LGBT Americans face a patchwork of civil rights protections from state-to-state, and their advocates say a potential new government office could increase discrimination.

Last Friday, the Department of Health and Human Services released details of a proposed rule for a new division in its Office of Civil Rights. That division would more vigorously enforce laws protecting the rights of conscience and religious freedom.

Naomi Goldberg, movement and policy researcher with the Movement Advancement Project, said enforcement of that rule could apply not only to those who refuse to provide abortion or contraceptive services, but also to those who refuse to provide services to LGBT people in need of medical care – and that can be life-threatening.

“Many of us who live in big cities say, ‘Just find another physician,'” Goldberg observed. “But for millions of people who live in smaller towns or rural communities, asking them to seek service elsewhere may simply not be an option.”

Supporters of the proposal say health care workers are being bullied into providing services that violate their religious convictions. But civil rights advocates see the new rule as a federal attempt to create a “license to discriminate.”

Goldberg pointed out that 19 states have civil rights laws explicitly protecting LGBT people from discrimination.

“What’s troubling about the proposed rule is that, even in those states, the federal government is going to jump in and try to defend people who deny health care to LGBT people and other people,” she said.

The Movement Advancement Project has published a new report offering a comprehensive overview of federal, state and local protections against discrimination in public spaces.

The report comes as the U.S. Supreme Court prepares to deliver a ruling on a case in which a bakery owner refused to make a cake for a same sex-wedding because he said it would violate his religious beliefs. Goldberg said a ruling for the baker could affect more than wedding cakes.

“It means that a business could say they don’t want to serve a person of color, or a woman or an interfaith couple,” she said. “So, it could lead to the erosion of the Civil Rights Act and many other nondiscrimination protections that we have across the country.”

The HHS proposal would apply to hospitals, dentist offices, pharmacies, ambulance services and others.