2 Religious Health Care Providers Can Deny Abortions, Gender-Transition Treatment: Judge

A judge ruled two religious health care providers can deny abortions, gender-transitioning treatments and other procedures which go against their beliefs, the Associated Press reported.

The injunction benefits the 19,000 members of the Franciscan Alliance and the Christian Medical & Dental Associations.

U.S. District Court Judge Reed O'Connor ruled that the U.S. Department of Health and Human Services violated the Religious Freedom Act, which prohibits the government from burdening a person's exercise of religion.

O'Connor said the HHS regulations forced providers to choose between religious beliefs and their livelihood which would lead to "irreparable injury."

The HSS denied that the Affordable Care Act required religious providers to perform procedures that go against their beliefs when the plaintiffs first sued in 2016. The HHS added that it never threatened to enforce rules like that either.

For more reporting from the Associated Press, see below.

Religious Health Care Providers, ACA Injunction
A judge ruled that religious health care providers don't have to provide services that go against their beliefs such as abortions or gender-transitioning treatment. A demonstrator holds a sign in front of the US Supreme Court in Washington, DC, on November 10, 2020, as the high court opened arguments in the long-brewing case over the constitutionality of the 2010 Affordable Care Act, under which then-president Barack Obama's government sought to extend health insurance to people who could not afford it. Nicholas Kamm/Getty Images

The decision underscores a continued dispute between conservative religious health care providers and HHS over an issue that has generated a patchwork of rulings that will likely have to be sorted out by appellate courts.

The injunction benefits only the plaintiffs — Franciscan Alliance, a Catholic hospital network in Indiana and Illinois, and the Christian Medical & Dental Associations and their 19,000 members nationwide — though O'Connor voided the disputed portions of the law in the earlier ruling.

Another federal judge issued a similar decision in favor of a Catholic health system in North Dakota in January. The Biden administration is appealing it.

The plaintiffs in O'Connor's Texas court sued in 2016 over Affordable Care Act-related rules issued by HHS that year under the Obama administration. Those rules — applying to most medical providers by virtue of their participating in federally funded programs — barred discrimination based on factors including sex, interpreted as including gender identity, and pregnancy status, such as "termination of pregnancy."

An HHS analysis at the time said health care institutions that, for example, perform hysterectomies for medical purposes would need to provide them to transgender men, though the rules said separately that federal protections for religious freedom and conscience would supersede any requirements. The analysis also noted that the ACA and other federal laws protected medical providers from having to provide abortions.

O'Connor in 2019 voided the parts of the rules barring discrimination based on gender identity and termination of pregnancy.

The Trump administration strengthened religious exemptions in 2020 and eliminated protections for gender identity — although other federal courts temporarily blocked that change. It was also soon followed by a Supreme Court ruling that interpreted the federal ban on sex discrimination as also prohibiting discrimination based on gender identity.

This May, HHS said it would interpret its rules according to that Supreme Court ruling but would also abide by previous court rulings such as that of O'Connor. The judge, in ordering the permanent injunction this week, said that was a contradiction.

Attorney Luke Goodrich, who represented the plaintiffs on behalf of Becket, a legal organization focused on religious liberty, applauded the decision.

"Everyone is better off when these doctors and hospitals can continue to provide top-notch medical care" without violating their consciences, he said.

But Omar Gonzalez-Pagan, senior attorney and health care strategist at Lambda Legal, which focuses on LGBTQ rights, said "the court and the plaintiffs were fabricating a controversy" when there "has been no threat of enforcement against the plaintiffs."

He noted there are conflicting federal court decisions on defining sex discrimination in the ACA rules, and "at some point and time there will be a consensus among the courts or the Supreme Court may have to intervene."

Lindsey Kaley, staff attorney with the American Civil Liberties Union's Center for Liberty, said the ruling limits federal enforcement but "does not change the fact that transgender people who have been turned away from health care can continue to pursue litigation." The ACLU's Texas branch intervened on behalf of HHS.

"Gender-affirming care is life-saving care, and doctors agree that it is medically necessary for many transgender people," Kaley said.

Religious Heath Care Providers, ACA Injunction
U.S. District Court Judge Reed O’Connor issued the injunction after he ruled that the U.S. Department of Health and Human Services violated the Religious Freedom Act. A general view of the U.S. Supreme Court on June 1, 2021 in Washington, DC Drew Angerer/Getty Images