Texas Leading Suit Over Federal Transgender Health Policy

_{Editor's note: This story has been updated throughout.}

_{*Correction appended}

Ramping up its fight over the rights of transgender people, Texas filed a lawsuit Tuesday against the federal government over a regulation prohibiting discrimination against transgender individuals in some health programs. 

Texas, on behalf of religious hospital network Franciscan Alliance, and four other states are claiming the new federal regulation would force doctors to perform gender transition procedures on children and requested the court to block the federal government from enforcing the regulation. The federal rule on nondiscrimination in health care prohibits denying or limiting coverage for transgender individuals, including health services related to gender transition.

The lawsuit was announced by the Becket Fund for Religious Liberty, which is representing the Franciscan Alliance. It was filed Tuesday morning in the Wichita Falls-based District Court for the Northern District of Texas.

The case was assigned to U.S. District Judge Reed O'Connor, who on Monday sided with the state and blocked the Obama administration's guidelines to accommodate transgender students. Those guidelines say that schools must treat a student's gender identity as the student's sex for the purposes of complying with federal nondiscrimination statutes.

Under the health rule, protections against discrimination based on sex extend to gender identity. The rule applies to health care providers, including hospitals and doctors that accept federal dollars and insurance plans offered through the federal marketplace.

The health care providers and the state are claiming that the federal government is redefining the term "sex" to "thwart decades of settled precedent" and impose "massive new obligations" on health care providers.

Among several legal claims, they argued that the new rule violates the federal Religious Freedom Restoration Act because it compels religiously affiliated health organizations to violate their sincerely held religious beliefs. The federal government is "forcing them to choose between federal funding and their livelihood as healthcare providers and their exercise of religion," the wrote in a court filing.

The federal health rule does not include a blanket exemption for religiously affiliated health care organizations, but it does indicate that those providers could claim exemptions under existing federal religious freedom laws.

A spokeswoman for the U.S. Department of Health and Human Services, which proposed the nondiscrimination rule in May, referred questions about the lawsuit to the Department of Justice. A DOJ spokeswoman declined to comment on the case.

Transgender rights activists say claims that the health rule prevents doctors from using sound medical judgment are unfounded.

The health rule "doesn’t force an individual to do anything in particular" but instead clarifies that health care providers can't deny services or insurance to someone because they're transgender, said Sarah Warbelow, legal director for the Human Rights Campaign.

"The example unfortunately used by individuals who oppose this is that this is going to force doctors to provide transition surgeries to children [but] this doesn't take away a doctor's ability to make informed decisions in the best interest of their patients," Warbelow said. "What the doctor can't do is say, 'I won't treat you because you're transgender.'"

Read more about Texas' fights against nondiscrimination policies for transgender individuals and the federal government: 

• A federal judge in Fort Worth blocked Obama administration guidelines directing the nation’s public schools to allow transgender students to use bathrooms and other facilities that align with their gender identity.
• Since President Obama took office in 2009, the state of Texas has sued his administration at least 42 times. Here's a look at each of those cases.

Correction: An earlier version of this story misidentified the District Court for the Northern District of Texas.