By Catholic News Service • Posted April 23, 2021

WASHINGTON (CNS) — The Biden administration has filed an appeal April 20 of a Jan. 19 federal court’s ruling to block an Affordable Care Act provision barring discrimination by health insurers and providers against transgender people.

The regulation was issued in 2016 by the U.S. Department of Health and Human Services requiring doctors to perform these procedures in children and adults or be held liable for discrimination.

Catholic and other opponents of the provision, Section 1557, call it a “transgender mandate” and say it forces doctors and hospitals to perform gender-transition procedures against their moral conscience and professional medical judgment.

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“This is bad for patients, doctors and religious liberty,” said Luke Goodrich, senior counsel at Becket, a law firm in Washington that focuses on religious liberty cases.

In a series of tweets April 20, Goodrich said: “The Biden Admin shouldn’t have appealed. But we look forward to another ruling that protects patients, aligns with current medical research, and ensures doctors aren’t forced to violate their religious beliefs and professional medical judgment.

“The government’s own doctors during the Obama Admin agreed: ‘Based on a thorough review of the clinical evidence …. there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for [patients] with gender dysphoria.”

This mandate, he tweeted, “not only threatens religious doctors and hospitals. It also threatens patients, as there is ample evidence that certain gender transition procedures can be deeply harmful.”

The Biden administration is appealing a ruling by the U.S. District Court for the District of North Dakota in Fargo in a case brought by several Catholic and other faith-based plaintiffs, including doctors, hospitals and clinics. The appeal is being handled by the U.S Court of Appeals for the 8th Circuit, based in St. Louis.

The Religious Freedom Restoration Act, or RFRA, “bars the U.S. government from forcing Catholic health care providers to perform gender-transition related procedures and from forcing employers to provide insurance to pay for them,” the District Court said.

“Thus, the government’s interpretation of the Affordable Care Act’s Section 1557 and Title VII as prohibiting discrimination on the basis of a person’s gender identity or transgender status can’t be enforced against entities that have sincerely held religious beliefs that preclude them from performing and covering such procedures,” it said.

This decision “protects patients, preserves the integrity of the doctor-patient relationship and vindicates crucial conscience rights in medicine,” a Becket statement said.

After the rule was first issued, Becket filed a lawsuit in the U.S. District Court in Texas, saying the rule violated RFRA.

The lawsuit was filed on behalf of Franciscan Alliance, a religious hospital network serving Indiana and Illinois that now goes by the name Franciscan Health, and the Christian Medical and Dental Associations. The states of Texas, Kansas, Kentucky, Nebraska and Wisconsin also joined in the suit.

In December 2016, two different federal courts ruled “the policy was an unlawful overreach by a federal agency and a likely violation of religious liberty.”

“The decision to undergo gender reassignment therapy is a difficult and deeply personal one, and it is especially complicated and sensitive in the case of children,” the courts said. “It is a health care decision that should be left between a family and their doctor, and not decided by politicians and government bureaucrats.”

Two other federal district court judges also ruled against the mandate in 2019 and 2020, followed by the District Court ruling in North Dakota this past January.

However, the courts didn’t issue a permanent injunction against HHS to prevent it from enforcing this rule in the future, so in early March of this year a group of doctors and hospitals sought such an injunction before the 5th Circuit, which is based in New Orleans.

In 2020, the Trump administration attempted “to fix the unlawful rule,” Becket said, but that effort was blocked by other courts.