Texas and Montana Legal Action Against Biden Administration Regarding Gender-Transitioning Care Regulation

Texas and Montana are taking legal action against the Biden administration regarding a new rule that prevents state Medicaid programs from prohibiting gender-transitioning care, as reported by The Hill.

Republican Attorneys General Ken Paxton of Texas and Austin Knudsen of Montana filed the lawsuit on Monday, aiming to overturn a final rule that enhances healthcare protections against discrimination for gay and transgender individuals.

Both states argue that the rule is unconstitutional, claiming it overrides state law and that the Affordable Care Act, the healthcare law established by former President Barack Obama, did not authorize the U.S. Department of Health and Human Services or any government entity to mandate institutions to offer or cover the expenses of gender-transitioning treatments.

The lawsuit contends that under the new rule issued under the ACA, individuals who do not adhere to the Biden administration’s gender ideology may lose all federal healthcare funding, including Medicaid and Medicare funds.

The legal challenge focuses on Section 1557 of the ACA, which prohibits discrimination based on various factors in certain health programs and activities, such as race, color, national origin, sex, age, and disability. This section has been a subject of heated litigation over the past decade, with differing interpretations by advocacy groups and lawmakers.

During the Obama administration, sex nondiscrimination protections were expanded to incorporate gender identity and sex stereotyping but did not encompass sexual orientation. The Trump administration subsequently reversed these protections, which have now been reinstated and broadened by the Biden administration to include sexual orientation as well.

The latest regulation enacted by the Biden administration in late April mandates that organizations receiving federal health funding and health insurers participating in government plans cannot deny gender-transitioning care that is available for other medical reasons. The rule explicitly prohibits any exclusions of such care.

As an example, a service covered for treating a medical condition like uterine cancer must also be covered for gender-transitioning purposes.

The rule underscores that federal protections for religious freedom and conscience remain intact. Healthcare providers are not discriminatory if they decline to provide services that conflict with their sincerely held beliefs, such as abortion.

However, the rule asserts that Section 1557 takes precedence over state laws that restrict access to gender-transitioning care.

A statement from Knudsen highlights the potential financial impact on Montana’s medical system, given that the state receives approximately two billion dollars in federal financial aid managed by HHS annually. Knudsen argues that the new rule imposes impermissible conditions on this aid, penalizing Montana for safeguarding its citizens from harmful medical procedures and for not covering these procedures in its health plans.