The same judge who ruled last year that Obamacare was unconstitutional has overturned protections for transgender patients, asserting that the guidelines infringed on the religious freedoms of Christian health care providers.
U.S. District Judge Reed O'Connor of the Northern District of Texas struck down Obama-era regulations that prohibited federally funded insurers and health care providers from denying protections based on sexual orientation or gender identity. He also vacated a policy that required doctors to provide "medically necessary" services to transgender patients.
O'Connor ruled on Tuesday that these anti-discrimination provisions, which are outlined in the Affordable Care Act (ACA), violate the federal Religious Freedom Restoration Act. The 1993 law states that the government can't substantially burden a person's right to exercise his or her religion.
It's not the first time that O'Connor has been at the center of a controversial Obamacare case. In a stunning decision in 2018, the conservative judge struck down the ACA on the grounds that its mandate requiring people to purchase health insurance was unconstitutional and that the entire law couldn't stand without it.
That ruling was quickly appealed and is expected to work its way up to the Supreme Court. The case is sitting with the 5th U.S. Circuit Court of Appeals, which heard oral arguments back in July as is expected to make a decision soon. Like his decision in the 2018 case, O'Connor's most recent ruling is also expected to be appealed.

LGBTQ advocates denounced O'Connor's decision on Tuesday, arguing that it is an attack on transgender rights and will allow hospitals to deny treatment to trans patients. The House Ways and Means Committee tweeted that the ruling was "just the latest act in the Trump Admin's crusade to dismantle our nation's healthcare system and turn back the clock on human rights."
Democratic Senator Ed Markey of Massachusetts called the decision "unjust and wrong" and framed it as another reason for Congress to pass the Equality Act.
The Equality Act was approved by the House of Representatives in May but has yet to be taken up in the GOP-controlled Senate. The act would prohibit employment discrimination based on sexual orientation and gender identity, as well as for housing, credit and other federal programs.
O'Connor's decision also comes as several cases concerning LGBTQ rights are being heard by the Supreme Court this term. Many of the cases deal with discrimination, especially in the workplace, and could reshape gay rights in America.
Last week, the Supreme Court heard oral arguments in a case about whether the landmark 1964 Civil Rights Act bars employment discrimination based on sexual orientation and transgender status. If the court rules that the act does cover the LGBTQ community, the decision would apply employment protection to millions of people across the country.
Conservative Justice Neil Gorsuch, who was appointed by President Donald Trump, said that the language in the legislation was "really close, really close" and that he feared a Supreme Court decision, instead of leaving the matter up to Congress, would cause "massive social upheaval."