Obamacare discrimination protections don’t apply to LGBT patients, Texas judge rules

A federal judge in Texas has ruled that the Biden administration cannot prohibit doctors from denying certain medical care based on a patient’s sexual orientation and gender identity. U.S. District Court Judge Matthew Kacsmaryk on Friday sided with two Texas doctors who sued to block a federal rule that barred discrimination against LGBT patients. Susan Neese, an Amarillo doctor who refuses to prescribe hormone therapy to minors with gender dysphoria, argued that sex discrimination is defined as different treatment given to men and women — not different treatment given based on patient’s sexuality or gender identity. Kacsmaryk went a step further, ruling that a recent U.S. Supreme Court decision protecting LGBT workers does not apply to decisions in the health care setting. The breadth of his decision sets up bigger arguments to come in the courts and legislatures over who is protected and what counts as discrimination in the doctor’s office.

“When adopting [the Affordable Care Act], Congress could have included ‘sexual orientation’ and ‘gender identity’ in the statutory text. Congress chose not to do so. Instead, Congress limited [the ACA’s] protections to those afforded by other federal statutes — including Title IX,” he wrote. “Because Title IX does not protect ‘sexual orientation’ or ‘gender identity’ status, neither does [the ACA].” The U.S. Department of Justice will be able to ask the Fifth Circuit Court of Appeals to revisit the decision. An agency lawyer assigned to the case did not immediately return request for comment. Gender dysphoria is the feeling of discomfort or distress that can occur for those who identify as a gender different from the gender or sex assigned at birth. The subject of medical treatment for transgender people, especially minors, has come under increased scrutiny by conservative politicians and the courts in recent years, and will likely be a topic of debate during the 2023 Texas legislative session. All of the major state and national health care groups, including the Texas and American Medical Association, support age-appropriate and individualized gender-affirming care for transgender youth, including puberty blockers and hormone therapy.