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What 7 Healthcare Execs Said About the HHS Freedom of Conscience Proposal

By Steven Porter  
   April 03, 2018

These comments were among tens of thousands submitted in response to the HHS Office for Civil Rights proposal to enhance protections for healthcare workers with conscientious objections.

A proposal to enhance legal protections for healthcare workers who decline to help provide medical services that contradict their religious or moral beliefs garnered more than 72,000 public comments online, all of which have now been released publicly.

The comments represent a diverse cross-section of stakeholders, from patients to providers, advocates, special interest groups, and others.

Some commenters—including at least one healthcare executive—offered full-throated endorsements of what the Health and Human Services (HHS) Office for Civil Rights (OCR) plans to do with its newly created Conscience and Religious Freedom Division. Others offered qualified support, outlining tweaks they hope to see in the final rule.

Others, meanwhile, urged HHS OCR to back away entirely from the plan, arguing that the proposal would contradict the office’s mission to expand healthcare access.

Here are seven of the comments submitted by healthcare executives:

1. OSF HealthCare

Chris Manson, vice president of government relations for OSF HealthCare, a Catholic system headquartered in Peoria, Illinois, wrote that OSF “strongly commends” HHS for the proposal.

“For over four decades, through enactments such as the Church Amendment and other pieces of Federal Legislation, Congress has sought to ensure that health care institutions and medical professionals will not have to choose between abandoning medicine and violating their conscience, particularly with respect to abortion and sterilization,” Manson wrote.

Related: HHS Policy Pendulum Swinging Back Toward Providers’ Rights of Conscience

“Unfortunately, in recent years this enforcement has been practically nonexistent. As we have seen in States like California and New York, lack of commitment on the Federal level can result in discrimination and instances where faith based providers are forced to violate their deeply held beliefs or be prevented from providing services all together. This is an unacceptable choice that needs to be corrected. These proposed regulations will do just that.”

2. Ascension

Rev. Dennis H. Holtschneider, CM, executive vice president and chief operations officer for St. Louis-based Ascension, the largest nonprofit system in the U.S. and the largest Catholic system in the world, signed a comment on behalf of his organization.

Ascension “applauds” the efforts by HHS OCR to protect religious freedom, “especially when it comes to healthcare workers and organizations that are called by their faith to serve all persons, especially those who are poor and vulnerable,” Holtschneider wrote.

As a member of the Catholic Health Association (CHA)—which submitted its own comment separately—Ascension “wholeheartedly endorses” the CHA statement of inclusion, Holtschneider wrote. That statement includes a commitment to serve patients in need regardless of “race, color, national origin, sex, age, or disability, or any other category or status.”

Without directly addressing concerns that the HHS OCR proposal could lead to more discrimination against LGBT people, Ascension’s comment outlined several tweaks it would like to see in the final version and agreed with the American Hospital Association’s comment that some of the reporting requirements in the draft proposal may be unnecessary.

3. Aurora Health Care

Cristy Garcia-Thomas, chief experience officer for Milwaukee-based nonprofit Aurora Health Care, a Catholic system that recently merged with Chicago-based Advocate Health Care, urged HHS to refrain from finalizing any provisions that would result in groups of patients being denied healthcare.

Aurora both respects the moral and religious beliefs of its healthcare workers and refuses to tolerate discrimination against patients on the basis of “race, creed, color, national origin, ancestry, religion, sex, sexual orientation, gender identity, marital status, age, disability or source of payment,” Garcia-Thomas wrote, citing discrimination against LGBT people in particular as linked to poorer health outcomes.

“We are committed to fostering a culture of inclusion that embraces and nurtures our patients, colleagues, partners, physicians and communities,” she added, arguing that Aurora’s existing policies already “strike the right balance between caregiver and patient rights.”

Accordingly, additional intervention by the federal government is unnecessary, Garcia-Thomas wrote.

4. BJC HealthCare

David L. McCune, vice president of corporate compliance for St. Louis-based BJC HealthCare, focused on two key technical recommendations.

“We are concerned that the proposed regulatory regime places unnecessary additional administrative and other burdens upon employers, while also inadequately considering the rights of patients and responsibilities of health care entities (‘employers’) to provide appropriate and necessary patient care, in part because it creates potential inconsistencies between existing, well-established bodies of federal and state anti-discrimination law,” McCune wrote.

First, HHS OCR should use language from Title VII of the Civil Rights Act and Equal Employment Opportunity Act (EEOA) when regulating matters pertaining to religious or conscience-based discrimination, McCune wrote. In particular, the final rule should adopt the concepts of accommodation and “undue hardship” found in the EEOA.

Second, the final rule should clarify its relationship to other laws, McCune wrote. It should defer to state and local religious antidiscrimination protections if they are stronger than federal protections, and it should permit providers to follow state enforcement and compliance regimes in certain circumstances, he argued.

5. Christiana Care Health System

Bettina Tweardy Riveros, chief health equity officer for Christiana Care Health System in Newark, Delaware, warned that the HHS proposal could undermine her system’s commitment to non-discrimination.

That commitment earned Christiana the honor of being named a 2017 Leader in LGBTQ Healthcare Equality, Riveros noted.

“Our mission is well known to our 11,600 employees, as is our commitment to ensuring that our caregivers’ needs are met,” Riveros wrote in a comment. “To that end, Christiana Care has developed and implemented policies and procedures that balance the provision of conscience protections and other reasonable accommodations for the religious beliefs of our caregivers with our obligations to provide appropriate and necessary care to our patients.”

Related: Meeting the Need for Gender-Affirmation Services

The “open-ended protections” for providers to decline to provide care on the basis of religious objections could force Christiana to make significant revisions to its existing policies and procedures, and it could jeopardize Christiana’s ability to continue fulfilling its mission, Riveros wrote.

6. Anne Arundel Medical Center

Maulik Joshi, DrPH, executive vice president of integrated care delivery and chief operating officer for Anne Arundel Medical Center in Annapolis, Maryland, raised several concerns about the HHS proposal.

“Simply put, this proposed regulation is bad policy and will hurt our patients and communities,” Joshi wrote. “Hospitals and health systems exist to treat patients and provide them with access to the information they need for treatment.

“Entities that serve patients must be committed to respecting both the values of health care workers and the patients and the communities they serve in a way that allows for the delivery of care. The sweeping exemption and its undefined boundaries of the proposed regulation will have a chilling effect on the provision of life saving and medically necessary healthcare.”

7. Boston Medical Center

Kate Walsh, president and CEO of the academic nonprofit Boston Medical Center (BMC), wrote a seven-page letter urging HHS to withdraw its proposal or at least narrow its scope, clarify its relationship to other laws, and reduce the burden it places on providers.

“The broad and undefined nature of the proposed rule gives individual providers’ beliefs priority over life-saving patient care and threatens to prevent the provision of services to patients in need,” Walsh wrote. “The lack of definition, structure, and guidelines will leave health care providers without standards and structures to guide the provision of necessary care to the most vulnerable populations, including LGBTQ people.”

Beyond unanswered questions of legality and clarity, the proposal fails to appreciate the existing protections state and federal laws provide healthcare workers to be free from religious discrimination, Walsh wrote, noting that BMC and many other hospitals already have policies in place to ensure such rights are respected.

“The existing protections are meaningful and familiar to health care providers who have navigated these personal obligations alongside their commitment to providing seamless, respectful health care to patients,” Walsh wrote. “There is no need to augment the existing protections.”

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.

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