A district judge has forbidden federal agencies to enforce requirements for healthcare providers and plans to deliver or cover gender-transition procedures over religious objections.
The Thursday ruling from Judge Peter Welte, of the U.S. District Court for the District of North Dakota Eastern Division, strikes an interpretation from the Biden administration’s Department of Health and Human Services (HHS) to include gender identity as part of the Affordable Care Act’s Title IX prohibition of discrimination “on the basis of sex.”
The department had promulgated regulation in May 2024 that gender-affirming care must not be prohibited, including for religious reasons. Welte permanently enjoined and restrained the department from such interpretation or enforcement.
Additionally, the judge made a similar decision regarding the Equal Employment Opportunity Commission’s (EEOC’s) enforcement of Title VII of the Civil Rights Act, which prohibits employers from discriminating against someone “because of … sex.” The EEOC may not implement and enforce regulations that would require employers to provide insurance coverage for gender-affirming care that violates their religious beliefs.
The case was brought to the court in late 2023 by the Catholic Benefits Association, a order of Catholic nuns and two Catholic care facilities. It initially concerned federal agency regulations on discrimination promulgated in the waning days of the Obama administration and the beginning of the Biden administration that were being hashed out in the courts but was amended in 2024 shortly following HHS’ May 2024 action.
Though the plaintiffs found success on the subject of gender-affirming care, Welte shot down their motion for summary judgment on requirements around abortion and fertility treatment. The judge, who considered each of the issues separately, said the plaintiffs arguments were “underdeveloped” because they leaned on a prior court decision the judge determined did not apply to the current case.
Martin Nussbaum, general counsel for the Catholic Benefits Association, told the AP that the ruling granting religious protections in the case of gender-affirming care was welcomed. He also said that the ruling related to abortion and fertility care implies no federal mandates are in place related to those services, suggesting healthcare organizations and employers have no need for the court’s protection on the issues.
The new administration is unlikely to appeal the court’s decision to strike HHS and EEOC gender-related protections. President Donald Trump signed an executive order shortly after taking office declaring that the federal government would not recognize gender identity, only male and female sex. The administration has also sought to clamp down on gender-affirming care services for children by disseminating a highly contested literature review on the subject and launching a review of providers that offer such services.