Court Rules for Catholic Groups Seeking “Right to Refuse” Transgender Healthcare

A federal court in North Dakota has ruled that certain Catholic healthcare providers and organizations can refuse to perform gender-confirming procedures, and also may deny insurance coverage for gender-confirming healthcare to church employees.

The Catholic Benefits Association (CBA), a group of 65 dioceses and 1,100 Catholic Church-affiliated institutions, was the plaintiff in a 2016 lawsuit against the U.S. Department of Health and Human Services, that argued against the implementation of protections for transgender individuals in the Affordable Care Act (ACA). The lawsuit notably also included reference to the language prohibiting discrimination “on the basis of sex” under Title VII of the Civil Rights Act.

President Joe Biden, however, has issued an executive order instructing federal organizations to interpret the language of “on the basis of sex” to include LGBTQ individuals. In contrast, the North Dakota ruling “prevents the United States Equal Employment Opportunity Commission from issuing similar mandates or enforcement actions based on how it interprets sex discrimination under Title VII of the 1964 Civil Rights Act,” Crux reported.

The ruling provided a “permanent injunction” for the members of the CBA, as well as the Sisters of Mercy, the University of Mary, and Sisters of Mary of the Presentation Health System in North Dakota. The ruling does not automatically allow any other Catholic organization to refuse services to transgender individuals, but the decision may be referenced as precedent in future court cases.

Furthermore, Crux noted in a clarification that “the permanent injunction in the Catholic Benefits Association case benefits not its present but also its future members,” thus, certain Catholic employers could refuse coverage to transgender individuals “by joining the CBA.”

Crux reported that certain church leaders have opposed legal protections for transgender individuals and the LGBTQ community, reporting:

“…Several prelates including Cardinal Timothy Dolan of New York and Archbishop Paul Coakley of Oklahoma City spoke out against [Joe Biden’s executive] order in a statement, stating ‘it threatens to infringe the rights of people who recognize the truth of sexual difference or who uphold the institution of lifelong marriage between one man and one woman’.”

A related 2016 case against the ACA’s so-called “transgender mandate” was filed by the Becket Fund, a conservative legal organization that has frequently targeted LGBTQ rights. The Becket Fund received a “vacatur” decision which allows them to “essentially set aside the mandate,” according to Crux, but did not give them a permanent injunction. The organization plans to appeal the ruling to seek a permanent injunction.

The Biden administration has not yet announced whether it will appeal the ruling to seek the federal enforcement of protections for LGBTQ individuals.

These rulings from a federal court are disappointing, but this is only the beginning of a longer battle to secure protections for LGBTQ persons. The CBA, The Becket Fund, and others who seek a “right to refuse” performing gender-confirming healthcare, as well as deny insurance coverage for such care to LGBTQ employees are engaged in a legal battle against both the Supreme Court’s recent Bostock ruling and President Biden’s executive order.

The permanent injunction granted to the CBA is a major blow to LGBTQ people who are employed by church institutions affiliated with CBA or are patients in such institutions’ care. But the injunction does not yet provide a substantial challenge to non-discrimination protections on a federal level. This fact, as well as the fact that the case could yet be appealed by the Biden administration, means that the fight is long from over. Furthermore, Catholic organizations such as the CBA would do well to remember that Catholic values include protecting vulnerable people generally, and, LGBTQ individuals, specifically, from  discrimination.

Madeline Foley, New Ways Ministry, February 27, 2021

1 reply
  1. Don E Siegal
    Don E Siegal says:

    Catholic Benefits Association

    1) A federal court in North Dakota has ruled that certain Catholic healthcare providers and organizations can refuse to perform gender-confirming procedures, and

    2) Also, may deny insurance coverage for gender-confirming healthcare to church employees.

    As a retired health care provider in the field of dentistry in the specialty of periodontics. I see this as a two-pronged issue. I do not believe a Catholic healthcare provider or organization should be forced to perform procedures that they consider to be morally unjust. That being said, I also believe it is morally wrong to deny healthcare benefits for gender-confirming procedures.

    There is yet another guideline that has to be considered in this situation. That is, “The Standard of Care” precept. If the established standard of care guideline for treating gender dysphoria includes gender-confirming procedures, then those procedures rightfully must be made available to the patient. The significance of this precept is, if a care giver is unable to provide that treatment for any reason, they are legally obligated to provide an informed referral to a qualified health care provider. Not to do so could be considered to be malpractice.

    As for insurance, no employer should be able to deny coverage for procedures that are considered to be safe and necessary. This certainly makes the case for a single payer health care insurance plan.


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