The Ohio provision was tucked inside a 700-page document of amendments to the state’s two-year budget bill, and remained largely unexamined until DeWine had signed it into law. The governor didn’t mention the change in a four-page summation of the amendments posted to his website. 

Dominic Detwiler, a public policy strategist for Equality Ohio, said that the provision was inserted at the very last moment in an attempt to avoid any publicity and any public hearings. “They know that they couldn’t pass this on its merits as a stand-alone bill, because literally no one is asking for this to be passed,” he told the Columbus Dispatch. 

The change will allow any medical professional, including doctors, nurses, lab technicians, and even insurance providers “the freedom to decline to perform, participate in, or pay for any health care service which violates the practitioner’s, institution’s, or payer’s conscience as informed by the moral, ethical, or religious beliefs.”

Ohio’s medical community—including the Ohio Hospital Association, the Ohio Children’s Hospital Association, the Ohio State Medical Association, and the Ohio Association of Health Plans—sent a letter to the governor opposing the rule change and saying that the bill could “unacceptably compromise” patient care. DeWine countered that very little would change; there is also a clause, he said, that asks a medical professional to transfer a patient to a colleague who will perform the procedure, when possible. 

But LGBTQ advocates in the state expressed concern. 

“Today Governor DeWine enshrined LGBTQ discrimination into law, threatening the medical well-being of more than 380,000 LGBTQ people in Ohio, one of the largest LGBTQ populations anywhere in the country,” said Human Rights Campaign president Alphonso David in a statement. “Medical practitioners in Ohio can deny care or coverage for basic, medically necessary, and potentially lifesaving care to LGBTQ people simply because of who they are.”

Pro-choice advocates and women’s health advocates are also worried about how this precedent will change medical care going forward. 

“This simply puts in statute what the practice has been anyways,” said DeWine. “Let’s say the doctor is against abortion, the doctor is not doing abortion.”

Under the new law, however, health insurance providers will also be able to deny coverage of procedures, regardless of doctors’ willingness to perform procedures. Lab techs can also refuse to analyze test results or perform screening procedures. 

“This bill creates even more places that can put people’s health and life in danger. This is a direct risk for the health of Ohioans,” said Jaime Miracle, deputy director of NARAL Pro-Choice Ohio. She worries that access to birth control could also be limited by a pharmacist who opposes the concept on moral or religious grounds. 

Advocates also worry that drug addicts or people living with HIV or sexually transmitted diseases could also be denied treatment under the loosely written clause. 

More than 250 anti-LGBTQ bills have been introduced by state legislatures in 2021; with five months left, it is already the worst year for anti-LGBTQ legislation in recent history, according to tracking and analysis by the Human Rights Campaign.