Catholic health organizations can deny trans care, court rules

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Catholic healthcare organizations that receive federal dollars cannot be required to provide or pay for gender-transition procedures if they have religious objections to them, a federal appeals court ruled Friday.

The case is the latest in a series of legal battles determining whether gender-affirming care is protected under the Affordable Care Act’s nondiscrimination regulations. Protections based on gender identity and sexual orientation were initially enshrined into law during President Barack Obama’s administration but were scrapped during Donald Trump’s presidency.

Under President Joe Biden, the Health and Human Services Department sought to reinstate the anti-discrimination rule by issuing a draft regulation in July that cites a 2020 Supreme Court ruling that employers cannot fire workers for being gay or transgender. During the ongoing rulemaking process, HHS has considered gender identity and sexual orientation to be covered under the ACA’s statutory language, even though the law doesn’t explicitly mention those attributes.

A three-judge panel from the U.S. Court of Appeals for the 8th Circuit disagreed, ruling that the regulation threatens to penalize Catholic health systems and other organizations for adhering to their religious beliefs, which they found to be unconstitutional. The U.S. Court of Appeals for the 5th Circuit decided similarly in August, ruling that Christian providers are not required to perform abortions or gender-transition surgeries that would violate their religious beliefs.

The 8th Circuit panel’s opinion notes that less-restrictive alternatives exist, including government-sponsored healthcare for gender transitions, the development of financial incentives to encourage employers to offer gender-transition services or redirecting patients to community health centers.

Plaintiffs in the case include the Religious Sisters of Mercy, Sacred Heart Mercy Health Care Center in Alma, Michigan, SMP Health System of Fargo, North Dakota, the University of Mary, and the Catholic Benefits Association, a legal advocacy group for Catholic employers.

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