55 F.4th 583
8th Cir.2022Background
- A coalition of Catholic healthcare entities and the Catholic Benefits Association (CBA) sued HHS and the EEOC under RFRA and related statutes, challenging interpretations that they must perform or provide insurance coverage for gender-transition procedures. The district court granted declaratory and permanent injunctive relief under RFRA.
- Regulatory history: HHS’s 2016 Section 1557 rule defined discrimination "on the basis of sex" to include gender identity and omitted Title IX’s religious exemption; the 2020 rule rescinded that regulatory definition and incorporated Title IX’s religious exemption.
- The Supreme Court’s Bostock decision interpreted Title VII’s prohibition on discrimination “because of sex” to cover sexual orientation and gender identity, affecting statutory interpretation across agencies.
- Multiple district- and circuit-court injunctions and HHS guidance/notifications (including a 2021 HHS Notification and a 2022 HHS Notice) created an unstable enforcement landscape and left plaintiffs alleging a credible threat of enforcement.
- The district court found the plaintiffs had standing, ripeness, and showed a RFRA violation that entitled them to a permanent injunction; the Eighth Circuit affirmed those holdings but rejected CBA’s associational standing for unnamed members and remanded for further proceedings consistent with that limitation.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Associational standing (CBA) | CBA may sue for unnamed members affected by HHS/EEOC interpretations. | Summers requires identification of specific affected members; CBA failed to name them. | CBA lacks associational standing for unnamed members; three named CBA members may proceed. |
| Standing to challenge Section 1557 enforcement | Refusal to perform or cover transition care implicates RFRA and is "arguably proscribed" by Section 1557 given prior rules, injunctions, and agency statements; credible threat of enforcement exists. | No present enforcement; 2020 Rule rescinded the 2016 Rule; alleged threats are speculative. | Plaintiffs have Article III standing: injury in fact, causation, redressability; credible threat and regulatory context support pre-enforcement challenge. |
| Standing to challenge EEOC interpretation of Title VII | EEOC has long interpreted Title VII to cover gender identity and has enforced exclusions; HHS referrals to EEOC and coordinated enforcement create a credible threat. | EEOC has not specifically targeted these plaintiffs; no concrete enforcement threat against religious employers shown. | Court affirmed standing: coordinated enforcement history and EEOC practice create a credible threat. |
| Ripeness | Claims raise purely legal questions and plaintiffs face concrete hardship (alter policies or risk penalties and funding loss). | Challenges are premature because enforcement is hypothetical. | Claims are ripe; ripeness closely tracks standing and plaintiffs’ injury is concrete. |
| Irreparable harm and permanent injunction | A RFRA violation (substantial burden on religious exercise) constitutes per se irreparable harm, justifying a permanent injunction. | Plaintiffs failed to show imminent irreparable harm sufficient for permanent relief. | RFRA success establishes irreparable harm; district court’s permanent injunction affirmed (except as to CBA’s unnamed-members standing). |
Key Cases Cited
- Bostock v. Clayton County, 140 S. Ct. 1731 (2020) (Supreme Court holding Title VII discrimination “because of sex” encompasses sexual orientation and gender identity and noting RFRA interactions).
- Franciscan Alliance, Inc. v. Becerra, 47 F.4th 368 (5th Cir. 2022) (addressing standing, mootness, and permanent injunctions in related challenges to HHS’s Section 1557 rule).
- Susan B. Anthony List v. Driehaus, 573 U.S. 149 (2014) (standards for pre-enforcement standing and credible threat of enforcement).
- Summers v. Earth Island Institute, 555 U.S. 488 (2009) (associational-standing requirement that organizations identify affected members).
- Tooker v. Iowa Right to Life Committee, 717 F.3d 576 (8th Cir. 2013) (standing/mootness analysis distinguishing credible threat of enforcement).