US judge blocks Joe Biden rule adding gender identity protections to healthcare

A US judge on Wednesday blocked the Biden administration from enforcing a new rule against discrimination on the basis of gender identity in healthcare while he hears a lawsuit challenging it by 15 Republican-led states.

The rule was finalized in May by the US Department of Health and Human Services (HHS) and was set to take effect on Friday. It states that a federal prohibition on sex discrimination, part of the Affordable Care Act health insurance law, extends to discrimination against transgender people.

States opposing the new rule had said in their lawsuit that it would require their Medicaid programs covering low-income residents to pay for treatments like hormones and surgeries for transgender people, including for minors. Many Republican states have passed laws banning such treatments, often called gender-affirming care, for minors.

The rule applies to recipients of federal funds, including Medicaid programs. It followed executive orders President Joe Biden issued in 2021 and 2022 instructing agencies like HHS to take measures protecting transgender people from discrimination.

Senior US District Judge Louis Guirola in Gulfport, Mississippi, said in his preliminary order on Wednesday that the Republican states were likely to succeed in their challenge. He said that the administration had overstepped its authority by interpreting “sex” in the federal law to include gender identity.

“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,” Tennessee Attorney General Jonathan Skrmetti, who led the lawsuit alongside Mississippi Attorney General Lynn Fitch, said in a statement. The states opposing the rule also include Georgia, Ohio and Virginia.

HHS did not respond to a request for comment.

“This ruling is not only morally wrong, it’s also bad policy,” Kelley Robinson, president of Human Rights Campaign, an advocacy group supporting transgender rights, said in a statement. “Everyone deserves access to the medical care they need to be healthy and thrive.”

In a court filing, HHS said states’ fears were “speculative” and that the rule did not override doctors’ medical judgment. It said that the states were not entitled to an order blocking the rule because they did not face any imminent enforcement.

Guirola, however, said in Wednesday’s ruling that the cost of ensuring compliance with the rule would be an immediate harm to the states.

Two other judges in Florida and Texas later on Wednesday issued separate, opens new tab rulings, opens new tab siding with other Republican state attorneys general challenging the rule, though those orders only prevented it from being enforced in those two states plus Montana.

US District Judge William Jung, an appointee of Republican former President Donald Trump in Tampa, wrote that nationwide rulings by judges in a single federal district, like Guirola’s, “ought to be the rare exception, not routine.”

The decisions came the week after the US Supreme Court curbed federal agencies’ power by ruling that courts must no longer defer to their interpretation of ambiguous laws. Guirola, who was appointed to the bench by Republican former President George W Bush, noted that ruling, though he ultimately concluded that the law was not ambiguous.