President Barack Obama is moving to tilt the balance of power back to patients in the struggle over whether health care providers must provide controversial services, regardless of whether they violate religious or moral principles.
In the final days of the prior administration, President Bush pushed through a rule designed to give health care workers the freedom to refuse to provide services deemed morally repugnant -- possibly including abortion counseling, birth control and sterilization.
Today, the new management at the Department of Health and Human Services sent the Office of Management and Budget a proposal that would rescind that Bush rule, according to an administration official. After OMB reviews the rule, it's likely to be published in the Federal Register, which will then open a 30-day public comment period.
"This policy of potentially allowing providers to refuse to provide contraception or family planning runs counter to the administration's goal of reducing abortions and unwanted pregnancies," an HHS official said on background. "It also could lead into other areas of medical care."
The official, speaking on condition of anonymity because the language had not yet been finalized by OMB, said Bush's rule was "too vague" and "upset the balance" between doctors, hospitals and patients.
Abortion-rights advocacy groups applauded the anticipated move, as did Rep. Dianna DeGette, D-Colo.
"The refusal rule was written so broadly that it would allow anyone working in health care to refuse to provide legal health care services or medications to any patient -- without regard to the needs of the patient," DeGette said in a prepared statement.
The final outcome of the rulemaking process could result in these limits going away for good. But Obama, the official said, has been an advocate of a "well-crafted provider conscience clause." So it's possible the administration will craft a new rule that is deemed to more effectively balance the rights of patients and providers.
In the text of the original rule, the Bush administration wrote that it was necessary, in part, to address a shortage of doctors and nurses:
"The department is concerned about the development of an environment in sectors of the health care field that is intolerant of individual objections to abortion or other individual religious beliefs or moral convictions. Such developments may discourage individuals from entering health care professions. Such developments also promote the mistaken belief that rights of conscience and self-determination extend to all persons, except health care providers."
Bush administration officials pointed out, and the rule itself said, that it would not create new limits. It was just a decision to enforce laws already on the books, they said.
"This rule implements federal laws protecting health care workers and institutions from being compelled to participate in, or from being discriminated against for refusal to participate in health services or research activities that may violate their consciences, including abortion and sterilization, by entities that receive certain funding from the department."
The Family Research Council, one of the groups that mostly strongly supported the Bush rule, called the expected action by the Obama administration "unfortunate."