Health care plan would allow moral objections

IOWA STATEHOUSE

DES MOINES — Iowa health care providers, facilities and insurance companies could refuse medical care based on moral and ethical — not just religious — objections under a House-passed bill advanced by Senate Republicans.

Republican Sens. Jeff Taylor of Sioux Center and Jesse Green of Boone signed off Thursday on House File 571, sending the proposal — dubbed the Medical Ethics Defense Act — to the full Senate Judiciary Committee. Sen. Matt Blake, D-Urbandale, opposed the measure.

The bill cleared the Iowa House last year but stalled in the Senate, which at the time was considering its own nearly identical version.

Under the House language, "health care institutions" — including hospitals, clinics, pharmacies and medical schools — and "health care payors," such as insurance companies, would not be required to participate in or pay for services or medications that conflict with the entity's governing documents. The bill specifies that those documents can include "published ethical, moral or religious guidelines or directives," mission statements, constitutions, articles of incorporation, bylaws, policies or regulations.

Supporters told senators the bill is meant to keep doctors, nurses and other health care workers from being pressured to provide procedures they find objectionable — particularly as medicine moves into what they described as new ethical flashpoints, such as gender transition procedures.

Opponents, though, said the bill could endanger patients and elevates the interest of providers over the health and needs of patients.

What the bill would do

Providers and facilities still would be required to provide emergency medical treatment.

It also bars a health care payor from refusing to cover a service simply because a medical practitioner, institution or the payor itself declined to participate if the payor is otherwise contractually required to pay for the service.

The bill, though, provides broad liability shields for conscience-based refusals, stating that medical practitioners, institutions and payors would not be "civilly, criminally, or administratively liable" when they act "in good faith" based on conscience. Health care institutions would likewise be protected from liability for conscience actions taken in good faith by practitioners they employ, contract with or grant privileges to.

The legislation also creates whistleblower protections for people and entities who report suspected violations, participate in proceedings or disclose information they reasonably believe shows legal violations, breaches of ethical standards or standard of care, gross mismanagement or waste, abuse of authority, unsafe practices, or threats to patient or public health — while stating those protections do not override HIPAA or other privacy laws.

It adds free-speech protections limiting when state agencies or licensing boards can discipline licensees based on constitutionally protected speech, expression or association, unless "clear and convincing evidence" shows the speech directly caused physical harm to a patient or client.

And it would make it unlawful to interfere — through coercion or duress — with a person's exercise of conscience, whistleblower or free-speech rights, allowing lawsuits for injunctive relief, damages and attorney fees.

Supporters point to workforce concerns and physician integrity

Greg Chafuen, senior counsel with Alliance Defending Freedom, pointed to clients he said faced punishment after objecting to abortion-related participation or raising concerns about gender transition procedures for minors, saying health care workers are increasingly being forced to choose between following their conscience and keeping their jobs.

Chafuen noted that several other states have similar conscience protections he said helps attract and retain medical professionals. Those laws, he argued, are narrowly focused on specific procedures — not patients or personal characteristics — and have been in effect for years without issue. As a result, supporters contend the approach is carefully tailored and ultimately benefits doctors, patients and the practice of medicine overall.

Retired Davenport surgeon Tim Millea argued that forcing clinicians to act against their judgment harms the workforce and could worsen shortages.

Joseph Heyrman, a third-year medical student at the University of Iowa who plans to go into family medicine, told lawmakers that conscience protections do not reduce access to care, but instead help retain clinicians in the profession. For many doctors, he said, acting against deeply held ethical beliefs is not an option — meaning the alternative to coercion is leaving medicine altogether, avoiding certain specialties or practicing in states with stronger protections.

Heyrman also warned that health systems without conscience protections risk creating a workforce that filters out clinicians with strong ethical convictions, leaving behind those more willing to set aside their judgment under pressure — a dynamic he said ultimately undermines patient trust. He said patients benefit from physicians whose recommendations are guided by integrity rather than fear of retaliation.

Backers also argued the bill extends long-standing conscience principles in Iowa law beyond abortion to other areas where providers may have objections.

Tom Chapman, executive director of the Iowa Catholic Conference, told senators conscience is "a fundamental right," and emphasized a distinction between refusing people and refusing practices.

"Freedom of conscience and health care is not about who we care for, but about which health care practices are ethical," Chapman said. " … It does not allow professionals to avoid caring for certain categories of people. The right of conscience protects an individual's right to not participate in morally controversial actions."

Sen. Taylor echoed that point in his closing remarks, emphasizing the bill's scope beyond religious claims and arguing that the definition of conscience — "ethical, moral or religious beliefs or principles" — would not cover what he described as "financial self-serving" motives.

He also said insurers would remain bound by contracts.

"It's not as though they can decide after the fact, I'm not going to pay off on the policy that we have entered into," Taylor said. "That's a contractual obligation, and they will have to pay."

Opponents: No duty to refer, sweeping immunity, risks in rural Iowa

Opponents warned that broad refusal rights — especially without a duty to refer patients elsewhere when care is refused — could delay or deny care, particularly in rural areas with limited options.

"This bill would only further exacerbate delayed medical care throughout Iowa," said Dr. Kaaren Olesen, an OB-GYN physician in Des Moines. "There are no protections for patients if there is an objection by a provider or an entire institution, including those patients who are in need of urgent care, especially for those in small towns."

Olesen said Iowa is already struggling with OB-GYN capacity and closed obstetrics units in some communities. She warned patients could travel long distances only to be turned away and described the bill as "extremely broad."

Dane Schumann, representing the American College of Obstetricians & Gynecologists, also warned the bill could invite frivolous lawsuits, particularly against smaller clinics and practices. Schumann argued employees could claim newly adopted religious or moral beliefs after being terminated and use those claims to challenge employment decisions — unlike traditional discrimination cases based on fixed characteristics.

Kyrstin Delagardelle of Planned Parenthood Advocates of Iowa said the organization opposes the bill, arguing that even if it does not explicitly discriminate based on who a patient is, the types of medical care people seek are often closely tied to sex, gender and other personal characteristics. She said treatments such as contraception are primarily used by women and people with ovaries, meaning refusals of those services could have discriminatory effects in practice. Delagardelle warned that because medical care is individualized and often linked to protected classes, the bill could enable impact-based discrimination regardless of its stated intent.

Damian Thompson of Iowa Safe Schools said Iowa's existing Religious Freedom Restoration Act already provides a balancing test for religious liberty against state interests such as patient safety and access, calling HF 571 "unnecessary."

Thompson also argued conscience laws are meant to protect personal beliefs, not to give large organizations system-wide authority to deny coverage or care. He also warned the bill grants sweeping immunity from civil, criminal and administrative liability, weakening oversight and accountability, and raises the bar for professional licensing boards to discipline providers, even in cases involving misleading or harmful conduct.

Connie Ryan, executive director and lobbyist for the Interfaith Alliance of Iowa Action Fund, said the bill expands beyond religious freedom to include broad moral and ethical objections and extends those rights to institutions and payers, raising concerns that insurers could cite self-defined ethical standards to deny coverage while prioritizing financial interests.

Sen. Blake, an attorney, pressed a similar point about corporations and coverage decisions. "What is the ethical, moral structure of a corporation, of a business?" he asked, arguing businesses are designed to make a profit and warning the bill could be used to justify broad denials.

"The unintended consequences of this bill far outweigh any protections that are already in place," Blake said.

What's next

With the subcommittee vote, HF 571 now heads to the full Senate Judiciary Committee, where it could be amended, advanced to the Senate floor, or stalled again.

Taylor said he expects "continuing this conversation" in committee — and possibly beyond — as lawmakers weigh whether expanded conscience rights for providers, institutions and payors protect medical professionals or jeopardize patient access in a state already facing steep health care workforce shortages.