Federal judge blocks Obamacare mandate that compels doctors to perform gender reassignment surgery

A federal court in North Dakota has made a ruling that will shield some doctors from penalty, should they refuse to perform gender transition surgery on the grounds of religious beliefs.

The decision, issued Tuesday by North Dakota District Court Chief Judge Peter Welte, granted a request to prevent the Department of Health and Human Services and the Equal Employment Opportunity Commission from enforcing an Obamacare mandate that requires health care providers to perform gender-reassignment surgeries and services.

In 2016, HHS clarified Section 1557 of the Patient Protection and Affordable Care Act, known as Obamacare, which prohibited several forms of discrimination in health care including on the basis of sex. At the time, this meant that insurers and third-party administrators could not create or administer plans with gender-transition exclusions. 

Also at the time, the HHS rule did not take into account an exemption for religious grounds. The agency argued, "a blanket religious exemption could result in a denial or delay in the provision of health care to individuals and in discouraging individuals from seeking necessary care."

Religious exemptions would, instead, be considered on a case-by-case basis under the 1993 Religious Freedom Restoration Act.

The Obamacare mandate was paused several times over the course of the Trump presidency, by both administrative action and several federal court rulings, though never stricken completely from existence. 

Judge Welte's opinion affirms the plaintiffs' entitlement to injunctive relief, arguing that a violation under the RFRA is akin to a violation of their First Amendment rights. 

The plaintiffs in the case, several Catholic organizations, "refusal to perform or cover gender-transition procedures is predicated on an exercise of their religious beliefs protected by the First Amendment," wrote the judge.

"Absent an injunction, [plaintiffs] will either be 'forced to violate their sincerely held religious beliefs' by performing and covering gender-transition procedures 'or to incur severe monetary penalties for refusing to comply.'"