FRANCISCAN ALLIANCE, INC. et al. v. XAVIER BECERRA, Secretary of the United States Department of Health and Human Services; and UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES
Civil Action No. 7:16-cv-00108-O
IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF TEXAS WICHITA FALLS DIVISION
August 9, 2021
AMERICAN CIVIL LIBERTIES UNION OF TEXAS et al., Intervenors. Document 205 Filed 08/09/21 PageID 5096
Before the Court are Plaintiffs’ Supplemental Brief on Remand (ECF No. 200), filed May 14, 2021; Intervenors’ Memorandum of Law in Opposition to Plaintiffs’ Supplemental Brief on Remand (ECF No. 201), filed June 4, 2021; Defendants’ Supplemental Brief on Remand (ECF No. 202), filed June 4, 2021; and Plaintiffs’ Supplemental Reply Brief on Remand (ECF No. 203), filed June 18, 2021. Having considered the motion, briefing, and applicable law, the Court GRANTS the motion.
I. BACKGROUND
Five years ago as part of the implementation of Section 1557 of the Affordable Care Act,
After a hearing, the Court concluded that it had jurisdiction over the dispute, that the 2016 Rule violated the APA by contradicting existing law and exceeding statutory authority, and that the 2016 Rule likely violated RFRA as applied to the Christian Plaintiffs. See Order, ECF No. 62. Accordingly, the Court granted a preliminary injunction, enjoining “Defendants from enforcing the [2016] Rule‘s prohibition against discrimination on the basis of gender identity or termination of pregnancy.” Order 46, ECF No. 62. In light of an HHS notice of upcoming rulemaking proceedings addressing the 2016 Rule, the Court granted a stay of the case, retained jurisdiction, and maintained the full effect of its preliminary injunction in the interim. Order 10, ECF No. 108.
For sixteen months, the case remained stayed until the parties jointly requested the case be re-opened, which the Court allowed. See ECF Nos. 125, 126. In the former half of 2019, the parties
While pending appeal, the landscape drastically shifted. HHS repealed the 2016 Rule and finalized a new rule in 2020. Nondiscrimination in Health and Health Education Programs or Activities, Delegation of Authority, 85 Fed. Reg. 37,160 (June 19, 2020) (the “2020 Rule“). The Supreme Court interpreted Title VII‘s prohibition of “sex discrimination” to include gender identity and sexual orientation in Bostock v. Clayton Cnty., 140 S. Ct. 1731 (2020). Two district courts extended Bostock‘s reasoning to Title IX as applied through Section 1557, entering injunctions modifying the 2020 Rule and purportedly restoring certain provision of the 2016 Rule. See Walker v. Azar, 480 F. Supp. 3d 417, 430 (E.D.N.Y. 2020) (“As a result [of the district court‘s injunction], the definitions of ‘on the basis of sex,’ ‘gender identify,’ and ‘sex stereotyping’ currently set forth in [the 2016 Rule] will remain in effect.“); Whitman-Walker Clinic, Inc. v. HHS, 485 F. Supp. 3d 1, 64 (D.D.C. 2020) (“HHS will be preliminarily enjoined from enforcing the repeal of the 2016 Rule‘s definition of discrimination ‘[o]n the basis of sex’ insofar as it includes ‘discrimination on the basis of . . . sex stereotyping.‘“). President Biden issued an executive order
The shifting landscape led the Fifth Circuit panel to remand the case to this Court for further consideration and to retain jurisdiction over the matter if again appealed. The panel offered this mandate:
On appeal, the providers argue that the district court should have granted them injunctive relief against the 2016 rule and the underlying statute, that they still suffer a substantial threat of irreparable harm under the 2016 rule, and that the subsequent developments have only made it clear that an injunction should have been granted in the first place. In response, the government contends that the case is moot and that the providers never asked the district court for relief against the underlying statute. On remand, the district court should consider these issues, and we express no view as to their relative merits at this time.
Franciscan All., Inc. v. Becerra, 843 F. App‘x 662, 663 (5th Cir. 2021). Since the Fifth Circuit‘s remand and presumably spurred by the President’ executive order and DOJ‘s guidance, HHS issued guidance documentation that it would now interpret Section 1557 to prohibit “gender identity” discrimination. “Notification of Interpretation and Enforcement” Dep‘t of Health and Hum. Servs., Notification of Interpretation and Enforcement of Section 1557 of the Affordable Care Act and Title IX of the Education Amendments of 1972 (May 10, 2021), https://www.hhs.gov/sites/default/files/ocr-bostock-notification.pdf (the “2021 Interpretation“).
from interpreting or enforcing Section 1557 of the Affordable Care Act,
42 U.S.C. § 18116(a) , or any implementing regulations thereto against Plaintiffs . . . in a manner that would require them to perform or provide insurance coverage for gender-transition procedures or abortions . . ..
Pls.’ Proposed Order, ECF No. 200-1; see also Pls.’ Supp. Reply 2, ECF No. 203 (“an injunction here would merely protect Plaintiffs, leaving HHS free to promulgate any rules it wants.“). The government and Intervenors (“the ACLU“) opposed the motion, and it is ripe for the Court‘s consideration. See Ints.’ Supp. Resp., ECF No. 201; Defs.’ Supp. Resp., ECF No. 202; Pls.’ Supp. Reply, ECF No. 203.
II. LEGAL STANDARD
A. Summary Judgment
Summary judgment is proper when the pleadings and evidence show “there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.”
When reviewing the evidence on a motion for summary judgment, the court must resolve all reasonable doubts and inferences in the light most favorable to the non-movant. See Walker v. Sears, Roebuck & Co., 853 F.2d 355, 358 (5th Cir. 1988). The court cannot make a credibility determination in light of conflicting evidence or competing inferences. Anderson, 477 U.S. at 255,
B. Permanent Injunction
A “court may grant a permanent injunction without a trial on the merits if there are no material issues of fact and the issues of law have been correctly resolved.” Calmes v. United States, 926 F. Supp. 582, 591 (N.D. Tex. 1996). The standard is “essentially the same” as the standard for a preliminary injunction. Id. “A plaintiff must demonstrate: (1) that it has suffered an irreparable injury; (2) that remedies available at law, such as monetary damages, are inadequate to compensate for that injury; (3) that, considering the balance of hardships between the plaintiff and defendant, a remedy in equity is warranted; and (4) that the public interest would not be disserved by a permanent injunction.” eBay Inc. v. MercExchange, L.L.C., 547 U.S. 388, 391 (2006). But unlike for a preliminary injunction, a plaintiff seeking a permanent injunction “must demonstrate actual success on the merits.” Millennium Rests. Grp., Inc. v. City of Dallas, 191 F. Supp. 2d 802, 809 (N.D. Tex. 2002).
C. Mootness
“The doctrine of mootness arises from
The Fifth Circuit recognizes two voluntary actions by a party that typically moot a case: (1) “if the plaintiff represents to a court that it is no longer seeking relief on its claim,” and (2) “if the defendant credibly pledges to the court that it will provide the plaintiff‘s requested relief . . ..” D.C. v. Klein Indep. Sch. Dist., No. 20-20339, 2021 WL 2492842, at *10 (5th Cir. June 17, 2021) (citing Patriot Cinemas, Inc. v. Gen. Cinemas Corp., 834 F.2d 208, 211–15 (1st Cir. 1987); 13B Charles Alan Wright, Arthur R. Miller & Edward H. Cooper, Federal Practice And Procedure § 3533.2 (3d ed. 1998); Lee ex rel. MacMillan v. Biloxi Sch. Dist., 963 F.2d 837, 839 (5th Cir. 1992)). But the “well settled rule” is that “a defendant‘s voluntary cessation of a challenged practice” will moot a case only if the defendant carries “[t]he heavy burden of persuading the court that the challenged conduct cannot reasonably be expected to start up again” Friends of the Earth, Inc. v. Laidlaw Env‘t Servs. (TOC), Inc., 528 U.S. 167, 189 (2000)
D. Ripeness
“The ripeness inquiry reflects ‘Article III limitations on judicial power’ as well as ‘prudential reasons for refusing to exercise jurisdiction.‘” DM Arbor Ct., Ltd. v. City of Houston, 988 F.3d 215, 218 (5th Cir. 2021) (quoting Stolt-Nielsen S.A. v. AnimalFeeds Int‘l Corp., 559 U.S. 662, 670 n.2 (2010). “Ripeness ensures that federal courts do not decide disputes that are ‘premature or speculative.‘” Id. (quoting Shields v. Norton, 289 F.3d 832, 835 (5th Cir. 2002)); see also Texas v. United States, 497 F.3d 491, 498 (5th Cir. 2007) (“[The] basic rationale [of the ripeness doctrine] is to prevent the courts, through avoidance of premature adjudication, from entangling themselves in abstract disagreements over administrative policies, and also to protect the agencies from judicial interference until an administrative decision has been formalized and its effects felt in a concrete way by the challenging parties.“) (citing Abbott Labs. v. Gardner, 387 U.S. 136, 148–49 (1967), overruled on other grounds, Califano v. Sanders, 430 U.S. 99 (1977)).
“[A] challenge to administrative regulations is fit for review if (1) the questions presented are ‘purely legal one[s],’ (2) the challenged regulations constitute ‘final agency action,’ and (3) further factual development would not ‘significantly advance [the court‘s] ability to deal with the legal issues presented.‘” Franciscan All., Inc. v. Burwell, 227 F. Supp. 3d 660, 681 (N.D. Tex. 2016) (quoting Texas, 497 F.3d at 498–99). “An additional consideration is ‘whether resolution of the issues will foster effective administration of the statute.‘” Texas, 497 F.3d at 498–99 (quoting Merchs. Fast Motor Lines, Inc. v. ICC, 5 F.3d 911, 920 (5th Cir. 1993). A “purely legal” question must still involve some hardship, which may include a legal harms, practical harms, or the harm
III. ANALYSIS
The greater a man‘s talents, the greater his power to lead astray. It is better that one should suffer than that many should be corrupted. Consider the matter dispassionately, Mr. Foster, and you will see that no offense is so heinous as unorthodoxy of behavior.3
Christian Plaintiffs ask to be exempted from the government‘s orthodoxy. Specifically, they ask the Court for a permanent injunction based on their RFRA claim to be exempt from the government‘s requirement to perform abortions and gender-transition procedures. See Pls.’ Supp. Br. 2, ECF No. 200. The government alone argues that the promulgation of the 2020 Rule rendered this case moot or unripe. See Defs.’ Supp. Br. 10–21, ECF No. 202. And, even if the case is justiciable, the government contends, together with the ACLU, that the Court should not or cannot grant injunctive relief because Christian Plaintiffs cannot show a permanent injunction is warranted, the Court‘s relief granted thus far is sufficient, and the Court lacks the authority to grant the relief requested. See Defs.’ Supp. Br. 12–13, 18, ECF No. 202; Ints.’ Supp. Br. 9–22, ECF No. 201. To provide clarity, the Court first reconstructs the Section 1557 regulatory scheme as it stands today and then turns to the justiciability and merits of the injunction requested.
Except as otherwise provided for in this title (or an amendment made by this title), an individual shall not, on the ground prohibited under title VI of the Civil Rights Act of 1964 (
42 U.S.C. 2000d et seq. ), title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq. ), the Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq. ), or section 794 of Title 29, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title (or amendments). The enforcement mechanisms provided for and available under such title VI, title IX, section 794, or such Age Discrimination Act shall apply for purposes of violations of this subsection.
During the final year of the Trump administration, HHS issued the 2020 Rule. 85 Fed. Reg. 37,160 (June 19, 2020). Departing from the 2016 Rule, the 2020 Rule incorporated Title IX‘s
After Bostock, numerous courts enjoined portions of the 2020 Rule and HHS modified its interpretation. On May 10, 2021, HHS issued the 2021 Interpretation of Section 1557 to put the Humpty-Dumpty scheme back together again. The 2021 Interpretation reads into Title IX‘s prohibition on discrimination “on the basis of sex” (as incorporated into Section 1557) as including “(1) discrimination on the basis of sexual orientation; and (2) discrimination on the basis of gender identity” and asserts that the interpretation is “consistent with the Supreme Court‘s decision in Bostock and Title IX . . ..” See 2021 Interpretation. HHS assured the public that
In enforcing Section 1557, as stated above, [the Office of Civil Rights] will comply with [RFRA] and all other legal requirements [and] with all applicable court orders that have been issued in litigation involving the Section 1557 regulations, including Franciscan Alliance, Inc. v. Azar, 414 F. Supp. 3d 928 (N.D. Tex. 2019); Whitman-Walker Clinic, Inc. v. U.S. Dep‘t of Health & Hum. Servs., 485 F. Supp. 3d 1 (D.D.C. 2020); Asapansa-Johnson Walker v. Azar, No. 20-CV-2834, 2020 WL 6363970 (E.D.N.Y. Oct. 29, 2020); and Religious Sisters of Mercy v. Azar, No. 3:16-CV-00386, 2021 WL 191009 (D.N.D. Jan. 19, 2021).
Even assuming the HHS Secretary has the power to reimagine Section 1557(a)—or the 2020 Rule for that matter—by administrative fiat,7 the 2021 Interpretation, while succinct, did little for clarity. According to the 2021 Interpretation, incorporating all of HHS‘s compliance measures, Section 1557(a) should be interpreted to read, in relevant part, as follows:
[A]n individual shall not, (1) on the basis of sexual orientation or (2) on the basis of gender identity, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title (or amendments) except
(1) the statute‘s implementing rule may not define sex discrimination to include “gender identity” as the 2016 Rule had, see Franciscan, 414 F. Supp. 3d 928; see also Order, ECF No. 182;
(2) the statute‘s implementing rule must define sex discrimination to include “sex stereotyping,” which should encapsulate “gender identity,” and may not incorporate Title IX‘s religious exemption until it is revisited in another round of rulemaking,8 see Whitman-Walker, 485 F. Supp. 3d 1;
(3) the statute‘s implementing rule must require the 2016 Rule‘s definitions of “on the basis of sex,” “gender identity,” and “sex stereotyping” remain in effect. And the statute‘s implement rule must require “healthcare providers to ‘treat individuals consistent with their gender identity’ and prohibit[] them from ‘deny[ing] or limit[ing] health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that the individual‘s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are
ordinarily or exclusively available,‘” Asapansa-Johnson, 2020 WL 6363970 (quoting 45 C.F.R. § 92.206); and
(4) the statute may not be applied or enforced by HHS against the Religious Sisters of Mercy, Sacred Heart Mercy Health Care Center (Alma, MI), SMP Health System, and University of Mary in a manner that would require them to perform or provide insurance coverage for gender-transition procedures, see Religious Sisters, 2021 WL 191009.
(5) And the Office of Civil Rights plans to “comply with the Religious Freedom Restoration Act . . . and all other legal requirements.”9
If this sounds entirely unworkable or, at worst, materially indistinguishable from the 2016 Rule, you‘re not alone. Compare the 2020 Rule and 2021 Interpretation, 86 Fed. Reg. 27,984, 27,984 (May 25, 2021); with the 2016 Rule, 81 Fed. Reg. 31,376, 31,466, 31,467 (May 18, 2016) (defining “sex” discrimination under Section 1557 to include discrimination based on “gender identity,” and promising “[i]nsofar as the application of any requirement under this part would violate applicable Federal statutory protections for religious freedom and conscience, such application shall not be required.“). The 2021 Interpretation effectuates a legal Penrose staircase to enforce Section 1557 in the near identical way as, if not an enhanced version of, how the 2016 Rule dictated.10 Having deciphered the current state of Section 1557, the Court turns to justiciability.
A. Justiciability
Mandated by the Fifth Circuit, the Court must decide whether “the case is moot[.]” Franciscan, 843 F. App‘x at 663. In its supplemental brief, the government contends that
The government relies on four cases to support its proposition that promulgation of the 2020 Rule automatically mooted this case, all of which are distinguishable. Defs.’ Supp. Br. 11–15, ECF No. 202. In one, the Fifth Circuit found a part of an appeal moot by the agency‘s express request of “a voluntary vacatur of the agency‘s final rules” satisfying the petitioner‘s vacatur request. See Louisiana Env‘t Action Network v. U.S. E.P.A., 382 F.3d 575, 581 (5th Cir. 2004). Defendants also cite Sannon v. United States, 631 F.2d 1247, 1250 (5th Cir. 1980). There, the court found the case moot where petitioners, barred originally by a prior regulation, sought to present their claims for political asylum to an immigration judge, but under newly promulgated regulations, they had the right to exactly the hearings they sought.
Left are two cases from outside this circuit. In the first, then-Judge Gorsuch found an appeal moot because “[b]y its terms . . . the district court‘s order ha[d] expired” once a new rule had been promulgated. Wyoming v. U.S. Dep‘t of Interior, 587 F.3d 1245, 1252 (10th Cir. 2009). In the other, a 1975 Ninth Circuit panel summarily dismissed a case without prejudice, finding the issues “moot or not ripe” after enforcement of a statute had been “indefinitely suspended” but urged re-filing once a new rule was promulgated or the suspension lifted. State of Alaska v. Env‘t Prot. Agency, 521 F.2d 842, 843–44 (9th Cir. 1975). Here, even assuming the Court found the cases to be more than persuasive, the Court‘s 2019 order had no such automatic expiration as did the order in the case before then-Judge Gorsuch. See Order, ECF No. 182. Similarly, enforcement of Section 1557 as the 2016 Rule proscribed has not been “indefinitely suspended.” Indeed, the facts suggest a threat well beyond the “mere risk that [HHS might] repeat its allegedly wrongful conduct” of the enforcement of Section 1557 against Christian Plaintiffs in the same religion-burdening way as the 2016 Rule proscribed. See Opulent Life Church, 697 F.3d at 285. In light of the Walker-Whitman and Walker nationwide injunctions and their incorporation via the 2021 Interpretation,
Because the injunctive relief Christian Plaintiffs now seek is plainly within the Court‘s power to grant and the current Section 1557 regulatory scheme credibly threatens the same RFRA-violating religious-burden that the application of the 2016 Rule threatened, this case is not moot. See infra Part III(B); see, e.g., DeOtte v. Azar, 393 F. Supp. 3d 490, 495-98 (N.D. Tex. 2019) (granting a permanent injunction where the plaintiffs faced a credible threat of enforcement of the Affordable Care Act‘s contraceptive mandate).
As for ripeness, even assuming the Fifth Circuit‘s remand mandate required its consideration, the Court has rejected the government‘s nearly identical argument in the past and again rejects the argument. See Mem. Op. 20–24, ECF No. 62. Like before, the Court concludes that the current regulatory scheme for Section 1557 “clearly prohibits” Plaintiffs’ conduct, thus, putting them to the “impossible choice” of either “defying federal law” and risking “serious financial and civil penalties,” or else violating their religious beliefs. Mem. Op. 20–24, ECF No. 62; see Texas v. United States, 497 F.3d 491, 498 (5th Cir. 2007).12 The Court also declines to heighten the harm required for ripeness by blurring it with the irreparable harm required for a permanent injunction. See Oh. Forestry, 523 U.S. at 734 (1998) (for the purposes of ripeness, being “force[d] . . . to modify [one‘s] behavior in order to avoid future adverse consequences” constitutes a practical harm); Dierlam, 977 F.3d at 477 (declining to blur the jurisdictional inquiry
B. Permanent Injunction
Mandated by the Fifth Circuit panel, the Court must decide whether it “should [] grant[] [Christian Plaintiffs] injunctive relief against the 2016 rule and the underlying statute” by considering whether “they still suffer a substantial threat of irreparable harm under the 2016 rule” and “the subsequent developments.” Franciscan, 843 F. App‘x at 663. Christian Plaintiffs contend they are entitled to a permanent injunction. Pls.’ Supp. Br. 9–21, ECF No. 200. The ACLU disagrees, maintaining Christian Plaintiffs have not demonstrated irreparable harm and the Court lacks authority to grant the requested relief. Ints.’ Supp. Br. 9–22, ECF No. 201. The government suggests that, because Christian Plaintiffs have not suffered sufficient harm for ripeness (an argument rejected above), ipso facto the Christian Plaintiffs fall short of irreparable harm for a permanent injunction. Defs.’ Supp. Br. 12–13, 18, ECF No. 202.
“[T]he standard for a permanent injunction is essentially the same as for a preliminary injunction with the exception that the plaintiff must show actual success on the merits.” Dresser-Rand Co. v. Virtual Automation, Inc., 361 F.3d 831, 847-48 (5th Cir. 2004). A “court may grant a permanent injunction without a trial on the merits if there are no material issues of fact and the issues of law have been correctly resolved.” Calmes, 926 F. Supp. At 591. Thus, a permanent injunction is proper if the plaintiff shows: “(1) that it has succeeded on the merits; (2) that a failure to grant the injunction will result in irreparable injury; (3) that said injury outweighs any damage that the injunction will cause the opposing party; and (4) that the injunction will not disserve the public interest.” Valentine v. Collier, 993 F.3d 270, 280 (5th Cir. 2021); see also eBay, 547 U.S. at 391. Unlike for a preliminary injunction, a plaintiff seeking a permanent injunction “must
A RFRA claimant may “obtain appropriate relief against a government.”
Here, the RFRA violation, the success on the merits, is all but conceded. No party disputes that the current Section 1557 regulatory scheme threatens to burden Christian Plaintiffs’ religious exercise in the same way as the 2016 scheme: namely, by placing substantial pressure on Christian Plaintiffs, in the form of fines and civil liability, to perform and provide insurance coverage for gender-transition procedures and abortions. Like before, the current scheme continues to fall short of the “more focused” RFRA inquiry. See Franciscan, 414 F. Supp. 3d at 944 (quoting Gonzales v. O Centro Espirita Beneficente Uniao do Vegetal, 546 U.S. 418, 430 (2006)). The government asserts no “harm [in] granting specific exemptions” to Christian Plaintiffs. See Burwell v. Hobby Lobby Stores, Inc., 573 U.S. 682, 726–27 (2014). Accordingly, for these reasons and those laid out in greater detail in the Court‘s October 15, 2019, Order, the Court holds that Christian Plaintiffs have shown success on the merits for its RFRA claim because the current Section 1557 regulatory
For irreparable injury, the mere “possibility” of injury is not enough. Plaintiffs must “demonstrate that irreparable injury is likely in the absence of an injunction.” Winter v. Nat. Res. Def. Council, Inc., 555 U.S. 7, 22 (2008) (emphasis in original). In the context of RRFA, if a plaintiff demonstrates a violation, that “loss of First Amendment freedoms, for even minimal periods of time, unquestionably constitutes irreparable injury.” Roman Catholic Diocese of Brooklyn v. Cuomo, 141 S. Ct. 63, 67 (2020) (internal quotation marks omitted)); Opulent Life Church, 697 F.3d at 294–96 (equating the First Amendment irreparable injuries to RFRA irreparable injuries).
Here, Christian Plaintiffs contend that violation of their statutory rights under RFRA is an irreparable harm. The Court agrees and concludes that enforcement of the 2021 Interpretation forces Christian Plaintiffs to face civil penalties or to perform gender-transition procedures and abortions contrary to their religious beliefs—a quintessential irreparable injury. See DeOtte, 393 F. Supp. 3d at 512 (“Plaintiffs rights will be violated day after day.“); see also
The Court need not speculate whether another lesser remedy would be adequate in providing Christian Plaintiffs’ relief because a vacatur was already insufficient as it led to an identical RFRA violation. see Monsanto Co. v. Geertson Seed Farms, 561 U.S. 139, 165–66 (2010) (“If a less drastic remedy [i]s sufficient to redress [plaintiff‘s] injury, no recourse to the additional and extraordinary relief of an injunction [i]s warranted.“). The changing landscape of Section 1557‘s regulatory scheme left the Court‘s 2019 order wholly inadequate compared to the relief the Court sought to provide. Franciscan, 414 F. Supp. 3d at 946; contra Monsanto, 561 U.S. 139, 165–66 (finding a permanent injunction overbroad where the court‘s vacatur based on an APA claim rendered the added injunctive relief superfluous—lacking “any meaningful practical effect independent of the vacatur.“). The Court finds no reason to depart from its charge to Christian Plaintiffs two years ago “inviting [them] to return if further relief independent of vacatur is later warranted.” Franciscan, 414 F. Supp. 3d at 946. Thus, the Court concludes that the permanent injunctive relief requested is the adequate remedy at this juncture.
If the Court found a permanent injunction appropriate in this case, the ACLU and the government offered an alternative argument: the scope of the injunctive relief requested would exceed the Court‘s authority by addressing relief outside the 2016 Rule. See Ints. Resp. 12, ECF No. 201; see also Franciscan, 843 F. App‘x at 663 (instructing the Court to determine whether
The ACLU and the government narrowly read Plaintiffs’ live pleading as challenging just the 2016 Rule and not Section 1557 itself; thus, limiting the possible scope of injunctive relief to the 2016 Rule. See Ints.’ Supp. Resp. 12, ECF No. 201. But Rule 54(c) provides no such limit. Under
Here, in the Amended Complaint, Plaintiffs identified the substantial burden on their religious exercise as resulting from HHS‘s attempt to “forc[e] them to choose between federal funding and their livelihood as healthcare providers and their exercise of religion.” Am. Compl.
Accordingly, the Court will grant Plaintiffs’ requested permanent injunctive relief.
IV. CONCLUSION
For the foregoing reasons, the Court GRANTS Plaintiffs’ request for a permanent injunction and PERMANENTLY ENJOINS HHS, Secretary Becerra, their divisions, bureaus, agents, officers, commissioners, employees, and anyone acting in concert or participation with them, including their successors in office, from interpreting or enforcing Section 1557 of the Affordable Care Act,
SO ORDERED on this 9th day of August, 2021.
REED O‘CONNOR
UNITED STATES DISTRICT JUDGE
Notes
Such claims present difficult religious liberty issues because some employers and healthcare providers have strong religious objections to sex reassignment procedures, and therefore requiring them to pay for or to perform these procedures will have a severe impact on their ability to honor their deeply held religious beliefs. Bostock, 140 S. Ct. at 1781–82 (Alito, J. dissenting).