A federal judge in Texas on Saturday issued a court order barring enforcement of an Obama administration policy seeking to extend anti-discrimination protections under the Affordable Care Act to transgender health and abortion-related services.
The decision sides with Texas, seven other states and three Christian-affiliated healthcare groups challenging a rule that, according to the judge, defines sex bias to include "discrimination on the basis of gender identity and termination of pregnancy."
In granting an injunction one day before the new policy was to take effect, U.S. District Judge Reed O'Connor held that it violates the Administrative Procedure Act, a federal law governing rule-making practices.
The judge also ruled that plaintiffs were likely to prevail in court on their claim that the new policy infringes on the rights of private healthcare providers under the Religious Freedom Restoration Act.
As explained in O'Connor's 46-page opinion, the plaintiffs argued that the new regulation would "require them to perform and provide insurance coverage for gender transitions and abortions, regardless of their contrary religious beliefs or medical judgment."
The same judge issued a similar court order in August blocking a separate Obama administration policy that would have required public schools, over the objections of 13 states, to allow transgender students to use restrooms of their choice.
It was not immediately clear whether the Obama administration, which has just 20 days left in office, would seek to appeal the latest injunction.
White House spokeswoman Katie Hill decried the ruling.
"Today's decision is a setback, but hopefully a temporary one, since all Americans - regardless of their sex, gender identity or sexual orientation - should have access to quality, affordable health care free from discrimination," she said.
The Affordable Care Act (ACA), also known as Obamacare, was passed in 2010 with an anti-discrimination section designed to prevent insurers from charging customers more or denying coverage based on age, race, national origin, disability or sex.
The rule in dispute on Saturday was adopted by the U.S. Health and Human Services (HHS) Department to implement those provisions, including definitions for sex discrimination that encompassed transgender and abortion services.
According to the court opinion, gender identity was defined under that rule as "an individual's internal sense of gender, which may be male, female, neither, or a combination of male and female, and which may be different from an individual's sex assigned at birth."
The state of Texas has led a string of legal cases brought by Republican-controlled states contesting various social policies advanced by President Barack Obama, most notably his 2014 executive action to protect millions of immigrants in the United States illegally and give them work permits.
That plan, challenged by Texas and other states, has been barred by the courts. But the U.S. Supreme Court in 2012 and 2015 issued rulings that kept the Affordable Care Act, his top legislative achievement, intact.
(Additional reporting by Jeff Mason in Honolulu; Editing by Mary Milliken)