A federal court in North Dakota ruled Jan. 19 that an order of Catholic nuns, a Catholic university and Catholic health care organizations could not be forced to violate their religious beliefs by performing or providing insurance coverage for gender transition procedures.

In 2016, the Obama administration implemented a new regulation through the Affordable Care Act commonly known as the “transgender mandate.” The mandate prohibited “sex” discrimination in health care—meaning hospitals, insurance companies and other health care entities that received federal funding were required to cover or perform abortions and gender reassignment surgeries, even if they had religious objections.

In response, Becket, a religious liberty law firm, filed suit in November 2016 against then Health and Human Services (HHS) Secretary Sylvia Burwell on behalf of the Sisters of Mercy, the University of Mary and SMP Health System in North Dakota. The State of North Dakota eventually joined Becket’s legal challenge as well.

Under the Trump administration, HHS broadened the exemptions for the regulation in 2020. However, these changes were complicated by the Supreme Court decision last year in Bostock v. Clayton County, which concluded that Title VII of the Civil Rights Act of 1964 applies to sexual orientation and gender identity when it speaks of sex discrimination—even though neither category is specifically mentioned in federal discrimination law.

In his Jan. 19 opinion, U.S. District Court Judge Peter Welte decided that the Bostock ruling did not fully return HHS to the 2016 version of the rule, noting that the Supreme Court “separately expressed continued commitment to safeguarding employers’ religious convictions.”

Welte cited the Religious Freedom Restoration Act (RFRA), writing, “An RFRA violation is comparable to the deprivation of a First Amendment right.”

He went on to explain that without an injunction, the doctors and insurance providers would be forced to violate their sincerely held religious beliefs and would face fines for refusing to comply with the HHS regulation. But an injunction, he wrote, will “advance the public interest, because the protection of constitutional rights is ‘always in the public interest.’”

Welte then granted permanent injunctive relief to the Catholic entities and concluded that they are exempted from HHS’ mandate.

Luke Goodrich, senior counsel at Becket, celebrated the decision:

“Now more than ever, Americans are grateful for the sacrifices of our medical professionals who serve on the front lines and use their training and expertise to serve the vulnerable,” he said. “The court’s decision recognizes our medical heroes’ right to practice medicine in line with their conscience and without politically motivated interference from government bureaucrats.”

Photo: Rui Santos/Alamy Stock Photo