A Trump-appointed federal judge in Texas has ruled against the Biden administration’s health care protections for LGBTQ people.
President Joe Biden has been applying the Supreme Court's landmark decision in Bostock v. Clayton County – which made anti-LGBTQ discrimination illegal in the workplace – to other areas such as education and health care.
The Supreme Court found that Title VII of the Civil Rights Act, which bans workplace discrimination “administrations based on sex," applies to LGBTQ people because it is impossible to discriminate based on sexual orientation and gender identity without taking sex into account.
Upon taking office, Biden signed two executive orders that said federal agencies should "fully implement" the decision by applying the reasoning that anti-LGBTQ discrimination inherently involves sex discrimination.
That led the U.S. Department of Health and Human Services to apply Section 1557 of the Affordable Care Act – bans healthcare discrimination based on sex – to LGBTQ people.
But U.S. District Judge Matthew Kacsmaryk has rejected that interpretation after two doctors sued. The doctors have been represented by former Trump advisor Stephen Miller's America First Legal Foundation.
Kacsmaryk said that Section 1557 could have explicitly included sexual orientation and gender identity but instead banned discrimination "based on sex," using the language put forth in Title IX – which prohibits discrimination in education.
Kacsmaryk emphasized that the Bostock ruling applies only to workplaces.
"Title IX's ordinary public meaning remains intact until changed by Congress, or perhaps the Supreme Court."
"For an action to occur 'based on sex,'" he added, "biological sex must be the motivating factor."
LGBTQ Healthcare protections have been in a tug of war for years. Rules released by the Obama administration provided those protections, but the Trump administration reversed them. Biden then reimplemented them through his interpretation of Bostock, though now they hang in the balance again.
In his ruling, the judge also managed to include an argument against allowing trans people to compete in sports as their gender, writing that the "reinterpretation of Title IX through the Notification imperils the opportunities for women Title IX was designed to promote and protect–categorically forcing biological women to compete against biological men."