Court Blocks Obamacare Transgender Surgery Mandate

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January 20, 2021

A federal court blocked an Obamacare mandate that would compel doctors to perform gender reassignment surgery.

An order of Catholic nuns challenged the mandate under the Religious Freedom Restoration Act, arguing that it forces doctors to violate their consciences and medical judgment. A North Dakota district court judge ruled on Tuesday that nuns and other religious health care providers were harmed by the law.

"Absent an injunction, they will either be 'forced to violate their sincerely held religious beliefs' by performing and covering gender-transition procedures 'or to incur severe monetary penalties for refusing to comply,'" District Court Judge Peter D. Welte wrote. "An injunction will also advance the public interest because the protection of constitutional rights is 'always in the public interest.'"

The decision came hours before President Biden took the oath of office and could complicate some of the new president's health care agenda. Biden has vowed to prioritize transgender rights as president. He pledged to ease access and provide support to those who want to obtain gender transition—also known as gender confirmation—surgery, among other initiatives.

"Biden will ensure that LGBTQ+ individuals have full access to all appropriate health care treatments and resources," his platform stated. "This includes covering care related to transitioning—including gender confirmation surgery."

Biden's prospective cabinet members have made similar pledges. Xavier Becerra, Biden's pick to lead the Department of Health and Human Services, used his position as attorney general of California to push for expanded transgender health care benefits. He helped file an amicus brief that argued in favor of taxpayer funding for gender transition surgery. Biden has also chosen transgender Pennsylvania health official Dr. Rachel Levine for a senior role at HHS.

Supporters of the Obamacare mandate argued that it would eliminate discrimination against transgender people seeking reassignment surgery. Biden echoed those sentiments at a town hall held shortly before the election. While he did not address the surgical procedure, Biden said "there should be zero discrimination" against children who describe themselves as transgender.

Lower courts have split on how anti-discrimination rules apply to transgender individuals. The Obama administration first issued the mandate in 2016 only to see the measure struck down by a Texas federal judge in 2019. In August, a New York federal judge blocked the Trump administration's attempt to reverse the policy.

The Becket Fund, a religious liberty law firm that argued for the plaintiffs, praised Tuesday's decision, saying it would protect doctors against being forced to "perform controversial, medically unsupported procedures that are against their religious beliefs."

"The court’s decision recognizes our medical heroes’ right to practice medicine in line with their conscience and without politically motivated interference from government bureaucrats," senior attorney Luke Goodrich said in a statement.