Judge blocks Biden administration's new transgender health protections

A federal judge on Wednesday temporarily blocked enforcement of a new Biden administration rule bolstering health care protections for LGBTQ people, handing a preliminary legal victory to more than a dozen Republican-led states that challenged it in court. 

The Department of Health and Human Services (HHS) in May unveiled a final set of sweeping changes to Section 1557, the nondiscrimination provision of the Affordable Care Act. The changes, which had been slated to take effect Friday, expand the rule’s definition of sex discrimination to include discrimination based on sexual orientation and gender identity, angering officials in conservative states. 

Fifteen GOP-led states — Tennessee, Mississippi, Alabama, Georgia, Indiana, Kansas, Kentucky, Louisiana, Nebraska, Ohio, Oklahoma, South Carolina, South Dakota, Virginia and West Virginia — sued the Biden administration in June, arguing in a federal lawsuit that the new rule supplants their health regulations “with a regime that sides with HHS’s commitment to gender ideology over medical reality.” 

States “could not have foreseen” that Section 1557 would be implemented in the way it has by the Biden administration, they argued. The latest interpretation of the law, the states said, “unlawfully coerces compliance” by threatening to strip billions of dollars in federal funding from state health programs that have come to rely on it. 

HHS, responding to the lawsuit, countered that the rule’s updated definition of sex discrimination is in line with a 2020 Supreme Court decision protecting employees from discrimination based on sexual orientation and gender identity. The department added that covered entities will not violate Section 1557 if they have “a legitimate nondiscriminatory reason for denying care or coverage to a transgender person.” 

District Judge Louis Guirola Jr., a President George W. Bush appointee, sided with the states in a ruling Wednesday. Allowing the Biden administration’s rule to take effect, he wrote, would “cause concrete, imminent injury” in the form of compliance costs or lost federal funding. 

Tennessee’s Republican Attorney General Jonathan Skrmetti, who led the states in their lawsuit, celebrated Guirola’s decision Wednesday in a statement. 

“Today a federal court said no to the Biden administration’s attempt to illegally force every health care provider in America to adopt the most extreme version of gender ideology,” Skrmetti said. “The administration has over and over again issued regulations that mangle the law to advance an ideological agenda.” 

“Today’s order puts the rule on pause while we keep fighting to ensure this illegal rule never goes into effect,” he added. 

HHS did not immediately return a request for comment. 

In a statement, Kelley Robinson, president of the Human Rights Campaign, a national LGBTQ advocacy group, called Guirola’s ruling “morally wrong.” 

“The discrimination LGBTQ+ people will continue to experience under this injunction is indefensible,” Robinson said. "Everyone deserves access to the medical care they need to be healthy and thrive. Instead, this court has sided with the fringe groups and politicians who want to bully our community at every opportunity. This isn’t over: all LGBTQ+ people should receive the health care they deserve and be able to make informed decisions about our own bodies.”