Bishops: New Biden HHS Obamacare rule advances ‘ideological view of sex’

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The U.S. bishops issued a statement criticizing a new Biden administration change to the Affordable Care Act that requires health providers to perform or cover sex-change surgeries and therapies. 

“Health care that truly heals must be grounded in truth,” wrote Bishop Kevin Rhoades, head of the U.S. bishops’ Committee for Religious Liberty. “These regulations, however, advance an ideological view of sex that, as the Holy See has noted, denies the most beautiful and most powerful difference that exists between living beings: sexual difference.”

The administration’s new rule amends the nondiscrimination clause in Section 1557 of the Affordable Care Act (also known as ACA or Obamacare), by removing the word “sex” and replacing it with the phrase “sex (including discrimination on the basis of sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity; and sex stereotypes).”

This change means that any insurer or physician receiving federal financial assistance must cover or provide sex-reassignment surgeries and therapies on the grounds that refusal to do so would constitute discrimination based on sex.

This reverses changes to ACA made under the Trump administration that excluded such procedures from mandated coverage.

The U.S. bishops argued against the rule change when it was being considered in 2022 on the grounds that sex-reassignment surgeries “stunt human sexual development, mutilate the body, and cause sterilization.”

The bishops also flagged the rule as a “major threat” to religious freedom in their 2024 “State of Religious Liberty in the United States” report.

Rhoades voiced the bishops’ disapproval of the rule, saying in a Tuesday statement that “the human right to health care flows from the sanctity of human life and the dignity that belongs to all human persons, who are made in the image of God.”  

“The same core beliefs about human dignity and the wisdom of God’s design that motivate Catholics to care for the sick also shape our convictions about care for preborn children and the immutable nature of the human person. These commitments are inseparable,” Rhoades wrote, adding: “I pray that health care workers will embrace the truth about the human person, a truth reflected in Catholic teaching, and that HHS will not substitute its judgment for their own.”

In responding to fears that the rule will violate religious and conscience rights, the Biden Health and Human Services Department (HHS) claims that it has included a provision within the rule that “respects federal protections for religious freedom and conscience.” 

In the final rule, which is set to be filed in the Federal Register on May 6, HHS states that any part of the new guidance that violates “applicable” federal religious freedom and conscience protections “shall not be required.”

Meanwhile, Chris Faddis, president of the Arizona-based Catholic group Solidarity HealthShare, said that the rule means that “physicians and medical staff can no longer opt out of performing morally objectionable procedures, like transgender surgeries, without the risk of losing critical federal funding.”

Faddis told CNA that the rule’s wording is dangerously vague and would force hospitals and providers to “beg” for religious freedom exemptions that should be automatically afforded under the First Amendment.

“We should not have to request something that the Bill of Rights says is a God-given right … we should not have to request our religious freedom,” he said. “Even the fact that putting the burden on an individual doctor or health system to come beg for clemency is a problem. This is not who this country is.” 

Given the Biden administration’s track record for prioritizing progressive gender ideology over religious freedom, Faddis believes that it is “very uncertain” that religious providers’ requests would be granted. 

“How can we possibly trust that they’re going to be favorable and friendly and not target or avoid answering these waiver requests?” he asked. 

To be clear, Solidarity HealthShare, which says on its website that it has served 55,000 patients since its founding in 2016, will not be impacted by the Biden administration’s change. This is because the rule specifically targets health insurers and providers. However, Faddis believes the new rule presents a broader danger to not just providers but also patients and the overall health care system. 

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One such problem Faddis foresees is the possibility that a Catholic or religious provider may not be eligible to receive Medicaid or Medicare funding while their exemption requests are being considered.

“If suddenly Catholic health care systems have to stop taking Medicare or Medicaid,” Faddis said, “not only would that drastically impact them and maybe even take them out of business, but it would also drastically impact the availability of care across the country, particularly in certain states that have a large percentage of their care is provided by Catholic systems.” 

HHS did not immediately respond to CNA’s request for comment.

In a Friday statement HHS Secretary Xavier Becerra said that the new rule is a “giant step forward for this country toward a more equitable and inclusive health care system.”

According to Becerra, the rule “means that Americans across the country now have a clear way to act on their rights against discrimination when they go to the doctor, talk with their health plan, or engage with health programs run by HHS.”

HHS also clarifies in the rule that “nothing in section 1557 shall be construed to have any effect on federal laws regarding conscience protection; willingness or refusal to provide abortion; and discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion.”

The rule will go into effect on July 5, 60 days after being filed in the Federal Register.

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This article has been updated.

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