Seven states, together with the American College of Pediatricians (ACPeds), are suing the U.S. Department of Health and Human Services (HHS) over a new Final Rule that forces health care professionals to administer harmful puberty blockers, hormones, and mutilating surgeries. The rule also puts no age limit on these experimental procedures and requires medical insurance providers to pay for them. According to the lawsuit, doctors who use sound medical judgment and refuse to perform the procedures will be financially penalized with exclusion from federally funded insurance programs, such as Medicare and Medicaid.
Co-leading the lawsuit is Missouri and Utah, joined by North Dakota, South Dakota, Iowa, Idaho, and Arkansas, all of which have state laws protecting children from mutilating interventions. The lawsuit states the HHS rule attempts to “override” these state laws, infringes on free speech in medicine, and supersedes conscience protections for doctors all as conditions for receiving federal funding.
As the lawsuit explains, the Biden administration from day one has been implementing a “whole-of-government agenda” to change the definition of “sex” to include “gender identity.” On January 20, 2021, Biden signed an executive orderdirecting federal entities like the HHS to interpret sex discrimination laws as prohibiting “gender identity” discrimination.
Within this framework, in May 2024, HHS released a 182-page Final Rule nesting under the Affordable Care Act (Obamacare) and interprets “sex” to include “gender identity.” The HHS rule, which took effect July 5, requires doctors and insurance companies to provide “equal access without discriminating on the basis of sex” to gender-related procedures regardless of a person’s age or “gender identity.” Under the rule, federally funded entities must not:
“Deny or limit health services sought for purpose of gender transition or other gender-affirming care that the covered entity would provide to an individual for other purposes if the denial or limitation is based on an individual’s sex assigned at birth, gender identity, or gender otherwise recorded.”
For example, the lawsuit alleges that if a health care entity performs hysterectomies or mastectomies on women and girls for therapeutic reasons, such as treating cancer, then the rule requires those entities to perform the same procedures on those with gender confusion who seek to appear as the opposite sex. ACPeds, a national nonprofit medical association with about 400 member physicians and professionals, noted in the lawsuit its members have “substantial, science-based objections” to “gender-transition” efforts. The lawsuit states “it is impossible to change a person’s sex.” However, ACPeds and the seven states claim the HHS rule is “based on politics, not science” and would prohibit them from speaking in ways that criticize or deny the medical legitimacy of “gender transitions.”
The HHS rule states, “…the rejection of a practice closely linked with a protected status may, in conjunction with other evidence, lead to a finding of discrimination.”
In addition, the lawsuit alleges the HHS rule will force doctors and insurers receiving federal funding:
- to “speak falsely” and fatally undermine their own medical ethical standards.
- to refer to patients by pronouns the patients prefer.
- to “tell patients that males can get pregnant, give birth, and breastfeed.”
- to not raise objections to gender procedures based on patients who regret having them.
According to the lawsuit, the HHS rule “creates a regime” of doctors and health insurers to silently perform and pay for these “harmful” and often irreversible procedures.
Ultimately the states and ACPeds are seeking an injunction to permanently block the rule arguing that HHS “arbitrarily” redefined “sex” to include “gender identity,” which exceeds its authority and “usurps” the role of Congress. They also allege the rule violates the rights of free speech, association, assembly, and unlawfully preempts state laws.
The rule imposes on doctors and health insurers a “no-win choice” of compromising their convictions, face financial punishment, or leave the field of medicine and abandon their patients, stated the lawsuit.
This legal challenge comes on the heels of four ongoing lawsuits against two other Biden administration rules. As per Biden’s executive order, these rules also infuse gender identity into the definition of “sex.” In these lawsuits, four federal courts have ruled against the Biden administration striking down these rules. Last week, a federal judge in Mississippi ordered a nationwide injunction blocking a different HHS Final Rule forcing states to use taxpayer dollars to pay for puberty blockers, hormones, and mutilating surgeries. Since June, three other U.S. district judges have blocked the Department of Education’s rewrite of a Title IX Final Rulewhich requires schools receiving federal dollars to force women and girls to share private spaces with gender-confused males. These three injunctions block the rule’s enforcement across 14 states, such as Alaska, Idaho, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Montana, Ohio, Tennessee, Utah, Virginia, West Virginia, and Wyoming.
Currently, 25 states ban harmful puberty blockers, hormones, and mutilating surgeries for children.
Liberty Counsel Founder and Chairman Mat Staver said, “Doctors should never be forced to harm children and health insurers should never be compelled to pay for this radical agenda. Gender ideology is completely detached from science and reality. Courts should continue to strike down these rules.”
