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Federal Court Blocks ACA Sex Discrimination Rules for Religious Providers

Tuesday, September 27, 2022

A federal court of appeals blocked the Department of Health and Human Services (HHS) from enforcing specific Section 1557 nondiscrimination rules under the Affordable Care Act (ACA) against some faith-based providers on August 26, 2022. The court upheld a permanent injunction prohibiting HHS from requiring the providers to perform or provide insurance coverage for gender transition procedures or abortions.

ACA Section 1557

Section 1557 forbids discrimination based on sex in any health program or activity that is administered by a federal agency or receives federal funds. An HHS rule from 2016 defined “sex” to include sex stereotypes and gender identity, alongside pregnancy termination and other conditions related to pregnancy.

HHS issued a proposed rule intended to strengthen protections against discrimination on the basis of sex, including gender identity, sexual orientation and pregnancy termination on July 25, 2022. Then, on March 2, 2022, HHS issued a notice highlighting the health privacy laws and federal civil rights protections that apply to gender-affirming care for transgender and gender nonconforming youth.

Federal Court’s Ruling

HHS was sued by a group of faith-based health care providers who challenged the Section 1557 prohibition against discrimination based on gender identity or termination of pregnancy. A trial court relinquished the Section 1557 provisions related to gender identity and termination of pregnancy, concluding that the provisions violated the Religious Freedom Restoration Act and permanently blocked HHS from imposing these requirements with respect to abortions or gender transition procedures upon the plaintiffs in the case.

The federal appellate court upheld this permanent injunction. According to the court, the 2022 proposed rule and the agency notice on gender-affirming care shows that the agency intends to enforce Section 1557 to prohibit discrimination based on gender identity and termination of pregnancy. Therefore, the permanent injunction was necessary.


  • Termination of Pregnancy  The 2022 proposed rule defines discrimination “on the basis of sex” to include discrimination on the basis of pregnancy, termination of pregnancy or recovery therefrom, false pregnancy, childbirth or related medical conditions.
  • Gender Identity Defined  One’s internal sense of gender, which may be different from the sex one is assigned at birth.

Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.