Texas and Montana are suing the Biden administration over a new rule preventing state Medicaid programs from banning gender-transitioning care, The Hill reported.
The lawsuit, filed Monday by Republican Attorneys General Ken Paxton of Texas and Austin Knudsen of Montana, seeks to overturn a final rule designed to strengthen healthcare protections against discrimination for gay and transgender individuals.
The states contend that the rule is unconstitutional, arguing that it seeks to supersede state law and that the Affordable Care Act, former President Barack Obama's healthcare law, did not permit the U.S. Department of Health and Human Services or any government entity to mandate institutions to provide or cover the costs of gender-transitioning treatments.
"Through a sweeping new rule promulgated under the Affordable Care Act (ACA), those who do not conform to the Biden Administration's gender-ideology regime stand to lose all federal healthcare funds, including Medicaid and Medicare dollars," the lawsuit states.
The complaint focuses on Section 1557 of the ACA, which prohibits discrimination based on race, color, national origin, sex, age, and disability in certain health programs and activities. This section has been the subject of significant litigation over the past decade, with advocacy groups and lawmakers debating its interpretation.
Under the Obama administration, sex nondiscrimination protections were expanded to include gender identity and sex stereotyping but did not cover sexual orientation. The Trump administration rolled back these protections, which the Biden administration has since reinstated and expanded to include sexual orientation.
The recent regulation from the Biden administration, issued in late April, mandates that entities receiving federal health funding and health insurers participating in government plans must not deny gender-transitioning care available for other medical reasons. The rule also explicitly forbids any exclusions of such care.
For example, if a service is covered for treating a medical condition like uterine cancer, it must also be covered for gender-transitioning purposes.
The rule maintains that federal protections for religious freedom and conscience remain applicable. Healthcare providers are not considered to be discriminating if they refuse to provide abortion or other care conflicting with a "sincerely held belief."
However, the rule asserts that Section 1557 supersedes state laws restricting access to gender-transitioning care.
"The rule will wreak financial havoc on Montana's medical system as the state receives around two billion dollars in federal financial aid administered by HHS every year. This new rule places unlawful strings on that aid, penalizing Montana for attempting to protect its citizens from harmful medical procedures and for declining to insure those procedures in its health plans," Knudsen said in a statement.
Jim Thomas ✉
Jim Thomas is a writer based in Indiana. He holds a bachelor's degree in Political Science, a law degree from U.I.C. Law School, and has practiced law for more than 20 years.
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