If you work in the health care industry, you will want to read this. I say this because your livelihood is primarily funded by your job. In other words, you are probably not lucky enough to enjoy an uninterrupted stream of income from any source other than your paycheck. You need your job and this blog tells you how your job is at risk. And it is not only your job, the consequences are much broader than that. You may lose the right to continue working in the entire health care industry.

You know a lot of people who work in the health care industry. Share this with them.

In September, 2015, the United States Department of Health and Human Services (HHS) published some proposed regulations which set forth significant changes to existing regulations which have a large impact on health care professionals, organizations and institutions. These regulations are not going to be nuisances or burdens. They will be much worse. The regulations will force health care professionals to make a choice between the patient’s best intereste and the wishes of the state. For many it will force them to choose between God and the state. Either one should cause your blood to boil.

For some people, choosing between God and the state is not a very difficult decision. They are either primarily disciples of Jesus or primarily citizens of the state. For such people, they have already made the decision on their own, without any duress. But most people are not like that. Most Americans will find this to be an excruciating decision because up until now, they have been able to follow God without ever having to consciously choose between God and their job, reputation or ability to support their family. I doubt there are more than a handful of medical providers who are okay with putting the state’s desires above the best interest of the patient. I’m hopefull there are many medical providers who put God above the state, especially when the state rejects God. 

Decisions like this have faced people many times over many centuries. On each occasion, the penalty for choosing God over the state has resulted in loss of the person’s ability to earn an income (loss of the ability to support their family), loss of their freedom due to imprisonment and/or in the most extreme cases the loss of their life. The most demonstrative examples are the persecution of Christians in the first three centuries of Christianity in the Roman Empire, the persecution of Catholics in 16^th and 17^th century England, the rejection of Christianity in the French Revolution, the persecution of Jews and Christians by Nazi Germany and the Atheist Communism that infected many countries after Marxism began its rampage through the 19^th and 20^th centuries.

Will HHS regulations result in the imprisonment or executions of Christian health care professionals in the near future? No. However, if we stand quietly and do nothing, the consequences become more likely and closer to us with each passing day. And with each passing day, the people imposing the regulations on us become more emboldened and more powerful. If you think about it, even the least severe consequence (loss of your job and/or your license) would be a catastrophic event for you and your family. If you are charged with a violation of the new HHS regulations the penalty could impoverish you and prohibit you from working in the health care profession for the rest of your life. Though this is not a death sentence, it would have a severe and detrimental impact on your family for generations to come.

The regulations proposed last September cover nearly every individual working in the health care industry in one way or another because it is all tied to federal funding and nearly every medical facility and medical provider in the United States receives some form of federal funding. The regulations apply to all health programs or activities any part of which receives Federal financial assistance administered by HHS as well as any health programs or activities administered by HHS or those established under Title I of the ACA, including federally facilitated and state-based insurance exchanges. If you or your organization receives any federal funding (including Medicaid and Medicare), you are included. Some people estimate that this covers nearly 1,000,000 physicians, 133,000 health care facilities, all private health insurance companies and likely all the individuals (directly or indirectly) who work for and receive care from these physicians and facilities.

By the way, 45 CFR Part 92 – Nondiscrimination in Health Programs and Activities; Final Rule – HHS goes into effect on July 18, 2016. It is unclear whether providers have a 90 day compliance window or if immediate compliance is required. It appears the most generous interpretatin give providers until November 18, 2016, to file an Assurance of Compliance with HHS’s Office of Civil Rights, or their federal funding could be suspended or curtailed.

It is times like this when it is unquestionably wrong to hope that evil does not prevail. Nobody (including God) fights our battles for us when we are fully capable of putting up our own hand and saying, “Stop”. Physician, heal thyself.

Let me take a little time to work through what these regulations are and what they could mean if an individual thought you had violated one of them.

The key language in the new regulations centers on “sex” discrimination in health care including “sex stereotyping,” “gender identity,” and “termination of pregnancy.” Additional regulations are being considered for “sexual orientation” and will likely include “sexual preference”.

The regulations will eliminate a physician’s ability to make the best medical decision for the patient.  If a physician is capable of performing a D&C (dilation and curettage), his or her patient could require the physician to either perform her surgical abortion or refer her to an abortion provider. If a physician administers treatments or perform surgeries that can further gender transitions, such as hysterectomies, mastectomies, cosmetic surgery, etc…, the physician could be required to provide them for gender transition or gender reassignment surgery as well and insurance must cover it, regardless of the independent medical judgment of the physician. 

As we have seen with florists, bakers, photographers and facility owners, new laws and regulations are used as weapons against people and businesses who disagree with the LGBT lifestyle.

According to the HHS’s own FAQ sheet, a physician may not deny or limit treatment for any health services that are ordinarily or exclusively available to individuals of one sex based on the fact that a person seeking such services identifies as belonging to the opposite sex. Therefore, this may require physicians to perform mammograms on men who identify as women and it would require insurance providers to pay for the mammogram, but more likely it means that cosmetic surgeons would be forced to perform gender reassignment surgery or at the very minimum, refer patients to surgeons who do perform such surgeries.

If you are an anesthetist, radiologist, physical therapist, R.N., L.P.N., counselor, etc… you may be required to assist with these surgeries and procedures, including recovery, aftercare and follow-up.

The regulations make reality illegal when reality conflicts with the patient’s desires, emotions and feelings. Failure to affirm the patient’s identity would be “stereotyping” and therefore, a violation of the regulation.

Acknowledging the following facts or holding the following beliefs would be prohibited under the new regulations:

1. The fact that a person’s maleness or femaleness is determined by their biological sex.
2. The fact that abortion is immoral and physically and psychologically unhealthy for the mother.
3. Belief that homosexual behavior is immoral and/or the fact that homosexual behavior poses a serious health risk to those who participate in homosexual activity.
4. The fact that gender transition treatment has not been proven to improve the patient’s mental health.
5. Your medical opinion that gender dysphoria is best treated by trying to help the person accept his or her biological makeup.
6. Your medical opinion that same-sex attraction is a disorder and that it is possible to provide treatment to reduce or eliminate the person’s attraction to the same-sex.

The new regulations may require the following from you if you are a health care professional:

1. To perform gender reassignment surgery.
2. To refer patients to physicians and facilities who perform gender reassignment surgery.
3. To provide hormone therapy for purposes of gender transition treatment.
4. To refer patients to physicians and facilities who perform gender transition treatment.
5. To prescribe artificial contraception.
6. To perform abortions.
7. To refer patients to physicians and facilities who perform abortions.
8. To assist with medical procedures and treatments that are contrary to your deeply held religious beliefs.
9. To provide counseling and/or therapy for patients who are pursuing gender reassignment.

Who could be impacted by this? Nearly every individual who works in health care. This includes nurse anesthetists, radiologists, LPN’s, counselors, clerical staff and even housekeeping. The impact is so extensive because the regulations not only deal with health care, but to the person’s access to facilities. This means rehabilitation and treatment centers that currently only accept women, may no longer be allowed to reject a man who says he identifies as a woman. The presence of one male in an all-female treatment center would have a top to bottom impact on the treatment center. This will effect nursing homes as well. Is it possible that an elderly women may be forced to share a room with a man who identifies as a woman? In the infamous words of Nancy Pelosi, we’ll just have to wait and find out.

If there are any violations, the penalties are severe. HHS can suspend or terminate licenses and agreements or they can refuse to continue to provide federal funding to the offender. But it doesn’t stop there, an individual can also sue the provider in federal court in order to recover actual damages, compensatory damages and attorney fees and costs of suit. Attorneys for the ACLU and Human Rights Campaign are sure to be waiting with baited breath for such an opportunity to make an example out of you.

In words often attributed to Edmund Burke, “All that is necessary for the triumph of evil is that good men do nothing”. Whether he actually said that is not important, it is simply true.

There are three types of law that are relevant to this issue, eternal law, natural law and positive law. Eternal law is simply put, the plan of divine wisdom which I describe as simply the way things are. Examples of eternal law are: Something cannot come from nothing, gravity exists and nobody likes being lied to. Natural law is the rational creature’s (human) participation in the eternal law: Things work best when we cooperate with reality. Positive law is the law created by man, including all the statutes and rules created by the state: Such as the regulations that will go into effect on July 18, by the stroke of an administrative pen, not by a vote of the people or even the vote of a legislative body.   

When a positive law is inconsistent with natural law and divine law, it is an unjust law, also known as tyranny, which is a doomed human attempt to resist reality.

“If you call a calf’s tail a leg, how many legs does the calf have? Four. Calling a tail a leg does not make it a leg.” – Abraham Lincoln

If you work in the health care industry, you need to stand up and defend your right to cooperate with reality. Since you work in the health care industry, you know that we cannot change reality by wishing, thinking or even believing one way or another.

The government is blatantly coercing you to ignore reality in the medical care you are to provide. This cannot, by any stretch of the imagination, be acceptable to any medical care provider. These regulations overreach to the point of compromising the quality of medical care you are allowed to provide to your patients. The patients and their families will suffer unless you stand up now and refuse to allow the state to interfere with the care you provide to your patients. You can try and stay under the radar and walk the thin and precarious line between God and the state, but you will not be successful. You or your patients will eventually fall victim to these regulations.

Since inaction is not an option, you must speak up now if you wish to be an advocate for patients and an advocate for your fellow health care workers. Contact your representatives in the federal and state government and tell them that you expect your elected officials to override the administrators who are exercising unlimited power through Obamacare. You should also invite your coworkers and others in the health care industry to join you in these efforts. If the American people do not see the people in the industry raising their hands and saying, “stop”, they will remain silent as well. That is how tyranny prevails.