Five states, led by Texas, and several nonprofit medical groups, all of which are religiously affiliated, filed a lawsuit on Tuesday challenging the Obama administration's efforts to ensure health care coverage to transgender people under the Affordable Care Act (ACA).
"On pain of significant financial liability, the [Health and Human Services Department's] Regulation forces doctors to perform controversial and sometimes harmful medical procedures ostensibly designed to permanently change an individual’s sex—including the sex of children," the complaint in the lawsuit alleges.
The lawsuit also contains claims challenging abortion-relation coverage protections in the same regulation, specifically highlighting the lack of a religious exemption in the regulation or underlying ACA provision.
The lawsuit was filed in the same division of the Northern District of Texas — the Wichita Falls Division — as the state's prior multi-state lawsuit challenging the Obama administration's other pro-transgender policies was filed. The judge in that division, US District Court Judge Reed O'Connor, issued a preliminary injunction on Sunday preventing the administration from advancing its efforts to protect transgender people under Title IX of the Education Amendments of 1972.
The new lawsuit — also assigned to O'Connor — alleges that a regulation under the ACA similarly "redefines 'sex' to include 'an individual’s internal sense of gender, which may be male, female, neither, or a combination of male and female, and which may be different from an individual’s sex assigned at birth.'"
The HHS regulation, the lawsuit alleges, "not only forces healthcare professionals to violate their medical judgment, it also forces them to violate their deeply held religious beliefs."
Specifically, the ACA provision — Section 1557 — prohibits discrimination in federally-funded health benefits, including based on sex. Over the course of 2015 and this year, HHS proposed and finalized a regulation interpreting the definition of "sex" in that provisions to include "gender identity" — defined as "internal sense of gender, which may be male, female, neither, or a combination of male and female" — as well as "sex stereotyping" and "termination of pregnancy."
The lawsuit alleges that the rule affects the states' efforts to protect standard of care, authority over medical facilities, and efforts to comply with other federal laws that they allege conflict with the new rule. The rule affects the medical groups' "medical, ethical, and religious concerns" due to their "infusion of faith into healthcare." Specifically, the rules, the lawsuit alleges, will require the groups "to provide insurance coverage for services that violate [their] religious beliefs."
The lawsuit claims that the rule violated the Administrative Procedure Act (APA) because the new rule is "not in accordance with law"; is "in excess of statutory jurisdiction, authority, or limitations"; and is "arbitrary, capricious, and an abuse of discretion" — specifically in violation of the Spending Clause of the U.S. Constitution, as well as the First, Fifth, Tenth, and Fourteenth amendments and the Religious Freedom Restoration Act. Additionally, the lawsuit claims independent related constitutional violations.
The Texas Attorney General's Office has led a series of multi-state efforts challenging federal policies put forth by the Obama administration, including its successful effort to stop the administration's Deferred Action for Parents of Americans (DAPA) immigration executive action — a case that went all the way to the US Supreme Court earlier this year.
The religiously affiliated nonprofit groups, meanwhile, are represented by the Becket Fund for Religious Liberty. The Becket Fund has been one of the key groups backing religious-based challenges to the Affordable Care Act, including, most notably, the Hobby Lobby challenge to the HHS contraception mandate rule issued under the ACA.