Trump-Appointed Judge Blocks Biden Order for Healthcare Providers to Cover Transgender Care

A federal judge on Monday ruled in favor of a Christian group that argued it should not be compelled to cover transition-related medical costs for transgender employees. However, in an unusual move, the ruling only applies to the companies in the group and not to wider US society.

On Monday, Judge Daniel M. Traynor of the US District Court for the District of North Dakota ordered the Equal Employment Opportunity Commission (EEOC) to stop interpreting or enforcing Title VII of the 1964 Civil Rights Act as requiring an organization to provide health insurance coverage for transition-related services for employees of Christian Employers Alliance (CEA) member organizations or their family members.

The order also bars the US Department of Health and Human Services (HHS) from doing the same with Section 1557 of the Affordable Care Act (ACA), effectively rolling back the clock for CEA employees to the summer of 2020, when the administration of US President Donald Trump revised Section 1557 to exclude LGBTQ people from its protections.

The case was brought in October by the Christian Employers Alliance (CEA), which describes itself as a “united network of employers … who are passionate about living out their faith in their workplace and agree to the CEA statement of faith and ethical convictions.” According to its website, that faith statement includes the belief that “male and female are immutable realities defined by biological sex. Gender reassignment is contrary to Christian Values.”

Appointed to the federal bench by former US President Donald Trump, Traynor has deep ties to the Republican Party.

In his decision, Judge Traynor made several wide-ranging assumptions, including arguing that the order could potentially be used to force employers to cover transition-related surgeries on infants. Such operations are extremely rare on teenage trans people and are not performed on prepubescent children, to say nothing of infants. His opinion notably shows no concern for infant circumcision, a surgery commonly performed on very young children.

"HHS Guidance encourages a parent to file a complaint if a medical provider refuses to gender transition their child, of any age, including an infant," the judge wrote. "The thought that a newborn child could be surgically altered to change gender is the result of the Biden HHS Notification and HHS Guidance that brands a medical professional’s refusal to do so as discrimination. Indeed, the HHS Guidance specifically invites the public to file complaints for acting in a manner the Alliance says is consistent with their sincerely held religious beliefs."

Traynor also justifies his opinion by citing medical practice rejected by the American Psychiatric Association (APA) nearly a decade ago, claiming that gender dysphoria is a “complex mental health question” and that Biden’s directives “frustrate the proper care of gender dysphoria.”

"By branding the consideration as ‘discrimination,’ the HHS prohibits the medical profession from evaluating what is best for the patient in what is certainly a complex mental health question,” he writes.

The APA removed gender dysphoria, then known as the mental illness Gender Identity Disorder, from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. In the DSM-5, gender dysphoria is described for purposes of relieving distress and is not described as pathological. Since then, it has become widespread medical practice in the US for transition-related services to be granted based upon a system of informed consent, according to the standards of care laid out by the World Professional Association for Transgender Health (WPATH).

The decision comes amid a raging battle in conservative-dominated states over transgender rights.

On Tuesday, a federal judge in Tennessee struck down a ban on trans women using women’s bathrooms. Last week, an Alabama judge blocked implementation of a felony ban on providing transgender youth with affirming healthcare, and a Texas judge removed blockage on the state’s Department of Family and Protective Services investigating parents who give their transgender children gender-affirming care for child abuse.

A Tuesday report by NBC found that 21 candidates and political committees have collectively spent $4.5 million on ads attacking trans people in the areas of education, healthcare, and sports. Nationwide, more than 200 bills attacking LGBTQ rights have been introduced in 2022, by far the most of any year.

Earlier this month, US Assistant Health Secretary Rachel Levine, a trans woman and former pediatrician, warned that trans youth are being “driven to the depths of despair” and committing suicide at alarming rates due to the increasing social stigma created by the GOP attacks.

“I want to say this very, very clearly: lesbian, gay, bisexual, transgender and queer Americans are committing suicide at a rate that should shock our conscience,” Levine said at the Out For Health Conference.

“Even after decades of progress, the most vulnerable among us continue to suffer … transgender women of color not only continue to be harassed, but are more likely than the population at large to suffer violence and even murder,” she added. According to the Human Rights Campaign, a national LGBTQ rights advocacy group, 12 trans people have been murdered in the US in the first five months of 2022, most of them trans women of color.