Federal appeals court strikes down Biden admin's transgender care mandate

A federal appeals court has ruled that the Biden administration cannot force religious healthcare providers to perform or pay for gender transition surgeries as it violates the religious rights of some Catholic organizations.

This is the second appeals court ruling blocking the administration’s controversial transgender mandate.

It marks the latest legal battle over whether gender-affirming care is protected under the Affordable Care Act's (ACA's) nondiscrimination regulations. The ruling is a setback for the Biden administration's attempt to uphold ACA transgender protections scrapped by the Trump administration.

During the Obama administration, the Department of Health and Human Services' (HHS') Office for Civil Rights announced it would bar providers that receive federal funding from discriminating on the basis of gender identity under a part of the ACA known as Section 1557.

During Donald Trump's presidency, those protections were scrapped when HHS issued a rule eliminating protections for transgender individuals under the ACA.

In July, the Biden administration issued a proposed rule to restore nondiscrimination protections to transgender individuals that were stripped in the Trump-era rule. The HHS rule interpreted the ACA ban on sex discrimination as extending to discrimination based on gender identity, citing a Supreme Court ruling that employers cannot fire workers for being gay or transgender.

HHS aimed to have that rule in place by 2023.

In a ruling issued Friday (PDF), a unanimous three-judge panel of the Eighth U.S. Circuit Court of Appeals disagreed with the Biden administration's argument and blocked the transgender care mandate. The federal appeals court agreed with a North Dakota federal judge who said the HHS rule infringes the religious freedoms of the plaintiffs, including a group of nuns who run health clinics for the poor and an association of Catholic healthcare professionals.

Plaintiffs in the case include the Religious Sisters of Mercy, Sacred Heart Mercy Health Care Center in Alma, Michigan, SMP Health System of Fargo, North Dakota, the University of Mary and the Catholic Benefits Association, a legal advocacy group for Catholic employers.

In August, the New Orleans-based Fifth Circuit also affirmed an order permanently blocking the government from requiring Christian medical groups to provide gender-confirming care to transgender people.

“The federal government has no business forcing doctors to violate their consciences or perform controversial procedures that could permanently harm their patients,” said Luke Goodrich of the conservative Becket Fund for Religious Liberty, who represents the plaintiffs, in a statement. “This is a common-sense ruling that protects patients, aligns with best medical practice, and ensures doctors can follow their Hippocratic Oath to ‘do no harm.’”  

HHS has not yet issued a comment on the ruling.

The Eighth Circuit panel's opinion concludes that “less restrictive alternatives” exist, including government-sponsored healthcare for gender-transition procedures, providing subsidies, tax credits or reimbursement to employees and paying for services at community health centers.

The court's ruling that strikes down HHS' transgender care mandate comes as children's hospitals across the country have been targeted in harassment campaigns over their policies to perform gender-affirming care services.