A federal judge in Texas blocked an Obama-era mandate reinstated by the Biden administration requiring medical facilities and health insurers to cover or provide gender transition procedures and abortions.
U.S. District Judge Reed O’Connor of the Northern District of Texas granted a permanent injunction on Monday against the regulation in the case of Franciscan Alliance, Inc. et al. v. Xavier Becerra.
O’Connor, a George W. Bush appointee, concluded that the mandate issued through the Department of Health and Human Services violated the Religious Freedom Restoration Act by unjustly harming the plaintiffs' religious practices.
“No party disputes that the [Transgender Mandate] threatens to burden Christian Plaintiffs’ religious exercise … by placing substantial pressure on Christian Plaintiffs, in the form of fines and civil liability, to perform and provide insurance coverage for gender-transition procedures and abortions,” wrote the judge.
“When the RFRA violation is clear and the threat of irreparable harm is present, a permanent injunction exempting Christian Plaintiffs from that religion-burdening conduct is the appropriate relief.”
Luke Goodrich, vice president and senior counsel at Becket, a legal nonprofit representing a religious hospital and a group of over 20,000 healthcare professionals, said in a statement that the ruling is a "victory for compassion, conscience, and common sense."
“No doctor should be forced to perform controversial, medically unsupported procedures that are contrary to their conscience and could be deeply harmful to their patients,"
In 2016, the Obama administration implemented the regulation via Section 1557 of the Affordable Care Act.
The controversial regulation required healthcare providers to perform gender transition procedures, including on minors, even if the providers held sincere religious objections. Violators of the rule could have faced penalties for unlawful discrimination based on “termination of pregnancy” and “gender identity."
To justify the rule, the Obama administration interpreted federal discrimination code that bans sex discrimination to include discrimination based on sexual orientation and gender identity, although neither of those terms are found in federal civil rights law passed by Congress.
The mandate was the subject of much litigation, with various religious entities that provide medical services filing lawsuits against the Obama administration.
Although the Trump administration finalized a new rule repealing the 2016 mandate, multiple courts moved to restore portions of the 2016 mandate. In May, the Biden administration pledged to revive the policy.
The justification for the restoration was the U.S. Supreme Court decision Bostock v. Clayton County. The nation's high court concluded that federal Title VII protections against sex discrimination applied to gender identity and sexual orientation.
The Franciscan Alliance lawsuit is one of multiple legal challenges against the mandate, with the district court initially ruling in its favor but not giving a permanent injunction.
Taking office in January, the Biden administration has worked to defend the Obama-era mandate in court, appealing a similar ruling against the mandate to the U.S. Eighth Circuit Court of Appeals in April.
O'Conner also ruled against the mandate in 2019. But in April, a three-judge panel of the U.S. Court of Appeals for the Fifth Circuit issued a per curiam decision sending a case back to the district court level for further consideration, though it did not rule on the lawsuit's merits.