Earlier this month, our nation’s health department did what once was unthinkable. It released a rule that would allow any health care provider—and, in fact, anyone working in health care—to discriminate against people and deny them care, so long as they come up with a “religious or moral reason” why they’re doing so.

That’s right. This comes from the U.S. Department of Health and Human Services (HHS), whose very mission is “to enhance the health and well-being of all Americans, by providing for effective health and human services.” HHS Secretary Alex Azar likes to paint himself as a technocrat, but with this rule he made it crystal clear that when it comes to “all Americans,” some restrictions apply.

What this new rule means is that if a health care worker disapproves of you—whether because of who you are, whom you love, or your decision to have an abortion—they can deny you care, and this administration will stand by them. What real-world implications will this have for the potential millions of people in the United States who may now find themselves being denied care?

First, the good news. Groups including the American Medical Association forcefully oppose the new HHS rule, citing fears that it could permit providers to withhold care from already vulnerable groups and create confusion. Providers typically take up their work knowing that they will see patients of all genders, sexualities, and family makeups, and they aren’t suddenly surprised after years of training that this is the case. Maternity nurses aren’t taken aback that they might need to provide for a baby born to two moms. Pharmacists aren’t shocked to find out that they may need to fill birth control prescriptions. Spoiler alert: 99 percent of sexually active women have used some form of birth control in their lives.

Now for the bad news. Providers who put their personal beliefs in the way of patient care do exist. Many in the LGBTQ community are already discriminated against by medical professionals, and this move will further embolden bigots to deny care—which will be dangerous, and even fatal, to some. This rule is so broad, so murky, and so open to interpretation that there is no telling how much harm it will cause to targeted and vulnerable communities. Legal experts are still taking time to find out what it means in all situations. For example, hidden deep within the 440-page rule is a section that might keep doctors from treating young people for depression or suicide prevention if their parents object for religious or moral reasons. You can anticipate a doctor, faced with a child struggling with their sexuality, hesitating to provide guidance to their patient for fear of retribution.

However, we actually do have a basic idea of what this rule will do, because we know where it originated and the history of the man behind it.

The HHS Office for “Civil Rights” (OCR) is the headquarters of this policy. Scare quotes are mine. OCR is run by Roger Severino, a transphobic bigot who has decades of experience advocating against trans people and women who have had abortions. On Friday, Severino took that a step even further by proposing a change to Section 1557 of the Affordable Care Act that would gut protections for LGBTQ patients and those seeking reproductive care.

Severino spring-boarded into the administration from the ultra-conservative Heritage Foundation, a group that advocated against marriage equality, against allowing people to use the bathroom that fits their gender expression, and against trans protections in health-care coverage. Under Severino’s reign since the spring of 2017, his office established the Conscience and Religious Freedom Division, a segment of HHS and OCR that has the sole aim of protecting health-care workers who feel their rights have been violated. And it seems to be working: From 2008 to November 2016, only ten complaints were filed for “conscience violations.” But in the last fiscal year, more than 300 complaints have been filed. It’s not hard to believe that this administration may be searching to find these so-called violations.

This rule is terrifying. It is frightening to know that our nation’s health department is working overtime to make it easier to deny care to people. OCR Director Roger Severino should be working to expand access to health services, not weaponizing religious freedom to rob women, LGBTQ people, and their families of access to care. People should never fear that they’re going to be denied care based on their gender, whom they love, or their past medical decisions. This recent move codifies discrimination and it will result in deep harm to patient care.

Alex Azar and Roger Severino should be ashamed. This is exactly the opposite of what our health department should stand for.