Growing tensions over the Trump administration’s policies that aim to strengthen religious freedom protections for health care workers have led to a partisan tug-of-war playing out in the House.

The Trump administration has tried to strengthen religious liberty protections through numerous policies over the past several months. Those include providing federal funds to religiously affiliated foster agencies who don’t allow LGBT people to adopt children and broadening religious and moral exemptions for employers who do not want to cover birth control.

The Department of Health and Human Services also finalized another rule that would expand exemptions for workers in medical offices who don’t want to participate in abortions, assisted suicides, or care for transgender people. Advocates worry that someone who schedules appointments or cleans medical instruments could object to assisting with an abortion or serving LGBT people.

Democrats and advocacy groups are attempting to counteract these policies through the courts and legislation.

For instance, the House passed a bill it dubbed the Equality Act Friday 236-173, which would broaden the definition of protected classes to include sex, sexual orientation and gender identity. Democrats say this would ensure that an LGBT individual would not be denied care, which could include counseling, well exams or hormone treatment. Debate over the bill has been partisan.

The House bill passed with the support of all House Democrats, but is unlikely to be taken up by the Republican-controlled Senate.

The Trump administration’s policies build upon the Religious Restoration Freedom Act of 1993, a bipartisan law that seeks to ensure that religious freedoms are protected. Some conservatives worry that moves by Democrats to expand protections for individuals such as those that identify as LGBT could violate that law. Supporters of the bill the House will vote on counter that the law will still be upheld but the bill would prevent instances of discrimination.

On Monday, a number of Christian and Evangelical leaders led by the Family Research Council wrote a letter to lawmakers over concerns with the legislation, calling it “riddled with threats to religious liberty and the sanctity of human life.” The group raised concerns over how it could restrict faith-based adoption agencies and expand access to abortion.

Family Research Council President Tony Perkins also joined House Republicans and advocates in a press conference Thursday condemning the bill.

“The Religious Freedom Restoration Act will be committed to the ‘memory hole,’ and we will then experience a catastrophic loss of religious freedom in America, and, as a result, every American, those who believe and do not believe, will suffer the consequences,” said Perkins.

However, Robin Maril, associate legal director at the LGBT advocacy organization the Human Rights Campaign, said that the bill would simply extend civil rights protections.

Gillian Branstetter, a spokesperson for the National Center for Transgender Equality, also emphasized the need to pass the bill before the Supreme Court is expected to hear a case related to LGBT employment discrimination next term.

Some political science experts suggest that the debate has grown too heated.

“There are ways to balance religious liberty and LGBT rights, but the concerns of both sides need to be kept in balance,” said Amy Black, a political science professor at Wheaton College. “In today’s politically charged climate, it is difficult to balance these competing concerns. Activists often create all-or-nothing, doomsday scenarios, ignoring the many examples of balancing religious liberty and LGBT rights.”

Agency actions

Liberal advocates are most at odds with two major health care actions the administration took this year that could impact marginalized groups and individuals with strong religious convictions.

The first is a wide-ranging rule, finalized by HHS in May, that would expand moral and religious protections for workers in health care. The move was previously announced by President Donald Trump on the National Day of Prayer.

“Everyone agrees that the right to believe is fundamental. The access to lifesaving care is just as essential,” said Maril, who worries that hospitals will preemptively deny care if a worker resists providing a certain service “even if a conscience exemption they are asking for isn’t covered by the law.”

“It really moves away from the foundation of how HHS regulations have always been designed. It moves patients away from the center of the discussion,” Maril added.

Progessive advocates also pushed back on an HHS decision earlier this year to allow a faith-based South Carolina foster home to receive federal funding. The Protestant agency said placing children with LGBT families or families of other faiths violates their beliefs.

At the time, Steven Wagner, the principal deputy assistant secretary for HHS’ Administration for Children and Families, wrote in an approval letter that denying this exception would have left the agency “substantially burdened by application of the religious nondiscrimination requirement.”

Trump addressed the issue at the National Prayer Breakfast in February, hinting that more states would likely be granted similar waivers.

“We will always protect our country’s long and proud tradition of faith-based adoption,” he said. “My administration is working to ensure that faith-based adoption agencies are able to help vulnerable children find their forever families while following their deeply held beliefs.”

The administration also is encouraging workers who feel their religious or moral beliefs have been violated to report that to the HHS Office of Civil Rights.

“We’ve seen an uptick in claims that the religious freedom of one group or another has been abridged. Some of that is to be expected at a time when hitherto marginalized groups are finally, and belatedly, being assured their full rights,” said Randall Balmer, a professor of religion at Dartmouth College. “Some of these groups regard this guarantee of rights as a kind of zero-sum game: Because the rights of others are expanding, ours must be contracting.”

Sara Hutchinson Ratcliffe, vice president for Catholics for Choice, which supports abortion rights, has concerns about some of the recent policy decisions.

“This administration had made a concerted effort to pay back their political allies that helped get them in office,” she said. “It’s a fact these really super conservative groups and allies, many of whom are driven by the Catholic hierarchy and U.S. Council of Catholic Bishops, are driving policy based on religious hierarchy.”

Black, of Wheaton College, said religious organizations should not run the government, nor should the government dictate what religious organizations do.

“We have long allowed practices that protect religious freedom, accommodating individuals’ deeply held beliefs without causing long-term harm to others,” said Black. “Some of the rhetoric around recent proposals suggests doomsday scenarios if an individual health care provider opts not to perform a particular service. But other providers can offer services. We’ve had religious freedom accommodations for decades, and it has worked for the common good.”