ND court blocks insurance mandate for gender transition services (for now)

On May 16, 2022, a federal court in North Dakota issued an order in a case challenging, on religious grounds, a requirement to provide insurance coverage for gender transition care under the Patient Protection and Affordable Care Act (ACA). The order preliminarily enjoins (or stops) the Equal Employment Opportunity Commission (EEOC) and the U.S. Department of Health and Human Services (HHS) from requiring the organization in the case—Christian Employers Alliance—or its members to provide the coverage. Read on to find out more about the ruling.

Background

The Alliance is a Christian membership ministry that assists its members (Christian employers) with providing health insurance and other employment benefits to employees in a manner consistent with Christian values. The Alliance believes “male and female are immutable realities defined by biological sex” and “gender reassignment is contrary to Christian Values.” Based on those views, the organization challenged any mandate under the ACA to provide insurance coverage for gender transition care.

Section 1557 of the ACA prohibits federally funded healthcare programs and activities, as well as health insurance marketplaces and insurers that participate in them, from discriminating based on sex. In 2020, the U.S. Supreme Court in Bostock v. Clayton County made clear that discrimination based on “sex” includes discrimination based on transgender status.