US Senator James Lankford (R-OK) and Congressman Greg Murphy, M.D. (R-NC-03) have led a group of lawmakers in urging the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) to take regulatory action to protect the conscience rights of medical residents in graduate medical education programs.
In a letter addressed to HHS Secretary Robert F. Kennedy, Jr. and CMS Administrator Dr. Mehmet Oz, the lawmakers highlighted concerns regarding recent accreditation requirements for obstetrics and gynecology residency programs. The letter was also signed by Senators Steve Daines (R-MT), Cindy Hyde-Smith (R-MS), Ashley Moody (R-FL), Ted Budd (R-NC), Ted Cruz (R-TX), Jim Banks (R-IN), as well as several members of the House of Representatives.
The letter refers to a final rule published by HHS-CMS on November 25, which will take effect on January 1, 2026. The rule addresses graduate medical education accreditation standards but leaves open questions about how federal healthcare conscience laws are applied to training requirements related to abortion and other procedures.
Quoting from the rule’s response to public comments: “Many commenters that supported the proposal also recommended that CMS expand the policy to explicitly prohibit the use of accreditation standards that violate Federal healthcare conscience laws, including the Church Amendments, the Coats-Snowe Amendment, certain provisions of the Affordable Care Act, and the Weldon Amendment. These statutory provisions generally prohibit discrimination against recipients of certain Federal funding who refuse to perform abortions or provide other services in violation of their moral or religious convictions… In response to comments recommending further expansion of the proposed policy, we may take these comments into consideration for future rulemaking.”
The lawmakers argue that current accreditation requirements compel all obstetrics and gynecology residents to receive training in induced abortion unless they actively opt out. They note this creates a coercive environment for first-year residents who must publicly declare their objections: “This not only sets up an extremely coercive environment where many residents feel they need to ‘go along to get along’ but we have also heard of several instances where residents who opt out are given increased workloads as a result.”
They further state that before 2018, abortion training was available on an opt-in basis rather than being mandatory with an opt-out provision. The shift has led some students with religious or moral objections away from pursuing careers in obstetrics and gynecology.
The letter asserts: “The idea that induced abortion is a standard part of OB/GYN practice is inaccurate, given that 76-93% of practicing OB/GYN physicians do not perform induced abortions.” It continues: “Every obstetrician-gynecologist is trained in the medical and surgical methods used to evacuate the uterus… Prior to 2018, all OB/GYN residents were already required to be trained in miscarriage management…”
Lawmakers claim that requiring trainees who object on moral or religious grounds to formally opt out violates existing federal protections such as those provided by the Coats-Snowe Amendment: “The opt-out requirement is a clear violation of the conscience protections provided by the Coats-Snowe Amendment.”
They urge HHS and CMS “to require any graduate medical education program to provide induced abortion as an opt-in only option in order to receive their federal GME funding and in order to receive CMS reimbursements.” The signatories argue this change would respect conscience rights while still allowing access for those seeking abortion training.
