The U.S. Department of Health and Human Services (HHS) issued a final rule that clarifies certain aspects of healthcare conscience laws, which sometimes allows healthcare providers to refuse medical treatment based on religious grounds.
However, the rule also provides some safeguards against discrimination for patients seeking treatment for conditions related to reproductive care, HIV prevention, and gender dysphoria. Critics of the 2024 final rule claim that the Biden administration is attempting to undermine the U.S. Supreme Court’s 2022 ruling overturning Roe v. Wade.
The rule, which HHS issued on January 11, 2024, becomes effective on March 11, 2024.
The Previous Healthcare Conscience Rule
The Trump administration issued a final rule clarifying healthcare conscience laws in 2019. That rule would have dramatically expanded the interpretation and application of those laws. According to critics, the 2019 final rule would have facilitated discrimination against women, people of color, people with disabilities, and the LGBTQ+ community. It would have allowed HHS to discontinue funding for healthcare facilities that took action against workers who refused to provide healthcare based on religious or moral objections.
The 2019 final rule never went into effect because federal court orders blocked it. Several courts found the rule unlawful under federal civil rights laws and the Emergency Medical Treatment and Labor Act. As a result, the 2024 final rule explicitly rescinds the 2019 final rule.
OCR Regulation and Enforcement
Under the final rule, the Office of Civil Rights (OCR) will monitor compliance and enforce violations of the federal conscience law. OCR will receive all complaints related to the law, conduct investigations, seek resolution of complaints, and handle compliance reviews.
Federal Agencies Already Enforcing Contraception Insurance Coverage Mandate
Despite the federal healthcare conscience laws in place, the Affordable Care Act (ACA) requires group health insurance plans and other insurers to cover women’s preventive services contraceptives, including emergency contraceptives, without cost-sharing. Women, therefore, should be able to easily access at least one form of FDA-approved contraceptive in each category identified by the FDA that is medically appropriate for their situation. The HHS, U.S. Department of Labor (DOL), and the Department of the Treasury (Treasury) issued guidance in 2022 to clarify this requirement. The agencies also clarified that they would enforce this mandate as needed.
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