State lawmakers in the House of Representatives gave broad approval Monday to a bill that would allow medical providers, health care facilities and insurers to deny services based on “ethical, moral, or religious beliefs or principles,” signaling the bill’s likely advancement to the Senate this week.
House Bill 303, sponsored by Rep. Amy Regier, R-Kalispell, passed the Republican-majority chamber largely along party lines, with 65 votes in favor and 35 against, after roughly 20 minutes of debate.
Regier portrayed the bill as a “preservation and protection for medical conscience” in the state for practitioners and health care institutions that object to specific “lifestyle and elective procedures” such as physician aid in dying, prescribing marijuana or opioids, abortion procedures and gender-affirming medical care for transgender people.
“To be clear, this bill would not give the right to refuse to serve a person. It would only apply to the narrow circumstances where a nurse or physician cannot conscientiously perform a specific procedure,” Regier said.
A subsection of the bill says it is not meant to conflict with the federal emergency health care access law known as EMTALA as it applies to health care institutions, such as hospitals. But the bill does not provide a holistic exemption for emergency departments and emergency health care providers. When it comes to abortion, for example, the bill would require providers to opt-in to participating in those procedures in writing beforehand.
Similar legislation has had recent success in other states. For instance, a Medical Ethics and Diversity Act was signed into law in South Carolina last spring. The legislation in that state saw support from the Alliance Defending Freedom, a conservative religious advocacy group that is also backing the Montana proposal.
The opposition to South Carolina’s legislation, including from transgender patients and LGBTQ advocacy groups, echoes concerns now surfacing in Montana over HB 303. Medical associations and groups, including the Montana Hospital Association, Montana Primary Care Association, Montana Nurses Association and the Montana Medical Association, testified against the bill during a January committee hearing, saying it would put patients’ care at risk.
During Monday’s debate on the House floor, Democrats reiterated that the bill includes no discrimination protection for patients, and does not guarantee that a patient has a right to access health care even if a specific provider declines to participate in those services.
Rep. Zooey Zephyr, D-Missoula, told fellow lawmakers the bill would mean transgender people like herself could be turned away from medical services they need.
“What is actually going to happen is it will be a denial based on diagnosis. Something like, I am diagnosed with gender dysphoria,” Zephyr said. “And the thing is, that is inherently discriminatory because you cannot pass my diagnosis from who I am. To deny me based on my diagnosis of gender dysphoria is to deny me based on my being a trans woman.”
Republican moderates appeared to try and derail the bill by proposing a strategic amendment during Monday’s floor session.
As written, HB 303 does not apply to a “health care institution or health care payer owned or operated by the state or a political subdivision of the state.” Some Republican representatives showed interest in striking that provision from the bill, an amendment that would have triggered a higher threshold for the bill to pass because of a specific provision of the state constitution. That amendment, proposed by Rep. Tom Welch, R-Dillon, failed in a 39-61 vote.
Republicans who spoke in support of the bill on the floor said they hoped the bill would protect freedom of expression for medical providers, even those they disagree with.
“I think in this increasingly lack of traditional values and conscience world, and oftentimes profit-driven world, that protection needs to be provided for providers and health care workers that do have those values and do have that conscience,” said Rep. Jerry Schilling, R-Circle.
Other Democrats who considered the bill as part of the House Judiciary Committee urged lawmakers to consider the unintended consequences of the bill. Rep. Laura Smith, D-Helena, said she’d heard stories from parents of young children faced with challenging medical circumstances who feared that, had HB 303 been in place, their desires for care would have been trumped by the prerogative or ideology of their providers.
“This is just one of many examples that I receive where medical teams have tried to deny parents’ rights to choose procedures for their children,” Smith said. “If the bill passes, it will take away parental rights, and your constituents’ parental rights, to make these life-and-death procedural and medical decisions for our own children.”
The bill ultimately passed with widespread Republican support and one affirmative vote from Rep. Frank Smith, D-Poplar. Four Republican lawmakers joined Democrats in opposition.
If the bill passes a third, non-debatable vote this week, it will then be transmitted to the Senate and assigned to a committee for a second hearing.
Speaking to Montana Free Press Monday afternoon, Regier said she was pleased by the vote margin.
“It’s what we all hope for,” she said.
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