A three-judge panel of the Eighth Circuit Court of Appeals unanimously decided that Catholic healthcare systems and providers cannot be forced to perform or cover gender-affirming healthcare, if such procedures violate the system or provider’s religious beliefs. The ruling also provided an exemption for religious institutions not to be required to provide health insurance plans that cover gender transition care.
In January 2021, a group of Catholic healthcare groups in North Dakota, including The Religious Sisters of Mercy, Catholic Charities of North Dakota, and the Catholic Medical Association, brought a lawsuit claiming that their religious liberty was being violated by directives from the U.S. Department of Health and Human Services (HHS) and the Equal Employment Opportunity Commission. The directives required them to provide gender-affirming care and insurance benefits in order to participate in federal health programs, such as Medicare and Medicaid.
The new ruling sustains a 2021 injunction that offered a religious exemption to Catholic healthcare systems and providers. The Religious Freedom Restoration Act was cited as the warrant for the court’s decision. Prior to this ruling, Catholic providers were required to care for transgender and nonbinary patients as part of the implementation of the Affordable Care Act, which prohibits sex discrimination in all healthcare settings. HHS previously ruled that this regulation meant that healthcare providers also cannot discriminate against patients regarding gender identity.
While the Obama administration expanded the definition of ‘discrimination’ to include gender identity, the Trump administration rolled back protections by revoking the Obama-era regulations. In June 2022, Biden proposed new legislation to strengthen the ACA’s original ruling prohibiting sex discrimination. However, it seems that the Biden administration will not be able to pass the bill.
LGBTQ+ individuals could face higher rates of discrimination from this new ruling. Another fear is that Catholic institutions may use this ruling as fuel to exclude transgender or gender non-conforming Catholics from other religious spaces. By eliminating healthcare for trans individuals, the Catholic Church is failing to recognize their dignity and worth, and ultimately taking a step back in terms of inclusivity. Going forward, it is necessary for Catholic healthcare providers to commit to serving marginalized communities in order to truly represent the Catholic values of love and acceptance.
—Sarah Cassidy (she/her), New Ways Ministry, December 22, 2022