553 F.Supp.3d 361
N.D. Tex.2021Background
- Section 1557 of the ACA incorporates Title IX’s prohibition on sex discrimination; HHS promulgated a 2016 Rule defining “on the basis of sex” to include gender identity and termination of pregnancy.
- Christian health providers and several States sued under the APA and RFRA, obtaining a preliminary injunction and later a judgment vacating the 2016 Rule’s definitions insofar as they included gender identity and termination of pregnancy.
- The Trump Administration issued a 2020 Rule that repealed the 2016 Rule’s definitional provisions; the Supreme Court decided Bostock (Title VII includes sexual orientation and gender identity).
- District courts entered injunctions affecting the 2020 Rule; HHS issued a 2021 Interpretation adopting a Bostock-based reading of Section 1557 while promising compliance with RFRA and prior court orders.
- The Fifth Circuit remanded for this Court to decide mootness and whether permanent injunctive relief against the 2016 Rule and the underlying statute is appropriate.
- The Court held the case justiciable, concluded Plaintiffs succeeded on their RFRA claim and face irreparable harm, and granted a permanent nationwide injunction preventing HHS from enforcing Section 1557 (or implementing regs) against Plaintiffs in a way that would require them to perform or insure gender-transition procedures or abortions.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Mootness / Ripeness of challenge after repeal and new guidance | Current agency actions (2020 Rule + 2021 Interpretation) continue to threaten the same RFRA burden; case is not moot or unripe | Repeal and replacement of the 2016 Rule (and pending rulemaking) moot or make claims unripe | Not moot or unripe; plaintiffs face a credible, concrete threat from the current regulatory scheme and are entitled to adjudication |
| RFRA success on the merits (substantial burden) | Application of Section 1557 as currently interpreted would coerce plaintiffs to perform/cover abortions and gender-transition procedures, substantially burdening religious exercise | Agency says rule changes and assurances avoid the RFRA problem; scope disputed | Court finds plaintiffs have succeeded on RFRA: the regulatory scheme substantially burdens their religious exercise |
| Permanent injunction: irreparable harm and equities | Violation of RFRA/First Amendment rights is irreparable; vacatur was insufficient; permanent exemption necessary | Defendants argue plaintiffs lack irreparable harm or relief sought exceeds court’s authority | Irreparable harm found; balance of equities and public interest favor injunction; permanent exemption granted |
| Scope of relief (rule vs statute; authority to enjoin broader enforcement) | Request relief against Section 1557 and any implementing regulation to protect plaintiffs regardless of agency formulation | Defendants/Intervenors contend relief should be limited to the 2016 Rule or to what plaintiffs specifically pleaded | Court permits broader relief under Rule 54(c) and prior proceedings: enjoins enforcement of Section 1557 (and implementing regs) against plaintiffs to require abortions or gender-transition procedures |
Key Cases Cited
- Bostock v. Clayton Cnty., 140 S. Ct. 1731 (2020) (Supreme Court held Title VII’s prohibition on sex discrimination covers sexual orientation and gender identity)
- Friends of the Earth, Inc. v. Laidlaw Env’t Servs. (TOC), Inc., 528 U.S. 167 (2000) (defendant’s voluntary cessation doctrine and the heavy burden to show challenged conduct will not recur)
- eBay Inc. v. MercExchange, L.L.C., 547 U.S. 388 (2006) (standards for permanent injunctive relief)
- Gonzales v. O Centro Espirita Beneficente Uniao do Vegetal, 546 U.S. 418 (2006) (RFRA framework and burden‑shifting)
- Burwell v. Hobby Lobby Stores, Inc., 573 U.S. 682 (2014) (RFRA may entitle employers to religious exemptions from federal requirements)
- Franciscan Alliance, Inc. v. Becerra, [citation="843 F. App'x 662"] (5th Cir. 2021) (remand order instructing district court to consider mootness and scope of injunctive relief)
- Whitman-Walker Clinic, Inc. v. U.S. Dep’t of Health & Human Servs., 485 F. Supp. 3d 1 (D.D.C. 2020) (preliminary injunctive relief affecting HHS’s 2020 Rule)
- Walker v. Azar, 480 F. Supp. 3d 417 (E.D.N.Y. 2020) (preliminary injunction restoring parts of the 2016 Rule)