Category: Elizabeth Sepper

The Ever-Expanding Right to Refuse to Provide Healthcare

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by Elizabeth Sepper

For the past decade, a blockbuster religion law case has been a feature of every Supreme Court term. The Court dramatically eased the ability of employers to claim religious exemptions. It overturned long-standing Establishment Clause precedent. And it revolutionized Free Exercise Clause doctrine to favor objectors to public health measures and antidiscrimination laws.  With no religious liberty claim on the docket, the 2023-24 term promised to be the exception.

Nevertheless, in a pair of abortion cases, the Court took the opportunity to broadly interpret federal conscience law to override patients’ rights to emergency care. The first, Food and Drug Administration v. Alliance for Hippocratic Medicine (AHM), challenged the FDA’s approval of mifepristone, the abortion pill. The second, Moyle v. United States, involved the conflict between state abortion bans and the Emergency Medical Treatment and Labor Act (EMTALA), a federal law that requires life- and health-saving care, including abortion, in emergency departments. Neither seemed to implicate the Church Amendment of 1973, which allows individual providers and institutions to refuse to perform or participate in abortion for religious or moral reasons.

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Fairview Heights, IL—Jan 5, 2020; Sign on medical clinic announces Planned Parenthood branch is now open, the southern Illinois clinic was built to serve St Louis after Missouri restricted abortions.

Financing Reproductive Justice Through Title X

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By Elizabeth Sepper

The Trump administration left Title X in tatters. In the last year, its capacity to finance family planning and reproductive health services for the poor was cut in half. Many family planning providers, including Planned Parenthood, whose clinics alone served 40% of patients, were forced out of the program. Six states were left with no active Title X providers at all. 1.5 million people lost access to care.

The Biden administration has said it will undo the harm. The Department of Health and Human Services (HHS) has promulgated new rules to restore the family planning network. But more than restoration is in order. The administration must actively pursue reproductive justice. Doing so will require Congress. But failure to do so will leave Title X’s poor and uninsured patients to serve as a political football once again.

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Los Angeles, California / USA - May 1, 2020: People in front of Los Angeles’ City Hall protest the state’s COVID-19 stay at home orders in a “Fully Open California” protest.

5 Questions About COVID-19 and Religious Exemptions

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By Chloe Reichel

On February 26th, the Supreme Court of the United States issued a shadow docket decision that could foretell sweeping limitations for public health measures, both within and outside the COVID-19 pandemic context.

The Court’s ruling in the case, Gateway City Church v. Newsom, blocked a county-level ban on church services, despite the fact that the ban applied across the board to all indoor gatherings. This religious exceptionalism is emerging as a key trend in recent Supreme Court decisions, particularly those related to COVID-19 restrictions.

To better understand what these rulings might mean for public health, free exercise of religion, the future of the COVID-19 pandemic, and potential vaccine mandates, I spoke with Professor Elizabeth Sepper, an expert in religious liberty, health law, and equality at the University of Texas at Austin School of Law.

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WASHINGTON, DC - OCT. 8, 2019: Rally for LGBTQ rights outside Supreme Court as Justices hear oral arguments in three cases dealing with discrimination in the workplace because of sexual orientation.

What the Supreme Court’s LGBT Discrimination Decision Means for Health Care

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By Elizabeth Sepper

On Monday, the Supreme Court held in Bostock v. Clayton County that LGBT discrimination is sex discrimination under Title VII, the federal workplace protection of the Civil Rights Act of 1964.

The ruling comes in stark contrast to a recent action taken by the Department of Health and Human Services (HHS). Just last Friday, HHS issued a new rule interpreting Section 1557 of the Affordable Care Act so as to strip LGBT people of rights to nondiscrimination.

Since it was enacted in 2010, Section 1557 of the Affordable Care Act has prohibited federally funded health programs, including insurers and health care providers, from discriminating based on the sex of patients. In 2016, the Obama Administration issued a rule making clear that transgender people and, to a lesser extent, LGB people were protected.

But under the Agency’s new interpretation, discrimination based on gender identity or sexual orientation is not sex discrimination.

In light of Monday’s Supreme Court decision, many are now wondering whether—and how—the new HHS rule interpreting Section 1557 of the ACA might be affected.

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The ACA’s Nondiscrimination Rule: Hobby Lobby 2.0?

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By Elizabeth Sepper

Should healthcare providers, researchers, and insurers be able to engage in sex discrimination for religious reasons? HHS asked the public to weigh in on this question with regard to the ACA’s nondiscrimination provision.

The answer is no for three important reasons. First, the statute doesn’t allow additional exemptions. Not only is the text clear, but Congress also considered and rejected broader religious exemptions. Second, authorizing sex discrimination for religious reasons is bad health policy with damaging effects for women and LGBT people. Third (as I argued in separate comments with a group of law and religion scholars), granting religious exemptions here runs into constitutional limits set by the Establishment Clause.

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The ACA’s Nondiscrimination Rule: Kudos and Critiques

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By Elizabeth Sepper

More than five years ago, Section 1557—a little known provision in the Affordable Care Act—promised to protect individuals from race, sex, age, and disability discrimination in health programs and activities that receive federal financial assistance. But until this fall, the Department of Health and Human Services (HHS) hadn’t offered any interpretation of what the nondiscrimination provision requires. Today, the comment period for the proposed rule closes, and HHS will set to work finalizing the Nondiscrimination Rule. Together with professors Jessica Roberts and Jessica Clarke and Yale Law students Elizabeth Dervan and Elizabeth Deutsch, I drafted lengthy comments on the proposed rule.  In a series of blog posts this week, we’ll explain what HHS got right, where its interpretation went wrong, and how it can provide clarity to healthcare programs and the public.

The ACA broke new ground in prohibiting sex discrimination in healthcare for the first time. Women and LGBT people face persistent and systemic discrimination at the hands of insurers, hospitals, and doctors. Women’s pain goes undertreated, and their heart attacks undiagnosed. Due in part to their capacity to become pregnant, women have largely been excluded from studies. More than half of LGBT people report facing discrimination in healthcare settings. Transgender men and women have encountered ridicule, refusals of treatment, and hostility in emergencies with fatal and near-fatal consequences.

The Affordable Care Act aims to change this. The Nondiscrimination Rule presents a historic opportunity for HHS to interpret sex discrimination broadly. In its proposed rule, HHS seems poised to take advantage of this opportunity by reaching pregnancy, sex stereotyping, and gender identity discrimination. To meet HHS’s goal of ensuring the most robust set of protections in current law, the final rule should also make clear that sexual orientation discrimination is sex discrimination.

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Bishops Reject Contraception Compromise

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By Elizabeth Sepper

It comes as no surprise that tonight the Catholic bishops rejected the White House’s attempts to bend over backward to accommodate religious objections to contraceptive coverage in health insurance plans. The administration’s rules first exempted religious groups. Now the proposed rules allow an even wider array of religiously affiliated employers—including hospitals, insurance companies, social service providers, and universities—to have insurance plans without any coverage of contraception, while making sure their employees can access it. Yet, the bishops are not satisfied.

In court, religiously affiliated employers insist that their concern is religious freedom. But the bishops’ reaction to the administration’s generous proposal suggests they don’t want liberty from the mandate. They want to end it altogether. The general counsel for the U.S. Conference of Catholic Bishops Anthony Picarello admitted as much just last year, saying that they would not accept any fix that did not remove contraceptive coverage from the Affordable Care Act altogether. Otherwise, “if I quit this job and opened a Taco Bell, I’d be covered by the mandate,” Picarello said. (For a list of for-profit companies challenging the contraceptive coverage mandate, see here (no Taco Bells just yet))

I’d hoped, as E.J. Dionne did, that the Church would accept the Obama administration’s olive branch. But it seems 2013 will be another big year for conscience and contraception.

Thanks to Holly for inviting me to blog for January (I’ve overstayed my welcome!). I very much enjoyed it.

Defending Roe v. Wade, Defending Human Rights

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By Elizabeth Sepper

Dr. Willie Parker is one of the few doctors in the United States who perform later-term abortions, up to 24 weeks.  He is one of three who provide abortions at Mississippi’s sole abortion clinic.  A Christian from the Deep South, Dr. Parker didn’t provide abortions for the first dozen years of his career.  But again and again he encountered women whose pregnancies endangered their lives, girls who had suffered rape or incest, and mothers who were too poor to raise another child.  He came to wrestle with the morality of abortion—torn between his religious tradition’s teaching against abortion and his moral commitment to his patients.  He listened to Dr. Martin Luther King’s sermon on the Good Samaritan.  According to Dr. King, the Good Samaritan was “good” because he did not consider himself but instead asked “What will happen to this person if I don’t stop to help him?”  Dr. Parker was moved to examine his own conscience and to ask, “What happens to women who seek abortion if I don’t serve them?”  From that day, he began to perform abortions. (This interview is well worth a read.)

Choosing to provide abortions is an act of bravery. Abortion providers face threats to their safety and families, targeted and expensive regulations, and professional and community stigma.  They share much in common with human rights lawyers, union organizers, and women’s rights advocates around the globe who are harassed by their governments and the majority.  This makes sense if we recognize abortion providers for what they are: human rights defenders, who work to ensure reproductive rights (the Center for Reproductive Rights has argued effectively for this framework under international law).

As we mark the fortieth anniversary of Roe v. Wade tomorrow, we should acknowledge the courage and commitment of these human rights defenders.  In the past two years, state legislatures passed more, and more novel, restrictions on women’s access to abortion and abortion providers’ practices than ever before.  The “graying” of current  providers represents a further challenge.  In the words of Justice Blackmun, “I fear for the future.  I fear for the liberty and equality of the millions of women who have lived and come of age in the . . . years since Roe was decided.”  But tomorrow I simply offer thanks to those who defend our rights on the front lines.

Flu Vaccine Myths and Healthcare Providers

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By Elizabeth Sepper

2013 is rife with reports of the terrible human costs of the flu.  Emergency rooms nationwide have been overwhelmed.  Art Caplan’s great blog post urges doctors to educate patients that the flu vaccine is not just for their benefit.  He tells healthcare providers to send a clear message by getting the flu shot themselves.  But what should we do when they refuse?

Flu vaccination of healthcare providers has come a long way.  Before 2009, rates never broke 49%.  Today, almost two-thirds of healthcare providers are vaccinated.

Still, one-third of healthcare providers do not protect themselves, their patients, and the public from influenza.  We remain far short of the national Health People 2020 target of 90%. Do these providers have religious beliefs that raise tricky constitutional and statutory questions?  Do they assert deeply held philosophical objections?  Media accounts suggest so.  We hear of the vegan customer service representative who refuses the flu vaccine because it is grown in chicken eggs, and the religious holistic nurse who objects both to vaccination and to wearing a mask.

But the main reason for going unvaccinated, according to the Centers for Disease Control, is that healthcare providers simply did not want to get vaccinated. Other common reasons: they think flu vaccines don’t work, fear experiencing side effects, or don’t think they will need the vaccine.  Some reasons do not reflect the evidence. Others suggest, as Art Caplan puts it that healthcare staff need to “stop thinking only about themselves.” Read More

Genetic Testing as Social Networking

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By Elizabeth Sepper

In the market for discount genetic testing?  Want to share your genetic markers with friends?  No?  You might soon be alone.

Last week, I got an email from the mega-discounter Groupon advertising 68% off a “DNA Self-Discovery Kit.”  The company, ConnectMyDNA, allows Groupon users to send in a cheek swab and receive back information on their genetic markers and how those markers compare to people around the world (what they call a “Gene RingTM”).

The big selling point:  sharing results with friends on social media and making new connections to people with similar genetic markers.  ConnectMyDNA’s website says, “You can use your Gene Ring™ as your personal badge anywhere you’d like—on your business card, email signature, or you can even create a cool T-shirt!”

This all seems fairly harmless.  But I wonder if sharing genetic information will represent the next step in the race to the bottom of privacy expectations.  People already regularly disclose extensive medical information related to illness, recovery, and injury on Caringbridge, Facebook, and public blogs.  As genetic tests come down in price and become more commercially available, will genetic information be next?  How will law and ethics respond to protect family members who share genetic information or shield those predisposed to disease from discrimination in this context?  Today, genetic screening raises ethical issues and contention among family members at risk, for instance, for hereditary breast or ovarian cancer.  Tomorrow, sharing one’s genome with Facebook friends, twitter users, and the public may be the norm.