A federal judge has issued a permanent injunction on behalf of religious health care providers who complained the Biden administration would stipulate the Affordable Care Act requires them to provide medical procedures such as abortions or gender-affirming surgery against their beliefs.

The U.S. Department of Health and Human Services had argued that it doesn't require religious providers to perform such procedures and has never threatened to enforce activity against a religious entity in such a case.

But U.S. District Court Judge Reed O'Connor interpreted HHS regulations as forcing the plaintiffs — a Catholic hospital system in the Midwest and a Christian medical association — to choose between their beliefs and their livelihood, resulting in “irreparable injury."

O'Connor, whose court is in the Northern District of Texas, issued the injunction based on his earlier ruling that found HHS in violation of the Religious Freedom Restoration Act, which requires deference to religion barring a "compelling government interest."

The decision highlights the ongoing tensions between conservative religious health care providers and HHS over an issue that has generated a patchwork of rulings that will fall to appellate courts.

The injunction benefits the Franciscan Alliance, a Catholic hospital network in Indiana and Illinois, and the Christian Medical & Dental Associations and their 19,000 members nationwide.

Another federal judge issued a similar decision in favor of a Catholic health system in North Dakota in January, which the Biden administration is appealing.

The Trump administration strengthened religious exemptions in 2020 and eliminated protections for gender identity, although other federal courts temporarily blocked that change. A successive Supreme Court ruling interpreted the federal ban on sex discrimination as also prohibiting discrimination based on gender identity.

Attorney Luke Goodrich, who represented the plaintiffs on behalf of Becket, a legal organization focused on religious liberty, has praised the decision.

“Everyone is better off when these doctors and hospitals can continue to provide top-notch medical care" without violating their consciences, he said.

Lindsey Kaley, staff attorney with the American Civil Liberties Union's Center for Liberty, said the ruling limits “does not change the fact that transgender people who have been turned away from health care can continue to pursue litigation." The ACLU's Texas branch intervened on behalf of HHS.

“Gender-affirming care is life-saving care, and doctors agree that it is medically necessary for many transgender people," Kaley said.

Photo by Sara Dubler on Unsplash

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LGBTQ+ Healthcare Issues

The Dobbs decision, otherwise known as the court case that overturned Roe v. Wade, has resulted in confusing medical situations for many patients. On top of affecting access to abortions for straight, cisgender women, it presents heightened risks for LGBTQ+ healthcare as a whole. Flipping the switch on reproductive rights and privacy rights is a far-reaching act that makes quality care harder to find for an already underserved community.

As the fight against the Dobbs decision continues, it’s important to shed light on the full breadth of its impact. We’ll discuss specific ways that the decision can affect LGBTQ+ healthcare and offer strategies for overcoming these challenges.

How the Right to Bodily Privacy Affects LGBTQ+ Healthcare

When the original Roe v. Wade decision was made, the bodily privacy of people across the United States was protected. Now that bodily autonomy is no longer guaranteed, the LGBTQ+ community must brace itself for a potential loss of healthcare rights beyond abortions. This includes services like feminizing and masculinizing hormone therapy (particularly for transgender youth) that conservative lawmakers have been fighting against this year, as well as transition-related procedures. Without privacy, gender-affirming care may be difficult to access without documentation of sex as “proof” of gender.

As essential services for the LGBTQ+ community become more difficult to access, perhaps the most immediate effect we’ll see is eroding trust between healthcare providers and LGBTQ+ patients. When providers aren’t working in the best interest of patients — just like in cases of children and rape victims denied abortions — patients may further avoid preventative care in a community that already faces discrimination in doctor’s offices.

The Dobbs Decision Isn’t Just a Women’s Issue

While the Dobbs decision is often framed as a women's issue — specifically, one that affects cisgender women — it impacts the transgender and non-binary community just as much. All people who are capable of carrying a pregnancy to term have lost at least some ability to choose whether or not to give birth in the U.S.

For transgender and non-binary individuals, this decision comes with the added complexity of body dysmorphia. Without abortion rights, pregnant trans men and some non-binary people may be forced to see their bodies change, and be treated as women by healthcare providers and society as a result.

The Dobbs decision also opens up the possibility for government bodies to determine when life begins — and perhaps even to add legal protections for zygotes and embryos. This puts contraceptives at risk, which could make it more difficult to access gender-affirming care while getting the right contraceptives based on sex for LGBTQ+ individuals.

Overturning Reproductive Rights Puts IVF at Risk

Queer couples that dream of having their own children often have limited options beyond adoption. One such option is in vitro fertilization, or IVF, which involves implanting a fertilized egg into a uterus.

While IVF isn’t directly affected by the Dobbs decision, it could fall into a legal gray area depending on when states determine that life begins. Texas, for example, is already barring abortions as early as six weeks. To reduce embryo destruction, which often occurs when patients no longer want more children, limits could be placed on the number of eggs that can be frozen at once.

Any restrictions on IVF will also affect the availability of surrogacy as an option for building a family.

How Can LGBTQ+ Individuals Overcome Healthcare Barriers?

While the Dobbs decision may primarily impact abortion rights today, its potential to worsen LGBTQ+ healthcare as a whole is jarring. So how can the community be prepared?

If you’re struggling to find LGBTQ+-friendly providers near you, using telemedicine now can be an incredibly effective way to start developing strong relationships with far-away healthcare professionals. Telemedicine eliminates the barrier of geography and can be especially helpful for accessing inclusive primary care and therapy. Be sure to check if your insurance provider covers telemedicine.

If you’re seriously concerned about healthcare access in your area — especially if the Dobbs decision affects your whole state or you need regular in-person services that may be at risk — it may be time to consider moving now. While not everyone has the privilege to do so, relocating gives you the ability to settle in areas where lawmakers better serve your needs. However, this decision shouldn’t be taken lightly, so preparing and making progress on a moving checklist now can help you avoid issues later.

The Dobbs Decision Isn’t LGBTQ+-Friendly

The Supreme Court of the United States has proven the power of its conservative majority with the overturning of Roe v. Wade. However, the effects of the Dobbs decision don’t stop at affecting cisgender women’s abortion rights. In states with bans, it also leads to forced birth for trans men and non-binary individuals. Plus, the Dobbs decision increases the risk of other rights, like hormone therapy and IVF, being taken away.

Taking steps now, whether it’s choosing a virtual provider or considering a move, can help you improve your healthcare situation in the future.