Appeals Court Rules Catholic Healthcare System May Deny Care to Transgender Patients

The U.S. Department of Health and Human Services (HHS) is permanently barred from requiring a Catholic hospital network in Indiana and Illinois to perform or provide insurance coverage for services related to gender transition or abortion.

This decision came in a ruling by Judge Reed O’Connor of the Fifth Circuit Court of Appeals in a case between HHS and Franciscan Alliance, the healthcare system. O’Connor upheld a district court decision that ruled in favor of Franciscan Alliance.

Health Affairs provided legal analysis of the recent ruling, noting that the case was ultimately decided on the interpretation of Section 1557 of the Affordable Care Act (ACA) and the protections for LGBTQ+ people that it placed upon health care providers and insurers. Health Affairs explained, in part:

“Section 1557 prohibits health programs or facilities that receive federal funds from discriminating based on race, color, national origin, age, disability, or sex. Section 1557 incorporates existing federal civil rights laws, including protections against discrimination on the basis of sex under Title IX of the Education Amendments of 1972, and applies them to federally funded health programs. In a rule finalized in 2016, the Obama administration interpreted discrimination ‘on the basis of sex’ to include discrimination based on gender identity and termination of pregnancy.”

In 2016, Franciscan Alliance challenged that interpretation of Section 1557 arguing that under the Religious Freedom Restoration Act (RFRA) they were entitled to a permanent injunction. This latest ruling is in favor of Franciscan Alliance does not necessarily mean conclusion to litigation. The federal government and the American Civil Liberties Union, which intervened on the case, could still appeal to the Supreme Court or ask for the case to be reviewed by the full panel of Fifth Circuit judges.

While conservatives understand this ruling to be a win for religious liberty, it is a loss for LGBTQ+ persons working at Catholic institutions or those undergoing medical treatment at Catholic hospitals. It is especially disheartening for transgender people seeking gender-affirming care.

Read more about the previous ruling and the history of the lawsuit on Bondings 2.0. You can find a narrative on harm caused to transgender patients denied surgery here.

—Bobby Nichols (he/him), New Ways Ministry, October 10, 2022