Christian health care professionals don’t have to perform transgender-related care that is contrary to their religious beliefs, a federal district court in Texas said, invalidating an Obamacare anti-discrimination rule.
The so-called “transgender mandate” implementing the Affordable Care Act’s anti-discrimination provision violates the Administrative Procedure Act and the Religious Freedom Restoration Act, the U.S. District Court for the Northern District of Texas said Oct. 15.
Judge Reed C. O’Connor vacated the rule, which interpreted the ACA’s Section 1557 as prohibiting providers and insurers from denying care or coverage based on gender identity or termination of pregnancy.
O’Connor stood by his December 2016 decision that the rule violates the APA because it defines prohibited sex discrimination in a way that is contrary to law, arbitrary, and capricious.
The judge also expanded on his previous ruling, holding that the rule violates RFRA. In the earlier decision, O’Connor said the rule’s challengers were likely to win because RFRA prohibits the government from imposing a substantial burden on religious exercise. The providers’ and insurers’ refusal to perform, refer for, or pay for gender transition-related care or abortions was a sincere religious exercise burdened by the rule, he said.
The rule’s defenders argued it satisfied RFRA’s requirements because it served a compelling interest in ensuring individuals aren’t discriminated against while seeking access to health care. But even if this was a compelling government goal, the defenders didn’t show the rule was the least restrictive means of accomplishing it, as RFRA requires, O’Connor said.
Christian health-care providers and five states sued the U.S. Health and Human Services Department in 2016 to stop the rule’s implementation. The HHS initially defended the rule, but the Trump administration switched sides and argued the rule should be invalidated. The HHS is working on an administrative fix.
The River City Gender Alliance and the American Civil Liberties Union of Texas intervened to defend the rule.
The Becket Fund for Religious Liberty represented the providers. The Texas Attorney General’s Office represented the states. The U.S. Department of Justice represented the HHS.
The American Civil Liberties Union Foundation, the American Civil Liberties Union of Texas, and the American Civil Liberties Union of Nebraska represented River City Gender Alliance and the ACLU.
The case is Franciscan Alliance, Inc. v. Azar, N.D. Tex., No. 16-cv-108, 10/15/19.