A federal judge on Thursday struck down a former President Biden-era rule that extended federal health anti-discrimination protections to gender-affirming care.
Judge Louis Guiroloa Jr. of the U.S. District Court for the Southern District of Mississippi ruled in favor of a coalition of 16 GOP-led states that had sued over the rule, which broadened sex discrimination by adding sex and gender identity to the list of protected characteristics in certain health programs and activities.
The Department of Health and Human Services “exceeded its authority by implementing regulations redefining sex discrimination and prohibiting gender identity discrimination,” Guiroloa ruled.
The decision is a significant loss for the transgender community, which is has faced a wave of state and federal policies and court decisions rolling back previously established rights.
The complaint centered on provisions in Section 1557 of the Affordable Care Act, which the Biden administration interpreted to bolster health care protections against discrimination for gay and transgender people.
The rule prevented covered entities from discriminating against certain protected groups in providing health care services, insurance coverage and program participation.
The challenged provision added gender identity to Title IX’s definition of discrimination “on the basis of sex,” which previously included discrimination based on sex characteristics, pregnancy, sexual orientation and sex stereotypes.
The Biden administration’s final rule, which was released in 2024, said organizations receiving federal health funding and health insurers that do business through government plans cannot refuse to provide gender-affirming care services that would be provided to an individual for other purposes.
The rule was first created under Obama in 2016. President Trump then reversed it during his first term before the Biden administration turned it back again.
The first Trump policy kept protections against discrimination based on race, color, national origin, sex, age or disability. But the administration narrowed the definition of sex to only mean “biological sex,” cutting out transgender people from the protections.
Guiroloa ruled that a statute “cannot be divorced from the circumstances existing at the time it was passed.”
The word “sex” is not defined in the statute, so the court said it must interpret the term according to its meaning in or around 1972, when the statute was enacted. At that time, the definition focused on the reproductive distinctions between males and females.
Guiroloa vacated the rule universally, meaning it’s not limited to the 15 red state plaintiffs. But the impact is likely limited because the rule had not taken effect.
In a statement, Tennessee Attorney General Jonathan Skrmetti celebrated the decision.
“Our fifteen-State coalition worked together to protect the right of health care providers across America to make decisions based on evidence, reason, and conscience. This decision restores not just common sense but also constitutional limits on federal overreach, and I am proud of the team of excellent attorneys who fought this through to the finish,” he said in a statement.
