Doctors Forced to Perform Controversial Surgeries or Lose Funding – Is This the End of Medical Freedom?
Seven states, alongside the American College of Pediatricians (ACPeds), have launched a lawsuit against the U.S. Department of Health and Human Services (HHS) in response to a new rule requiring healthcare providers to administer puberty blockers, hormones, and gender-related surgeries. This rule, which does not impose age restrictions, also mandates insurance companies to cover these procedures. The lawsuit argues that medical professionals who refuse to comply, based on their medical judgment, will face financial penalties and exclusion from federally funded insurance programs such as Medicare and Medicaid.
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The lawsuit is spearheaded by Missouri and Utah, with support from North Dakota, South Dakota, Iowa, Idaho, and Arkansas. These states argue that the HHS rule infringes on their state laws that protect children from such medical interventions. They claim that the rule also violates free speech in medicine and overrides conscience protections for healthcare providers, all tied to the receipt of federal funding.
Seven States Challenge HHS Mandate on Gender Procedures
According to the plaintiffs, the Biden administration has been pursuing a “whole-of-government agenda” to redefine “sex” to encompass “gender identity.” On January 20, 2021, President Biden signed an executive order directing federal agencies, including HHS, to interpret sex discrimination laws as also prohibiting discrimination based on gender identity.
In May 2024, HHS issued a 182-page Final Rule under the Affordable Care Act (Obamacare), interpreting “sex” to include “gender identity.” Effective from July 5, the rule mandates that doctors and insurance companies must provide “equal access without discriminating on the basis of sex” to gender-related procedures, irrespective of a person’s age or gender identity. Federally funded entities must not:
“Deny or limit health services sought for the purpose of gender transition or other gender-affirming care that the covered entity would provide to an individual for other purposes if the denial or limitation is based on an individual’s sex assigned at birth, gender identity, or gender otherwise recorded.”
The lawsuit contends that if a healthcare entity performs hysterectomies or mastectomies on women and girls for medical reasons, such as cancer treatment, the rule obligates these entities to perform the same procedures for individuals seeking gender transition. ACPeds, a national nonprofit medical association with around 400 member physicians and professionals, asserts in the lawsuit that its members hold “substantial, science-based objections” to gender transition efforts. The lawsuit states, “it is impossible to change a person’s sex,” and claims the HHS rule is politically motivated rather than scientifically grounded, restricting their ability to critique or deny the medical validity of gender transitions.
The HHS rule indicates, “…the rejection of a practice closely linked with a protected status may, in conjunction with other evidence, lead to a finding of discrimination.”
The lawsuit further alleges that the HHS rule will compel federally funded doctors and insurers to:
- “Speak falsely” and compromise their medical ethical standards.
- Use patients’ preferred pronouns.
- “Tell patients that males can get pregnant, give birth, and breastfeed.”
- Avoid raising objections to gender procedures based on patients’ regret.
The plaintiffs claim the HHS rule imposes a “regime” where healthcare providers and insurers must perform and fund these “harmful” and often irreversible procedures.
Seeking a Permanent Injunction
The states and ACPeds seek a permanent injunction against the rule, arguing that HHS “arbitrarily” redefined “sex” to include “gender identity,” exceeding its authority and bypassing Congress. They also allege the rule violates the rights to free speech, association, and assembly, and unlawfully preempts state laws.
The lawsuit asserts that the rule forces a “no-win choice” on healthcare providers and insurers: compromise their convictions, face financial penalties, or leave the medical field and abandon their patients.
Further Legal Challenges to Biden Admin
This lawsuit follows other legal challenges to Biden administration rules that integrate gender identity into the definition of “sex.” Four federal courts have recently ruled against such rules. A federal judge in Mississippi recently issued a nationwide injunction blocking another HHS rule requiring states to use taxpayer funds for puberty blockers, hormones, and gender surgeries. Additionally, three U.S. district judges have halted the Department of Education’s revised Title IX Final Rule, which mandated schools receiving federal funds to allow gender-confused males in women’s and girls’ private spaces. These injunctions apply across 14 states, including Alaska, Idaho, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Montana, Ohio, Tennessee, Utah, Virginia, West Virginia, and Wyoming.
Currently, 25 states prohibit puberty blockers, hormones, and gender-related surgeries for minors.
Liberty Counsel Founder and Chairman Mat Staver stated, “Doctors should never be forced to harm children, and health insurers should never be compelled to pay for this radical agenda. Gender ideology is completely detached from science and reality. Courts should continue to strike down these rules.”
