Attorney General Becerra Continues Fight to Stop Trump Administration’s Dangerous “Healthcare Refusal Rule”

The Rule would open the door to discrimination in healthcare and threaten the timely delivery of lifesaving care

SACRAMENTO – California Attorney General Xavier Becerra today filed a brief in the Ninth Circuit Court of Appeals continuing the fight against the Trump Administration’s unconstitutional and illegal “Healthcare Refusal Rule.” The broad, unfettered Rule jeopardizes the health and safety of Californians by allowing anyone remotely involved in a healthcare transaction—from doctors to ambulance drivers or front office staff— to deny care. This exemption would open the door to discrimination, particularly against women, LGBTQ individuals, people of color, individuals in rural and low-income communities, and endanger the timely delivery of critical lifesaving care. In the brief, Attorney General Becerra reasserts that the Rule violates the U.S. Constitution and the Administrative Procedure Act, arguing that the District Court was correct to vacate the rule in its entirety.  

“In the midst of a devastating pandemic, the Trump Administration continues to heartlessly attack Americans’ access to lifesaving healthcare by allowing a blank check for discrimination which will leave our communities vulnerable to loss of care or stigmatized for receiving basic care,” said Attorney General Becerra. “The Healthcare Refusal Rule dangerously and unlawfully throws open the doors to discrimination, going so far as to allow an EMT worker to leave a woman to bleed out by the side of the road. It’s unconscionable that the government would push this heartless rule. California will continue fighting for the right to healthcare and to ensure that this illegal rule will never take effect.”

The Trump Administration’s rule vastly and illegally expands federal law and coerces state compliance by threatening federal funding. For California, nearly half a trillion dollars of federal funding is at stake. The State of California has laws and regulations to protect access to healthcare while respecting “conscience” objections, in accordance with numerous existing federal conscience provisions. However, the Healthcare Refusal Rule issued by the Trump Administration’s U.S. Department of Health and Human Services (HHS) goes far beyond existing provisions, creating a broad exemption that risks access to care. The new rule would allow anyone remotely involved in a healthcare transaction – from front desk staff to emergency personnel to private entities – to object not just for religious reasons, but for “moral, ethical, or other” reasons as well.

In the brief, the attorney general asserts that the Rule would compromise patient access to care, and encourage discrimination against vulnerable patient populations, including women, people of color, LGBTQ individuals, and rural and low-income communities. The Rule would also have devastating impacts on patients and employers: the rule does not require any notice be given to patients who are refused care, and it provides no guidance for employers who must navigate how to accommodate these refusals. Furthermore, the Rule contains no exception for patients who need emergency care, thus threatening serious, potentially irreversible, harm to those in need of life-sustaining care. HHS’ counsel has even conceded that the Rule would permit an ambulance driver to cease driving in the middle of Central Park “en route to hospital…upon learning that the patient sought emergency care for ectopic pregnancy,” and that an employer’s failure to accommodate that ambulance driver could “result in a loss of federal funding.” These harsh outcomes not only conflict with federal law, but would greatly undermine California’s longstanding efforts to ensure access to emergency care for its residents.

Attorney General Becerra also argues that the Rule violates the Administrative Procedure Act and the U.S. Constitution’s Spending Clause by threatening federal funding for California’s programs that provide crucial health, education, and labor services, including:

• $63 billion for healthcare services such as Medi-Cal;
• $1.5 billion for public health initiatives including emergency preparedness and vaccination programs;
• $6 billion for in-home supportive services;
• $2.5 billion for child welfare and refugee assistance;
• $3.8 billion for educational programs, including child care and state preschool programs, migrant education, adult education, education for homeless children, special education, and vocational education; and
• $900 million for providing short-term income to unemployed individuals, funding local workforce development, and providing services to job seekers and employers.

Today’s filing is the latest step in Attorney General Becerra’s continued fight to protect Californians’ healthcare rights. In 2018, Attorney General Becerra submitted a comment letter to HHS opposing the Rule, and arguing that it would harm California’s residents, healthcare providers, licensees, and consumer protection laws. On February 15, 2019, the California Attorney General’s Office met with the U.S. Department of Health and Human Services and the Office of Management and Budget to discuss the Rule’s harms and its negative impact on California. On May 21, 2019, Attorney General Becerra filed a lawsuit, arguing that the Rule is unlawful and contradicts laws that establish protections for patients against discrimination. On September 12, 2019, the attorney general filed a motion for summary judgment in the district court, which was granted on November 19, 2019, vacating the rule in its entirety.

Attorney General Becerra filed today’s brief alongside Santa Clara County, the City and County of San Francisco, Trust Women Seattle, Los Angeles LGBT Center, Whitman-Walker Clinic, Inc., Bradbury Sullivan LGBT Community Center, Center on Halsted, Hartford Gyn Center, Mazzoni Center, Medical Students For Choice, The Association of LGBT+ Psychiatrists, American Association of Physicians For Human Rights: Health Professionals Advancing LGBT Equality, and individual plaintiffs. 

A copy of the brief can be found here.