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Eighth Circuit shields Catholic groups from transgender health care rule

The federal appeals court upheld an order blocking the Biden administration from requiring Catholic hospitals to provide gender-affirming care for transgender patients.

(CN) — A federal appeals court Friday issued a permanent injunction barring enforcement of a Biden administration rule under the Affordable Care Act that would have forced Catholic hospitals to provide transgender medical services that violate their religious beliefs.

Friday's ruling by the St. Louis-based Eighth Circuit is the second decision blocking the rule from taking effect, following an August ruling from the Fifth Circuit in New Orleans.

In 2016, the U.S. Department of Health and Human Services issued a rule implementing Section 1557 of the Affordable Care Act, otherwise known as “Obamacare,” which prohibited discrimination on the basis of sex under Title IX of the Civil Rights Act. The rule's definition of sex discrimination includes gender identity and sex stereotyping.

The government was sued by two groups of Catholic employers and health care providers who object on the basis of their religious beliefs to being forced by the federal government to insure or provide gender-affirming surgeries and related services.

U.S. District Judge Peter D. Welte in North Dakota ruled for the two groups in January 2020, and permanently enjoined enforcement of the rule against the Catholic plaintiffs “in a manner that would require them to perform or provide insurance coverage for gender-transition procedures.” The Donald Trump-appointed judge also permanently enjoined the U.S. Equal Employment Opportunity Commission from similarly interpreting or enforcing Title VII of the Civil Rights Act of 1964 to require the Catholic plaintiffs as employers to provide insurance coverage for sex reassignments.

In affirming the district court decision Friday, an Eighth Circuit panel of three Republican-appointed judges said the trial court correctly held that “intrusion upon the Catholic Plaintiffs’ exercise of religion is sufficient to show irreparable harm.”

Luke Goodrich, vice president and senior counsel at the Becket Fund for Religious Liberty, which represents the plaintiffs in the case, called Friday’s decision a “a common-sense ruling that protects patients, aligns with best medical practice, and ensures doctors can follow their Hippocratic Oath to ‘do no harm.’” 

“The federal government has no business forcing doctors to violate their consciences or perform controversial procedures that could permanently harm their patients,” Goodrich said.

The U.S. Justice Department did not respond to a request for a comment Friday.

In oral arguments before the Eighth Circuit a year ago, the government argued the plaintiffs failed to show any harm from the rule.

Justice Department attorney Ashley Cheung told the panel in December 2021 that the trial court’s injunction was based on positions that the government has not taken.

“The plaintiffs have not demonstrated a credible threat of enforcement,” she said. “The district court’s permanent injunction is based on the premise that HHS and EEOC have interpreted and will enforce Section 1557 of the Affordable Care Act and Title VII [of the Civil Rights Act] to mandate that these religious plaintiffs provide and cover gender transition services. This premise is incorrect.”

In fact, she said, “neither agency has ever taken any enforcement action against any entity for declining to cover transition services, let alone any objecting religious entity.”

In its ruling Friday, however, the Eighth Circuit disagreed.

“Contrary to the government’s position, we conclude that the district court correctly determined that the [Catholic Benefits Association] plaintiffs face a ‘credible threat’ of enforcement” from both Health and Human Services and the Equal Employment Opportunity Commission,” wrote Chief U.S. Circuit Judge Lavenski Smith, who was appointed to the court by George W. Bush.

Smith was joined on the unanimous panel by U.S. Circuit Judges Raymond Gruender, another George W. Bush appointee, and Jonathan Kobes. a Trump appointee.

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