A bill allowing health care providers to refuse to give treatment based on deeply held beliefs — including their religion or conscience — failed in committee on Wednesday, but could come back with enough support to advance.
SB174, sponsored by Sen. Keven Stratton, R-Orem, was narrowly defeated after a 3-3 vote in the Senate Health and Human Services Committee. Senate President Stuart Adams tried to vote remotely, but was too late. A spokesperson for Senate Republican majority leadership confirmed he would have cast the tie-breaking yes vote, as the bill sponsor plans to bring SB174 back.
It has already made it onto the committee’s agenda for Thursday afternoon.
Supporters say the bill — which doesn’t apply to emergency care — protects health care providers from being forced to do something they fundamentally disagree with, pointing to various procedures like cosmetic surgery and abortion.
“The biggest strength of SB174 is how nuanced it is, using common sense mechanisms to make sure that one individual’s rights, the provider’s, do not come at the expense of another, the patient’s,” said Robin Fretwell Wilson, a law professor at the University of Illinois who spoke to the committee in a personal capacity.
Critics say protections already exist, bill does more harm than good
Sen. Jen Plumb, D-Salt Lake City, was among committee members who voted no. Outside of the Legislature, she’s a pediatric physician and professor for the University of Utah Department of Pediatrics and Primary Children’s Hospital. She told the committee that protections for providers already exist, and SB174 gives insurance providers more power to restrict care while opening the door to patient discrimination.
“Within the practice of medicine, we have really good boundaries set up that allow us to find ways out of care that we don’t think is appropriate for a patient,” she said. “This is not needed, and I think we’re crossing into some very dangerous space here.”
Federal law protects health care conscience rights, prohibiting recipients of federal funds from requiring individual providers to give treatment they find religiously or morally objectionable, pointing to abortion and assisted suicide.
Others, including Jessica Black with the Utah Mental Health Counselors Association, argued the bill gives insurance providers too much power to restrict health care coverage.
“This bill is granting moral beliefs to million-dollar insurance companies,” she said. “They can deny payment for basic medical care like psychological therapy or diagnostic testing.”
She said the bill “could impact Utah employees,” arguing “if a corporate payer just decides to drop mental health coverage beyond their moral mission statement, then the employees (are) entrapped.”
How the bill works
Wilson told the committee that the bill allows health care providers to object to treatment types, not individual patients, arguing the bill “strikes a delicate balance between protections for religious belief and conscience and the interests of patients and the public.”
“An objector, for example, could refuse to do cosmetic surgery for all patients, but they could not pick and choose,” she said. “You can choose not to do a service, but you cannot choose to not serve a particular category of person.”
Wilson emphasized SB174 does not allow objections in emergency settings, and “there’s no objection inside the emergency department.”
The bill requires providers to notify Utah’s Department of Health and Human Services when they object to a type of treatment, and post a prominent, visible sign in their office noting the objection. Wilson told the committee that the bill also requires DHHS to direct patients to other providers when their physician objects to desired forms of care.
While critics expressed concerns for discrimination against patients, Wilson emphasized the bill only applies to objecting to types of treatment, rather than types of people.
“You can choose not to do a service, but you cannot choose to not serve a particular category of person,” Wilson said.
But, critics say, discrimination could persist
Sarah Stroup, legislative chair for the Utah Association for Marriage and Family Therapy, said the bill “would allow insurance companies to change their bylaws so that they can have a right of conscience and deny mental health care,” which she argued would allow health care providers to discriminate against their patients.
“We’re talking about procedures, but we are talking about people,” she said. “This bill defines health care services as including psychological therapy or counseling, diagnosis and therapy. By allowing this broad definition, we are concerned that this will create barriers to treatment, and sometimes these are life-saving mental health care.”
Stroup, a licensed marriage and family therapist who owns a private practice, said the bill “creates an impossible mandate for employers,” which would impact patient care.
“I cannot legally ask someone I’m interviewing what their beliefs are, and yet this could harm my business if they decide not to treat someone,” she said. “It hurts a reputation, and I have no way of correcting that later.”
Black also expressed concern over hiring providers who later object to specific types of care.
“I’m very concerned about the adverse action specifically for those clinics that have a specialty, either working with a specific population or having a clinic that specializes in LGBTQ affirming care,” Black said. “They would then be able to hire someone that maybe says that they do that, but then refuses that care to a specific population.”
Plumb raised concerns about addiction treatment.
“People going through addiction are a rough lot, they make choices that you don’t understand. You get mad, you get frustrated, and sometimes you want to say, ‘get out of here, I can’t take care of you, you’re not taking care of yourself,’” she said. “I can’t fathom the idea that someone could say, ‘I morally cannot take care of this person because they’re making poor, illegal choices that I don’t agree with.’”
Speaking to the committee, she urged her colleagues to vote no.
“I wish I could think of more questions to be more lawyerly, but right now, I feel like a provider,” Plumb said. “I feel like it’s so crucial that you hear me say, this is not the right direction.”
