Health policy also intersects with the work of the Catholic Church, which historically has had a large and heavy footprint on U.S. health care. Perhaps in no other area, aside from education, does the Church work more with the broader society.
An estimated one in six hospital beds in the U.S. is in a Catholic hospital, according to the ACLU. Catholics provide adoption and foster care services around the country, and help resettle refugee families. They operate shelters for human trafficking survivors. Catholic doctors, nurses, and foster mothers may work anywhere in the healthcare system, not just at Catholic institutions.
Furthermore, many Catholic employers offer health coverage to their employees—another area of HHS oversight in the wake of the Affordable Care Act.
It is also true that in health care, the “culture war” battles are raging the hardest. A number of groups—chief among them the ACLU—have for years been pushing for contraceptives, abortions, same-sex marriages, and gender-transition procedures to become the norm in health care and family life, whether or not religious organizations agree.
An administration which is willing to aggressively back abortion, marriage redefinition, and gender ideology could pick a lot of fights with Catholic organizations—and that is exactly what happened under the Obama administration.
The HHS crafted the contraceptive mandate, which forced many Catholic employers—including the Little Sisters of the Poor—into court. Even after the sisters were granted a broader conscience and religious freedom exemption, it was challenged by several state attorneys general, including Becerra.
In 2016, the agency required doctors to perform gender-transition surgeries upon the referral of a mental health professional, whether or not doctors agreed with the procedure. In addition, many insurance companies and employers were required to cover the procedure.
The HHS also has some authority over how taxpayer dollars appropriated by Congress can be spent, by making funds to health providers or other grantees conditional upon certain mandates. And the Obama-era HHS began making controversial requirements of grant recipients—requirements that Catholic organizations said they could not obey in conscience.
HHS required adoption and foster care agencies to work with same-sex couples in order to receive federal funding.
In 2011, the U.S. Conference of Catholic Bishops (USCCB) saw its anti-trafficking grant application denied by HHS because it would not refer trafficking victims for abortions or contraceptives. Agency leadership reportedly overruled other staffers who said the USCCB had superior qualifications to those of the other grant applicants.
HHS also helps resolve health care-related discrimination complaints through its Office of Civil Rights (OCR). This office may often be involved HIPAA-related cases, defending the privacy of patients’ medical records, or in ensuring access to health care for disabled persons with communication issues.
However, OCR can also be involved in other discrimination complaints regarding religious freedom or gender identity.
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In 2015 the Obama-era OCR settled a dispute where an individual identifying as a transgender female had requested not to share a room with a male at a Brooklyn hospital. The administration sided with the transgender female.
Beginning in 2017, however, the Trump administration began moving in the opposite direction in the “culture wars,” prioritizing conscience protections, religious freedom, and curbing funding of groups promoting abortion.
Although the administration clashed repeatedly with the U.S. bishops on immigration and refugee resettlement, it often offered much-desired relief for religious groups in health care.
The administration crafted conscience protections for health care workers, granted relief to the Little Sisters of the Poor from the contraceptive mandate, declared “there is no international right to abortion” at the United Nations General Assembly, and made religious and conscience exemptions for federal grantees in adoption and health care.
The Trump HHS blocked family planning grants from groups that refer for abortions, or are co-located with abortion clinics. As a result, Planned Parenthood backed out of the program and forfeited an estimated $60 million annually in grants rather than comply with the new regulations.
In 2018, the administration established a new Conscience and Religious Freedom Division within the HHS OCR. The office said it experienced a surge in religious freedom-related discrimination complaints following the move.