Appeals court rules transgender care and transition infringes upon religious freedom

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A federal appeals court has rolled back a Biden administration proposed rule on sex discrimination in a ruling blocking a transgender care mandate.

The United States Court of Appeals for the Eighth Circuit upheld a North Dakota district court opinion in ruling in favor of Catholic health systems and associations, and the Religious Sisters of Mercy. The appeals court said implementation of Section 1557 of the Affordable Care Act prohibiting certain forms of discrimination in healthcare compels providers to perform and provide insurance coverage for gender transition, which infringes upon religious freedom.

It affirmed the district court's opinion that the Religious Freedom Restoration Act of 1993 entitles the plaintiffs to permanent injunctive relief from the provision or coverage of gender-transition procedures. 

WHY THIS MATTERS 

In July, HHS announced a proposed rule implementing Section 1557 of the Affordable Care Act that prohibits discrimination on the basis of race, color, national origin, sex, age and disability in certain health programs and activities. This proposed rule aimed to restore and strengthen civil rights protections after a Trump-era 2020 version of the rule limited its scope and power. It was expected to go into effect in 2023.

The Religious Sisters of Mercy; Sacred Heart Mercy Health Care Center, Alma, Michigan; SMP Health System; University of Mary; Catholic Benefits Association; the Diocese of Fargo; Catholic Charities of North Dakota; and the Catholic Medical Association brought a lawsuit and won in federal court in North Dakota.

The Department of Health and Human Services and the Equal Employment Opportunity Commission appealed on the grounds that the district court erred in determining "that plaintiffs had demonstrated standing, ripeness, and imminent irreparable injury sufficient to justify permanent injunctive relief." 

The three-judge panel of the Eighth U.S. Circuit Court of Appeals unanimously disagreed.

THE LARGER TREND

The ruling is a setback for the Biden administration's attempt to uphold ACA transgender protections that were rolled back by the Trump administration.
 
In October, the American Medical Association, the American Academy of Pediatrics and the Children's Hospital Association sent a letter to the U.S. Attorney General urging the Department of Justice to investigate the threats of violence against physicians, hospitals and families of children for providing and seeking gender-affirming care.

In June, a Texas judge reportedly temporarily blocked the state from investigating families of transgender children who had received gender-confirming medical care.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org