In an interview, Severino said the goal is to achieve "parity" in civil rights, enforcing existing laws passed by Republicans and Democrats alike to ensure those with moral objections are not excluded from the health care field.
In January, Severino unveiled the agency's Conscience and Religious Freedom Division, which will have equal standing with OCR's existing Civil Rights and Health Information Privacy divisions, right down to getting its own staff and a director. Previously, conscience complaints from health care providers were reviewed alongside other discrimination complaints by the Civil Rights Division.
Last week, an HHS spokesperson said the office had received at least 40 more conscience-related complaints from providers in the weeks since the division opened, part of what the spokesperson characterized as "a clear surge" in such complaints under the Trump administration.
Under the proposed rule outlining HHS' plans, the division would collect and investigate complaints filed by health care professionals and entities, in addition to reviewing the policies of HHS and its partners to make sure they comply with a slew of conscience-protection laws. If any recipient of federal funding is found to have violated the law, HHS "would consider all legal options." That could include cutting off federal funds, taking back previously allocated funds or even referring the culprit to federal law enforcement officials.
That means a hospital that forces a nurse to participate in a vasectomy against her religious objections to sterilization, for instance, could risk having its federal funding revoked. But beyond objections to abortion and sterilization in particular -- which have some explicit protections under federal law -- it is murky which complaints HHS would deem valid. For example, it is unclear whether conscience-protection laws would shield a primary care doctor who refused to prescribe pre-exposure prophylaxis, or PrEP, which drastically lowers the risk of contracting HIV and is often used by gay men.
Severino rejected the notion that his office is elevating the concerns of a small group of conservative, Christian health care providers above others. In an interview, he argued HHS is early in the normal regulatory process and will work out the practicalities of how to balance the rights of providers with the rights of those they have sworn to treat as it reviews comments from the public and finalizes its proposal.
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"We're about increasing access for everybody," Severino said. "And part of increasing access for all is making sure we have a diverse set of providers for people."
Hinting at the scope of the changes in store, officials filed notices in January rewriting OCR's mission statement to emphasize conscience and religious freedom and empowering Severino to implement related laws.
Jocelyn Samuels, a former Justice Department civil rights lawyer who led OCR under Obama, said the office's latest efforts suggest officials are setting the stage for an unprecedented expansion in the ability of providers to deny care.
The recent changes, she said, "presage a commitment to invest more resources in protecting people's rights to deny care than promoting expansions of access to care."