Democratic Health Leaders Seek Answers from Trump Administration on Refusal of Care Rule

Aug 1, 2019
Press Release
Change Permits Expansive Category of People to Refuse to Provide Health Care Services Based on Any Personal Belief

Washington, D.C. – Democratic Health leaders sent a letter to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar today seeking documents and raising a series of questions regarding the Trump Administration’s refusal of care rule, which drastically expands the types of health care providers that can refuse to provide care to patients based on any personal belief as well as the type of care they can deny.  The bicameral leaders voiced their concerns with the rule and pressed for an explanation on how the HHS Office for Civil Rights (OCR) is addressing discrimination against patients and how it is ensuring patients have access to medical services in the event they are refused care based on a provider’s personal belief.

The letter was signed by House Energy and Commerce Chairman Frank Pallone, Jr. (D-NJ), House Education and Labor Chairman Robert C. “Bobby” Scott (D-VA), House Oversight and Reform Chairman Elijah E. Cummings (D-MD), and Senate Health, Education, Labor, and Pensions (HELP) Ranking Member Patty Murray (D-WA).

“This new HHS rule—which broadens the scope of existing refusal of care laws by redefining the type of care that may be refused, as well as the people who are permitted to deny that care—is an unprecedented and illegal expansion of OCR’s enforcement authority,” the Democratic Committee leaders wrote to Secretary Azar.  “In addition, the rule undermines the Department’s mission ‘to enhance the health and well-being of all Americans’ and instead threatens the health and well-being of women, LGBTQ people, and others facing marginalization by entrenching and sanctioning discrimination in the health care system.”

Under the Trump Administration’s refusal of care rule, patients could be refused access to care in a number of scenarios.  For example:

  • An individual provider receiving federal funds, including Medicaid, could refuse to offer certain services, such as HIV and other sexually transmitted infection testing, pre-exposure prophylaxis, reproductive health services, or gender reassignment surgery,

  • A pharmacy or pharmacist could refuse to fill prescriptions for a patient experiencing a miscarriage,
  • An emergency medical technician could deny transportation to a woman seeking the standard course of treatment for an ectopic pregnancy,
  • An insurance company could refuse to cover miscarriage management services,
  • A hospital room scheduler could refuse to book a facility for a woman seeking an abortion, and
  • A volunteer at a medical provider could refuse to assist a transgender patient.

In their letter, the Democrats also raise concerns that the refusal of care rule was finalized without ensuring it satisfied statutory and administrative rulemaking requirements.  The members cite specific concerns that the refusal of care rule may be arbitrary and capricious and that the rule is based on insufficient and flawed data that did not account for the full spectrum of ways the rule could harm patients such as negative health and economic impacts resulting from delays or refusals to provide care.

As part of their inquiry, the Democratic Committee leaders are seeking documents and answers to a series of questions from Secretary Azar by August 15, including:

  • What is the HHS OCR doing to address discrimination against patients in health care settings, including discrimination against patients that face multiple forms of discrimination? 
  • What is OCR doing to ensure patients, particularly those in rural areas or with limited access to health care providers, are able to access medical services when they are refused care based on a religious or conscience objection?
  • What impact does HHS believe the rule will have on patients who already disproportionately face discrimination in health care settings, including women, LGBTQ people, people of color, people living in rural areas, and other historically underserved groups? 
  • Did HHS communicate or coordinate with external entities to solicit complaints in the year leading up to the issuance of the proposed rule in January 2018?
  • All communications among HHS personnel and among any non-governmental organization, entity, or individual regarding the solicitation or submission of complaints to OCR.
  • All internal and external analyses of the potential impact of the refusal of care rule on patient access to health care services.

To read the full letter, click here.

116th Congress