The Trump administration is embarking on a sweeping effort to redefine civil rights in health care, with critics accusing the Department of Health and Human Services of sidestepping the rights of patients to soothe a far smaller constituency: conservative nurses, hospitals and other caregivers.
The department's Office for Civil Rights (OCR) has been greatly strengthening and expanding protections for health care providers who have religious- or conscience-based objections to procedures such as abortion. By way of explanation, officials cite 36 complaints OCR received from, or on behalf of, those working in the health care system from President Donald Trump's election through early January of alleged affronts to religious beliefs and moral convictions -- up from 10 such complaints it had fielded since 2008.
What officials did not mention is that those 36 complaints pale against the more than 30,000 total complaints that OCR received during 2017, according to the agency's latest budget request; most involved alleged breaches of privacy or discrimination against patients.
"Times are changing," Roger Severino, OCR's director, said in a speech in January. "And we are institutionalizing a change in the culture of government, beginning with HHS, to never forget that religious freedom is a primary freedom; that it is a civil right; that it deserves complete enforcement and respect."
During the Obama administration, OCR operated under a two-pronged, patient-centric mission: to protect civil rights and health information privacy. The office focused on a part of the Affordable Care Act known as Section 1557, which, for the first time, barred providers who receive federal funding from discriminating on the basis of gender identity.
But the new, wide-ranging proposal to strengthen conscience protections at OCR involves the creation of a division, hiring of staff and re-evaluation of which civil rights it will protect.
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Overseen by Severino, who has deep ties to the religious right, the makeover appears radical, one that critics worry will jeopardize the care of pregnant women and transgender individuals, as well as others who could be denied certain procedures. Officials spent months quietly rethinking policies and plans for enforcement, Severino has said, preparing to remake the office as a guardian of objections to abortion, sterilization and physician-assisted death, for example.
"Administrations are able to come in and put their own stamp and agenda on how they see policy. And that is politics. That is politics as usual," said Mary Alice Carter, executive director of a new watchdog group called Equity Forward. "But the core issue here is we have individuals coming in who fundamentally don't believe in the very mission they're serving."
"They are coming in with the agenda of burning it down," she said.
Trump's selection of Severino -- a former Justice Department lawyer who most recently researched religious issues at the conservative Heritage Foundation -- signaled the changes in store. In 2016, he co-authored a paper that argued OCR's interpretation of Section 1557 as barring discrimination based on gender identity threatened health care providers who "as a matter of faith, moral conviction, or professional medical judgment, believe that maleness and femaleness are biological realities to be respected and affirmed, not altered or treated as diseases."