The Trump administration official who enforces civil rights protections in healthcare sees his work on religious liberty as his biggest legacy for the Department of Health and Human Services.
“There is a real problem out there of lack of respect for conscience and religious freedom that needs to be addressed and we are taking the concrete steps to finally address it,” said Roger Severino, 44, director of the Office for Civil Rights at HHS. “And I think this is an awakening of sorts that has opened up people’s eyes, both in the healthcare industry and beyond, that this is a right that had been under-enforced, that people were being discriminated against and felt they had nowhere to turn, and now they have somewhere to turn. And it would be a shame if that door ever closed on them again.”
Severino, who is Catholic, enshrined the administration’s commitment to religious liberty last year by creating a Conscience and Religious Freedom Division at the agency. Most recently, his office sent a notice to the University of Vermont Medical Center accusing the hospital of forcing a Catholic nurse to assist with an abortion despite her objections to the procedure. The hospital has until Friday to respond.
“This shouldn’t be a controversial issue,” Severino said in a wide-ranging interview with the Washington Examiner. “After Roe v. Wade, the American people came out in overwhelming numbers to say that whatever you think about the legality of abortion, you cannot coerce people to pay for it, or perform it, or assist in it. And most people who are pro-choice or pro-life can agree on that point, that you should not force people to violate their conscience on this deeply held belief, whether it comes from science, whether it comes from faith, whether it comes from conscience, you don’t coerce people on this question.”
The University of Vermont Medical Center has denied the nurse’s account of what happened. Spokesman Michael Carrese said in an email that “an internal investigation found that the facts did not support the allegations in the claim” but didn’t specify which parts were inaccurate.
“As we’ve indicated to OCR, and throughout this process, we are open to adjustments in our policies that are in the best interest of our patients, employees and our community,” he said. “We remain committed to respecting the beliefs of our employees while also protecting access to safe, legal treatment for our patients.”
The notice to the Vermont hospital is the third such enforcement on conscience objections that the civil rights office has taken under President Trump. The other two cases related to crisis pregnancy centers, which aim to steer pregnant women toward motherhood or adoption, in California and Hawaii that objected to state laws forcing them to post signs that refer patients for abortions. The Supreme Court also struck down the California law in 2018.
Since Trump took office, hundreds more conscience complaints have poured in, Severino said, reaching 343 complaints last year. During the Obama administration, there was only about one such complaint a year.
“That’s tremendous growth in part because in the previous administration there was insufficient attention paid to these issues, and we’ve signaled a new openness and we’ve been informing and educating the public that these rights have existed for decades,” Severino said.
Besides religious liberty, OCR enforces federal anti-discrimination laws relating to race, color, national origin, disability, age, and sex in healthcare facilities that get HHS funding, including from Medicare and Medicaid. It takes complaints from patients who can’t get access to their medical records and whose personal data is breached. In all, it got 33,194 complaints in 2018.
But it’s the religious liberty work that has gotten the most media attention. Liberal groups have been critical of the work. Severino oversaw a rule issued in May that lets medical workers file civil rights complaints to the federal government when they are forced against their religious or moral beliefs to discuss, refer, or participate in abortions, sterilizations, or medically assisted suicide.
The rule won’t be enforced until Nov. 22, but it’s also facing a court fight with liberal groups and California, who call it the “healthcare refusal rule.”
They say the rule would force employers to provide accommodations for workers who refused to provide care that is supposed to be part of their job. Healthcare clinics may be forced to keep receptionists employed who won’t schedule appointments for contraception, according to an example from the Guttmacher Institute, which supports abortion rights.
But Severino said he saw the matter as aimed at improving diversity in healthcare, noting that faith-based groups were motivated by their beliefs to help the poor and often go to areas of the U.S. that are most needy. They shouldn’t be required “to shed that religious identity when it comes to their provision of the menu of services that they provide,” he said, adding that being forced to participate in something against one’s beliefs “leaves deep and lasting trauma.”
“We shouldn’t say that a religious or faith-based providers should be excluded from the practice of medicine because they stick to their religious identity,” he said. “That would be a terrible outcome not only for the providers who suffer these moral injuries, but also for patients who would have less options, especially under-served communities.”
The office is working on another rule that will re-write Obama administration protections for transgender patients. The Obama administration determined that sex discrimination in healthcare includes discrimination based on “gender identity” and “stereotypical notions” about how men or women should look or act. Organizations that supported the rule said it was necessary because transgender patients often face harassment and are denied medical care.
But a federal judge blocked the rule in 2016, saying it didn’t provide accommodations for people who had faith-based objections to providing abortions or care related to gender transitions. Severino wouldn’t comment on where the rule would end up under the Trump administration, or respond to hypotheticals about circumstances transgender patients might face.
“I think we approach this with an issue with a perspective of not questioning people’s motives, but to think that people are coming from a place of sincere beliefs on all sides of this question and making sure that we’re compliant with the law is our lodestar in how we’re approaching this issue,” he said.
He noted that pharmacists aren’t forced to provide drug cocktails for lethal injections and conscientious objectors can be exempt from wartime drafts. To him, the exemptions should be the same for the medical field.
Given the backlash from outside liberal groups, it’s not clear that a future Democratic administration would feel the same way. The next person who takes on the role of director at the Office for Civil Rights could gut the Conscience and Religious Freedom Division.
“Religious freedom should not be dependent on who sits in my office. It’s too important for that,” Severino said when asked whether he was concerned about such a possibility. “I think it should be treated just like every other civil right where it is beyond debate that this is a fundamental right that’s enshrined in our Constitution.”
Severino, who was born to Colombian immigrants, previously worked at the Justice Department and for the Heritage Foundation and the Becket Fund for Religious Liberty, both conservative groups. He is married to Carrie Severino, who runs the Judicial Crisis Network, which backs for conservative judicial appointments. He got a bachelor’s degree in business from the University of Southern California, a master’s degree from Carnegie Mellon University, and his law degree from Harvard Law School.
Asked whether he planned to stay on as the director through the remainder of the president’s term, he replied: “I serve at the pleasure of the president, and I am doing everything I can to fulfill his priorities, to fill [HHS] Secretary [Alex] Azar’s priorities to the best of my ability. I think this is the best, hardest job I’ve ever had, and I get tremendous satisfaction in serving the American people to the best of my ability.”
