Samuels, who held Severino’s job as head of the Office of Civil Rights under Obama, pointedly disputes this claim. “We were open for business during the Obama administration. We had extensive resources on the website that explained to covered entities their obligations under the provider-conscience laws,” she told me. “Whatever the perception might have been, in the world at large, that we were not enforcing the law, or that they would not get a hospitable reception if they were to file complaints, [that] was not borne out by the facts.”
HHS’s new guidelines apply directly to cases of abortion and sterilization, but Samuels and others worry that they will also limit care for LGBTQ people. In the final years of the Obama administration, a new set of legal challenges began to emerge, focused on religious objections to transition services for transgender people. Several queries submitted to HHS during the legally required notice-and-comments process for the Trump administration’s new rule raised this concern, but the department demurred, responding that the policy only implements statutes written by Congress, and does not “apply to women, LGBTQ persons, or religious minorities in any way that differs from how Congress applied the terms.” Over the past few days, LGBTQ-advocacy groups issued a barrage of alarmed press releases, sometimes getting viciously personal: One, from the group Equity Forward, called Severino a “transphobic bigot.” In our interview, Severino responded that he has “dedicated my career to the defense of civil rights for everyone, and I will continue to discharge my duties to the best of my abilities, and to be as fair to everyone as I can be, while respecting the inherent human dignity of everybody, no matter what their walk of life.”
[Read: When doctors refuse to treat LGBT patients]
Religion does not always compel people to oppose LGBTQ rights or abortion. “People of faith have a wide variety of views when it comes to issues like abortion and LGBTQ rights,” says Elizabeth Platt, the director of the Law, Rights, and Religion Project at Columbia University. In her view, this new rule unfairly favors a conservative interpretation of religion—and of existing federal statutes. “I don’t think that people’s access to health care and health-care information should necessarily be dependent on their providers’ religious beliefs,” she says.
The conflict between religious liberty, LGBTQ rights, and abortion access is about to intensify. In the coming weeks or months, HHS is expected to issue a revised version of Rule 1557 of the Affordable Care Act, which extended nondiscrimination protections to transgender people and women who have terminated pregnancies. The Supreme Court is also slated to consider civil-rights protections for LGBTQ individuals in several high-profile upcoming cases; while those cases mostly involve protections provided under employment law, they similarly pit religious liberty against LGBTQ rights.