Catholic health care organizations that receive federal funding cannot be required to provide or pay for gender transition procedures if they have religious objections, a federal appeals court ruled Friday.
The case is the latest in a series of legal battles over whether gender-affirming care is protected under the Affordable Care Act’s nondiscrimination provisions. Protections based on gender identity and sexual orientation were originally written into law under President Barack Obama but were repealed under President Donald Trump. A draft statute reinstating anti-discrimination rules was released in July, citing a 2020 Supreme Court ruling that employers cannot fire workers because they are gay or transgender. During the ongoing rulemaking process, HHS considers gender identity and sexual orientation to be included in the ACA’s statutory language, even though the law does not explicitly refer to these attributes.
A three-judge U.S. Court of Appeals for the Eighth Circuit dissented, ruling that the statute could punish Catholic health systems and other organizations that uphold their religious beliefs, which they say is unconstitutional. The U.S. Court of Appeals for the Fifth Circuit issued a similar ruling in August, ruling that Christian providers are not required to perform abortions or sex reassignment procedures that violate their religious beliefs.
The Eighth Circuit Panel Opinion states that less restrictive alternatives exist, including government-funded gender transition health care, creating financial incentives for employers to provide gender transition services, or Refer the patient to a community health center.
Plaintiffs in the case include the Sisters of Mercy, Sacred Heart of Mercy Health Care in Alma, Michigan, SMP Health System in Fargo, North Dakota, the University of Mary, and the Catholic Welfare Association, a Catholic legal advocacy organization employer.