Bloomberg Law
Nov. 20, 2019, 2:43 AM

Trump Religious Health-Worker Rule Strikes Out in Federal Courts

Mary Anne Pazanowski
Mary Anne Pazanowski
Legal Reporter

A Trump administration rule that threatens to strip health-care providers of federal funding if they require workers to provide services that go against their religious or moral beliefs is invalid, a federal judge in California said.

Judge William Alsup ruled Nov. 19 that the Health and Human Services Department exceeded its authority when it adopted a religious conscience rule designed to protect workers from retaliation by their employers.

The opinion echoes recent decisions from New York and Washington federal courts.

The rule conflicts with “the underlying statutes and is in conflict with the balance struck by Congress in harmonizing protection of conscience objections vis-a-vis the uninterrupted flow of health care to Americans,” Alsup, of the U.S. District Court for the Northern District of California, said.

“When a rule is so saturated with error, as here, there is no point in trying to sever the problematic provisions. The whole rule must go.”

The rule was set to go into effect Nov. 22.

Other Courts

The Southern District of New York invalidated the rule Nov. 6, and the Eastern District of Washington vacated the rule Nov. 7.

The New York federal court said Congress hadn’t delegated rulemaking authority to the HHS in connection with existing laws providing conscience protections.

The HHS also failed to produce evidence the rule was needed to ensure enforcement of those laws, the federal court in New York said. And, it didn’t consider the rule’s effect on other federal provisions, such as the Emergency Medical Treatment and Labor Act, the court said.

Back to California

The Northern District of California reached its decision in three cases brought by the City and County of San Francisco, state Attorney General Xavier Becerra, and Santa Clara County. All three argued the rule invites discrimination against vulnerable patients, such as LGBT people.

Losing federal funding because of the rule’s enforcement would be catastrophic for state and local health-care facilities, the challengers said.

But the rule’s strong enforcement mechanisms are needed to give teeth to federal conscience laws, the government said. And the government has the right to condition funding on compliance, it said.

The California Attorney General’s Office, the San Francisco City Attorney’s Office, the Santa Clara County Attorney’s Office, Americans United for Separation of Church and State, the Center for Reproductive Rights, Lambda Legal Defense and Education Fund Inc., and Mayer Brown LLP represented the plaintiffs.

The U.S. Department of Justice represented the HHS.

The cases are City & Cty. of San Francisco v. Azar, N.D. Cal., No. 3:19-cv-2405, 11/19/19; California v. Azar, N.D. Cal., No. 3:19-cv-2769, 11/7/19; Santa Clara Cty. v. U.S. Dep’t of Health & Human Servs., N.D. Cal., No. 5:19-cv-2916, 11/19/19.

To contact the reporter on this story: Mary Anne Pazanowski in Washington at

To contact the editors responsible for this story: Jo-el J. Meyer at; Rob Tricchinelli at