In May 2019, the U.S. Department of Health and Human Services issued a new administrative rule, referred to as the “Denial of Care Rule,” that would have allowed healthcare providers and employees to use their religious or moral beliefs as a basis to refuse to assist patients. The rule was written extremely broadly, appearing to allow even receptionists to refuse to schedule procedures they oppose or janitors to refuse to clean a room where an objected-to procedure took place. The rule threatened the ability of patients—especially those who are most vulnerable and at risk of suffering discrimination—to receive the care they need, as well as the ability of providers to provide that care over employees’ objections.

In a case of ours and other related cases, three federal district courts invalidated the Trump administration’s Denial of Care Rule, thus blocking it from ever taking effect. The government appealed those rulings to the U.S. Courts of Appeals for the Second and Ninth Circuits.

On December 29, 2022, the Biden administration proposed new regulations that rescind the harmful aspects of the Trump administration’s rule and substantially improve protections for patients against religiously motivated denials of healthcare. The new regulations were finalized on January 9, 2024. The government’s appeals from the decisions blocking the Trump administration’s rule were placed on hold while the Biden administration worked to finalize the new regulations.

County of Santa Clara v. U.S. Department of Health & Human Services

On May 28, 2019, Americans United—with cocounsel from the County of Santa Clara California, the Center for Reproductive Rights, Lambda Legal, and the law firm Mayer Brown LLP—filed suit in the U.S. District Court for the Northern District of California to challenge the rule on behalf of the County (which runs public hospitals and public-health programs) and several other healthcare providers. Our complaint explained that the rule violated both statutory and constitutional law. We also moved for a preliminary injunction against implementation of the rule. The federal government filed a motion to dismiss or, in the alternative, for summary judgment on August 21, 2019. We filed our motion for summary judgment and opposition to defendants’ motion on September 12, 2019. We argued that the regulation was arbitrary and capricious in violation of the Administrative Procedures Act, that HHS lacked statutory authority to implement the rule, that the rule violated nondiscrimination provisions in existing law, and that the rule was unconstitutional under the Establishment Clause, the Equal Protection Clause, the Due Process Clause, the Free Speech Clause, and the Spending Clause. Oral argument took place on October 30, 2019.

On November 19, 2019, the district court granted summary judgment in our favor on our Administrative Procedure Act claims, vacating the rule in its entirety. The government then appealed this and other decisions enjoining the rule. Later, the appeal was  placed on hold while the Biden administration worked to finalize a new rule.

Mayor & City Council of Baltimore v. Azar

On June 5, 2019, Americans United, partnering with the Baltimore City Law Department and the law firm Susman Godfrey LLP, filed suit in the U.S. District Court for the District of Maryland to challenge the Denial of Care Rule.

The federal government moved to dismiss or, in the alternative, for summary judgment on August 22, 2019. We filed Baltimore’s opposition and its own motion for summary judgment on September 19, 2019, making arguments similar to those in Santa Clara. After other federal district courts blocked the Denial of Care Rule, the district court held the case in abeyance while the U.S. Courts of Appeals for the Second and Ninth Circuit heard the government’s appeals.

Congress needs to hear from you!

Urge your legislators to co-sponsor the Do No Harm Act today.

The Do No Harm Act will help ensure that our laws are a shield to protect religious freedom and not used as a sword to harm others by undermining civil rights laws and denying access to health care.

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