Bush judge blocks Joe Biden’s new LGBTQ+ health care protections

Close up of doctor lab coat wearing a stethoscope and heart-shaped trans flag pin
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A federal judge blocked the Biden administration’s new healthcare discrimination protections for LGBTQ+ people, many aimed at trans people. The ruling could make it harder for trans people to get coverage for gender-affirming care.

Biden’s Department of Health and Human Services (HHS) introduced a series of changes to Section 1557 (the nondiscrimination provision) of the Affordable Care Act to extend and strengthen protections for LGBTQ+ people under the argument that bans on discrimination on the basis of sex also ban anti-LGBTQ+ discrimination because it’s impossible to discriminate against LGBTQ+ people without taking sex into account. Though the changes were set to go into effect on Friday, the judge’s ruling blocks enforcing the protections.

District Judge Louis Guirola Jr., who was appointed by George W. Bush, issued the ruling on Wednesday. He wrote that allowing the protections would “cause concrete, imminent injury in the form of compliance costs or lost federal funding.”

HHS says that the rule’s definition of sex discrimination aligns with a 2020 Supreme Court decision that protects employees from discrimination based on sexual orientation and gender identity, Bostock v. Clayton Co.

This is a win for Republicans. Fifteen Republican-led states sued the Biden administration in June, saying that the changes to the provision force their own state health regulations to align “with a regime that sides with HHS’s commitment to gender ideology over medical reality.” They argued that their Medicaid programs would be forced by the rule changes to cover gender-affirming care.

Tennessee’s Republican Attorney General Jonathan Skrmetti led the lawsuit. He said, “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.”

“The administration has over and over again issued regulations that mangle the law to advance an ideological agenda.”

The rule would have brought back Obama-era rules, which said that the provision also banned anti-LGBTQ+ discrimination.

During Donald Trump’s tenure as president, the rules were rolled back, and doctors were allowed to deny care to LGBTQ+ patients. The so-called  “Denial of Care Rule” allowed doctors, nurses, pharmacists, billing staff, receptionists, and emergency responders to claim a religious exemption from doing their jobs.

The Human Rights Campaign strongly condemned the ruling. HRC President Kelley Robinson said, “The discrimination LGBTQ+ people will continue to experience under this injunction is indefensible. This ruling is not only morally wrong, it’s also bad policy. 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.”

HRC also noted that under the new ruling, there could be increased incidents of doctors denying hormone replacement therapy (HRT) for trans people, verbal or physical abuse by doctors towards LGBTQ+ people, and denying LGBTQ+ people from receiving care.

“The consequences of this preliminary injunction may impact many patients across the country. Without enforcement of Section 1557 against discrimination based on gender identity, health care providers who receive federal funding may be encouraged to discriminate and deny coverage, limiting, and under some circumstances, denying critical access to necessary medical services for patients in need,” the press release further states.

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