James Gallant, a retired emergency physician who serves pro bono as the medical director of the Hope Life Center in Sterling, Illinois, a crisis pregnancy center , doesnt offer abortions, and doesnt want to tell women who visit his facility that they can get them elsewhere. Doing so which is required under a 2016 state law would violate Gallants religious freedom, he says. Earlier this month the Thomas More Society, a pro-life nonprofit law firm, filed a federal complaint on his behalf with President Donald Trump s Department of Health and Human Services. In the complaint, the firm claims this requirement flies in the face of federal laws that exempt health care providers from participating in abortions if they claim a religious objection.

But far more than Gallants conscience could be at stake. He maintains that federal funding for health and safety net programs for Illinois residents is contingent on the protection of his wall-to-wall conscience rights. Although they have never been applied so broadly, federal conscience protection laws may allow for this radical application, according to legal experts and its up to a bevy of sympathetic bureaucrats Trump has installed at HHS to decide. If Gallant prevails, Illinois could lose federal funding for a whole range of social welfare services, from Medicare and Medicaid to food stamps, welfare, and Head Start all because one man didnt want to tell women where they can obtain abortions.

Gallants argument is novel. A states federal funding for essential health care programs has never been withheld under these laws. Past complaints have simply resulted in narrow settlements exempting the complainants from having to provide whatever services they object to. But Gallants complaint asserts that he cannot, in conscience, even refer women to providers of abortion procedures. (A spokesman for the Thomas More Society did not respond to interview requests.)

Gallants is just one of a rush of similar complaints HHS has received since Trumps election. Under President Obama, the department received only a handful of complaints citing federal conscience protection laws. These laws include the 1973 Church Amendment, which requires federally funded health care facilities to allow providers to opt out of participating in abortion, sterilization or other procedures to which they have religious or moral objections; the 1996 Coats-Snow Amendment, which extends those protections to medical students and residents; and the 2004 Weldon Amendment, which extends these conscience exemptions related to abortion to a broader range of health care entities. Obamas HHS infuriated conservative lawmakers and activists because they maintained it was slow to act on those complaints, or closed investigations without finding violations.

But the complaint procedure, managed by HHS Office for Civil Rights, is now controlled by Trump political appointees who want to more vigorously enforce conscience protection laws, and who are actively seeking more complaints. A year ago, Gallants complaint would have been a non-starter; now it will receive a sympathetic, if not enthusiastic, hearing.