On Aug. 9, a federal judge in Texas blocked an Obama-era mandate—which was reinstated by the Biden administration—that forced all medical professionals and hospitals to perform abortions and gender-transition procedures, even if they had moral or religious objections. The mandate also compelled all private health insurance companies to cover such procedures. 

Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas granted a permanent injunction, writing that the mandate violated the Religious Freedom Restoration Act (RFRA) by “placing substantial pressure on Christian plaintiffs, in the form of fines and civil liability, to perform and provide insurance coverage for gender-transition procedures and abortions.”

In 2016, the Obama administration implemented the regulation via Section 1557 of the Affordable Care Act. Section 1557 “prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs or activities.” When it came to addressing the term sex, the Obama administration argued that it included sexual orientation and gender identity too. In implementing what is often called the “Transgender Mandate,” the administration did not include any religious exemptions for health care workers, providers or insurers. 

The case of Franciscan Alliance v. Becerra was brought by a religious hospital, an association of over 20,000 health care professionals and nine states. A district court issued a preliminary nationwide injunction against the mandate on Dec. 31, 2016, noting that the mandate “likely violates” the RFRA.

In the most recent ruling, O’Connor concluded that a permanent injunction was necessary because “the RFRA violation is clear and the threat of irreparable harm is present.”

“Today’s ruling is a victory for compassion, conscience and common sense,” said Luke Goodrich, vice president and senior counsel at Becket, the law firm representing the plaintiffs. “No doctor should be forced to perform controversial, medically unsupported procedures that are contrary to their conscience and could be deeply harmful to their patients.

“These religious doctors and hospitals provide top-notch medical care to all patients for everything from cancer to the common cold,” he added. “Everyone benefits when doctors are able to follow their professional medical judgment and their Hippocratic Oath to ‘Do No Harm.’”  

The Biden administration has 60 days to decide whether to appeal the court’s ruling.