A New Court Ruling Could Make Health Care Harder to Get for Transgender People

A federal judge in Texas on Saturday ordered a halt to another Obama administration effort to strengthen transgender rights, this time over health rules that social conservatives say could force doctors to violate their religious beliefs.

The latest injunction signed by U.S. District Judge Reed O'Connor comes four months after he blocked a higher-profile new set of transgender protections—a federal directive that required public schools to let transgender students use bathrooms consistent with their gender identity. Several of the Republican-controlled states that brought that lawsuit, including Texas, also sued over the health regulations that were finalized in May.

Civil rights groups had hailed the new health rules as groundbreaking anti-discrimination protections. The Transgender Legal Defense & Education Fund said the new U.S. Health and Human Services regulations advised that certain forms of transgender discrimination by doctors, hospitals and insurers violated the Affordable Care Act.

But a coalition of religious medical organizations said the rules could force doctors to help with gender transition contrary to their religious beliefs or medical judgment. O'Connor agreed in his 46-page ruling, saying the rules place "substantial pressure on Plaintiffs to perform and cover transition and abortion procedures." The rules were set to take effect Sunday.

"Plaintiffs will be forced to either violate their religious beliefs or maintain their current policies which seem to be in direct conflict with the Rule and risk the severe consequences of enforcement," O'Connor wrote. Transgender rights advocates have called that a far-fetched hypothetical, saying a person would not approach a doctor who lacked suitable experience and expertise.

The Transgender Legal Defense & Education Fund criticized the injunction as contrary to existing law and said it expects the ruling to be overturned on appeal. "Judge O'Connor's conclusion that transgender people and persons who have had abortions are somehow excepted from protection is deeply troubling, legally specious, and morally repugnant," said Ezra Young, the organization's director of impact litigation.

Federal officials did not immediately react to the ruling, and adding to the uncertainty is a new administration under President-elect Donald Trump. Many transgender people expect him to abandon or weaken the transgender protection efforts pursued by the Obama administration. Trump sent mixed signals about his approach to transgender rights during his campaign, at one point saying transgender celebrity Caitlyn Jenner could use whatever bathroom she preferred in one of his luxury buildings.

At the same time, Trump has declined to repudiate a divisive North Carolina law that restricts transgender people's bathroom access. He has said such policy decisions should be left up to the states.

O'Connor's ruling also comes amid the fears of transgender people that more GOP-governed states will approve legislation limiting transgender rights and will reject proposals to expand such rights.

Joining Texas in the lawsuit over the health regulations were Wisconsin, Kentucky, Nebraska and Kansas, along with the Christian Medical and Dental Association and Franciscan Alliance, an Indiana-based network of religious hospitals.

The Obama administration finalized the regulations around the time it issued its directive to public schools regarding transgender students. Thirteen states signed on to fight that directive, including three involved in the health regulations lawsuit, and won a temporary injunction in August from O'Connor.

At the time, O'Connor wrote in that case that the federal education law known as Title IX "is not ambiguous" about sex being defined as "the biological and anatomical differences between male and female students as determined at their birth."

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