There is a difference between this rule and the already existing conscience clauses. This rule seeks a certification process for facilities receiving federal funds. These agencies now need to certify that they do not “discriminate” in employment against people who would refuse to perform services required by their job description, and that they do not make these refusers refer patients to an alternative provider who will be willing to provide legal medical care.
So, for example, there is a clinic in my county that is run by the county Department of Health. It is a family planning clinic, accessed almost entirely by patients of low socioeconomic status. They provide birth control and related medical care, like pap smears and STD screening. They perform pregnancy tests there (no one should get a prescription for birth control without one) and counsel pregnant patients on their choices.
This rule can easily be interpreted to say that this department of health family planning clinic cannot ask its potential employees if they supported dispensing birth control as a prerequisite of employment. So, someone could get hired that not only was opposed to distributing birth control, but also could refuse any supportive health care that might be linked to birth control use, such as the pap smears and STD screenings, or may even refuse to book any appointments for any patients since they are most certainly seeking birth control. And, they can refuse to refer to an employee who would provide any of these services. So, in order to prove that they do not discriminate, they may be forced into hiring and continuing to employ a person who refuses to fulfill any of the job description.
Of course no one should be forced into performing medical treatments that he or she thinks is unethical. I would refuse to put seven embryos in a woman in an IVF treatment. But, I wouldn’t continue working at a facility that did that five days a week. I wouldn’t expect them to keep me on the payroll if I sat out of most of their procedures, or interfered with a patient who desired such services by refusing to put her in contact with someone who would agree to provide them.
Edited to add: there is a brilliant piece about the reality ignored by the rule, written by an ob/gyn and up at RH Reality Check.