BISMARCK, N.D. — In a significant court decision, a federal judge has ruled that Catholic employers and healthcare providers are not required to offer gender-affirming care to transgender individuals or to provide insurance coverage for such services due to religious objections. This judgment prevents federal agencies from penalizing these organizations based on their religious beliefs.
The ruling was issued by U.S. District Judge Peter Welte, who serves as the chief federal judge in North Dakota. It prevents the U.S. Department of Health and Human Services from implementing a health care regulation from 2024. Under President Joe Biden’s administration, this rule had expanded the definition of sex discrimination to include gender identity, threatening to cut federal funding from providers denying gender-affirming care.
Judge Welte’s decision also restricts the U.S. Equal Employment Opportunity Commission from compelling employers to cover gender-affirming care in health plans, as failing to do so would have been deemed discrimination based on sex, potentially leading to legal consequences.
However, Judge Welte declined a plea from a religious order and associated Catholic organizations to extend these protections to issues surrounding abortion and fertility therapies. He determined that these topics were not adequately presented for judicial assessment.
The judge reasoned that enforcing these federal policies on gender-affirming care or insurance could infringe upon religious freedoms, protected by a 1992 federal law offering broad support for religious beliefs. Though the HHS rule allowed for religious exemption on a case-by-case basis, Welte found this approach inadequate.
“The case-by-case exemption procedure leaves religious organizations unable to predict their legal exposure without furthering any compelling antidiscrimination interests,” Judge Welte stated in his ruling.
While the HHS and EEOC have yet to comment on the decision, the Catholic Benefits Association praised the outcome. Serving over 9,000 employers and having 164,000 employees in their health plans, the association champions religious freedom in employment benefits consistent with Catholic doctrine.
Martin Nussbaum, General Counsel for the association, expressed satisfaction with the ruling, affirming that it provides their members the protection to align health plans and medical services with their beliefs without federal mandates on abortion or fertility treatments.
The U.S. Supreme Court ruled in 2020 that the Civil Rights Act’s protections against sex discrimination also cover anti-LGBTQ+ biases in employment, despite the absence of specific provisions for gender identity or sexual orientation. Yet, courts have occasionally ruled to limit federal action against anti-LGBTQ+ discrimination when it involves religious organizations.
Both the health care rule from HHS and the EEOC’s guidance on sex discrimination trace their origins back to initiatives under President Barack Obama to bolster LGBTQ+ rights towards the end of his term.
During Donald Trump’s presidency, a directive was issued against recognizing transgender individuals’ gender identities. Furthermore, reports indicated EEOC deprioritized gender identity discrimination cases, effectively shelving many of them.
The rule from HHS in 2024 also touched upon discrimination concerning “pregnancy and related conditions.” Although Catholic healthcare providers feared repercussions if they refused abortion services, HHS assured that the rule did not mandate abortion provision or coverage—only that healthcare could not be denied to someone who had undergone an abortion.