Missouri AG files suit against Biden administration over gender transition mandate

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Missouri Attorney General Andrew Bailey has led a coalition of seven states in filing a lawsuit against the Biden Administration’s Department of Health and Human Services (HHS) over a rule that mandates healthcare providers to perform gender-transition procedures and requires states to fund these interventions. The rule, based on Section 1557 of the Affordable Care Act, is claimed to enforce a transgender ideology that conflicts with the personal beliefs of many healthcare providers.

Attorney General Bailey stated, “Joe Biden is once again exceeding his legal authority to force his radical transgender ideology onto the American people. His Administration is threatening to hold federal funding hostage from any healthcare provider that refuses to perform or affirm harmful and irreversible transgender procedures. I am filing suit because I will not allow out-of-touch federal bureaucrats to force Missouri healthcare providers into performing experimental and dangerous gender transition procedures on the taxpayer dime.”

The states argue that the rule should be withdrawn for the following reasons:

  • It is ultra vires, created without legal authority, and is arbitrary and capricious.
  • It exceeds Congress’s Article I powers and infringes on states’ rights under federalism and the Tenth Amendment.
  • It violates the First and Fifth Amendment rights of healthcare providers.
  • It employs unconstitutional coercion by threatening to withhold federal healthcare funding.
  • It attempts to preempt states’ historical powers to regulate health and welfare without clear federal statute authorization.

In the lawsuit, Bailey and the coalition assert, “Doctors should not be compelled to harm children. But a new final rule from the U.S. Department of Health and Human Services (HHS) under Section 1557 of the Affordable Care Act forces doctors to perform, refer for, or affirm harmful gender-transition procedures and forces States to pay for these dangerous procedures in state health plans. This radical mandate will hurt children.

“HHS threatens to punish doctors and States who do not comply with the mandate by imposing huge financial penalties and excluding them from federally funded healthcare programs like Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). This punishment would effectively preclude doctors and States from providing healthcare for the most vulnerable children in low-income communities.”

The lawsuit continues, “This harmful rule violates the Affordable Care Act (ACA), the Administrative Procedure Act (APA), the structural principles of federalism, and the freedom of speech. Congress did not authorize any of this. The rule purports to implement the sex-discrimination prohibition in Section 1557 of the ACA, but there is no gender-transition mandate in that statute, nor in Title IX of the Education Amendments of 1972 from which it is derived. Nor did the rule (or the ACA) satisfy the constitutional requirements of clear notice for such a mandate: the States and healthcare providers did not agree to provide, pay for, or affirm gender-transition procedures when they began Medicaid, Medicare, and CHIP.”

As HHS persists in prioritizing its ideology over prior court judgments, the coalition requests the court to deem this fourth attempt at the mandate permanently unlawful. They seek judicial relief to protect their patients and doctors from this rule.

The American College of Pediatricians and the attorneys general of Arkansas, Idaho, Iowa, North Dakota, South Dakota, and Utah support the lawsuit.

Read the full lawsuit here.

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