\n These were, at this point, purely hypotheticals: \u201cNo patient ever asked her for a referral for such drugs or procedures, and she never used pronouns contrary to a patient\u2019s wishes,\u201d the suit claimed.<\/p>\n But when Kloosterman requested a religious accommodation, she was \u201csummoned\u201d to a meeting with administrators, who \u201ccalled her \u2018evil\u2019 and a \u2018liar,\u2019 mockingly told her that she could not take the Bible or her religious beliefs to work with her, and blamed her for gender dysphoria-related suicides,\u201d according to the lawsuit, which alleges she was fired in August 2021, shortly after the meeting.<\/p>\n The health system denied all allegations, and in April 2024, U.S. District Judge Jane Beckering dismissed Kloosterman\u2019s case to proceed into arbitration. Kloosterman\u2019s lawyers filed an appeal with the U.S. Court of Appeals for the 6th Circuit. Appellate judges heard oral arguments in the case in February but have not issued a decision.<\/p>\n HHS initiated its investigation under the Church Amendments because it\u2019s \u201ccommitted to enforcing Federal conscience laws in health care,\u201d said Paula M. Stannard, director of the department\u2019s Office for Civil Rights, in a statement announcing the investigation. \u201cHealth care workers should be able to practice both their professions and their faith.\u201d<\/p>\n But the investigation \u201crepresents a real expansion beyond what the Trump administration did in the first term, and also in terms of the text of the law,\u201d Sepper said.<\/p>\n The Church Amendments date to the 1970s and allow health care institutions and providers to refuse to participate in abortion or sterilization procedures.<\/p>\n \u201cSome of these also apply to end-of-life care and to physician aid in dying. So they have relatively narrow scope,\u201d Sepper said. \u201cThey focus on a set of procedures. They don\u2019t allow health care providers or institutions to refuse to provide all kinds of care based on their religious or moral objections.\u201d<\/p>\n There is one broader provision in these laws that \u201cis about the conscience-based decision to perform, or not to perform, a lawful medical procedure,\u201d said Bagenstos, the former HHS general counsel during the Biden administration. But that applies only to recipients of a \u201cgrant or contract for biomedical or behavioral research,\u201d he said. So this case is \u201can extreme stretch of the conscience protections, and probably more than a stretch.\u201d<\/p>\n But Ismail Royer<\/a>, director of Islam and religious freedom at the Religious Freedom Institute, which filed an amicus brief supporting Kloosterman\u2019s lawsuit, said the Church Amendments are just a few of the laws HHS enforces, along with broad civil rights protections<\/a> and laws that prohibit discrimination on the basis of religion<\/a>.<\/p>\n \u201cThis is not a case where someone is refusing to treat someone who is LGBT,\u201d Royer said. \u201cThis is a case of someone who does not believe that they should be forced to use pronouns that would constitute a lie.\u201d<\/p>\n Other providers are available if a patient\u2019s \u201cfeelings are hurt,\u201d he said. \u201cBut hurt feelings do not constitute the basis for the government violating our constitutional rights.\u201d<\/p>\n The stakes for a health system are very different in an HHS investigation than in civil suits, Sepper said. The government agency, which oversees the vast majority of health care spending, could decide to strip Medicare and Medicaid funding from the health system. HHS has previously been hesitant to remove funding, Sepper said.<\/p>\n But it would be highly unusual \u2014 and possibly illegal \u2014 for HHS to actually withhold funding from the health system over a case like this, Bagenstos said.<\/p>\n By taking up these investigations so publicly, Sepper said, HHS is putting health systems \u201cin a very difficult situation.\u201d Antidiscrimination laws require them to treat transgender patients equally, she said. But now the administration is prioritizing \u201cemployees that might want to make it more difficult for transgender patients to receive care.\u201d<\/p>\n These investigations are \u201cmeant to offer red meat to the anti-LGBT rights movement, to tell them that HHS is squarely on their side,\u201d Sepper said.<\/p>\n This article is from a partnership with <\/em>Michigan Public<\/em><\/a> and <\/em>NPR<\/em><\/a>.<\/em><\/p>\n<\/p><\/div>\n\n\t\t
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