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US government can’t force Christian groups to perform abortions, gender reassignment surgery, court rules

Christian medical groups cannot be compelled by the federal government to perform abortions or gender reassignment surgeries under a new court ruling.

The federal government cannot force Christian medical organizations to perform abortions or gender transition surgeries under the Affordable Care Act, a federal appeals court ruled Friday. 

In a unanimous ruling, the 5th U.S. Circuit Court of Appeals upheld a lower court’s permanent order shielding the Christian groups from anti-discrimination lawsuits under a provision known as Section 1557 in the ACA. 

Those groups in the lawsuit were Christian Medical and Dental Associations, Specialty Physicians of Illinois, and Catholic hospital system Franciscan Alliance Inc. Each said performing an abortion or gender reassignment surgery would violate their religious freedoms. 

The judges wrote that the providers faced harm because the U.S. Department of Health and Human Services (HHS) had "repeatedly refused to disavow enforcement" against them. 


"In its brief on appeal, HHS simply says it ‘has not to date evaluated’ whether it will enforce Section 1557 against Franciscan Alliance – in other words, it concedes that it may," Circuit Judge Don Willett wrote in rejecting the government’s argument. "We have repeatedly held that plaintiffs have standing in the face of similar prosecutorial indecision." 

Joe Davis of the Becket Fund for Religious Liberty, which represented the Christian groups, called the ruling "a major victory for conscience rights and compassionate medical care in America." 

The case, Franciscan Alliance v. Becerra began when the groups sued in a federal court in Wichita Falls, Texas, challenging an Obama-era HHS rule, which interpreted Section 1557 as requiring health care providers to perform abortions or gender reassignment surgery if they receive federal funding or participate in ACA exchanges. 

In 2019, U.S. District Judge Reed O’Connor vacated parts of the ruling but declined to enter an injunction. A year later, the Trump administration rescinded the rule. 

The plaintiffs appealed to the 5th Circuit, asking for an injunction. The court remanded the case to O’Connor for further consideration. He then entered a broad injunction against enforcing 1557 against the Christian groups to require the abortion and gender reassignment services. 

HHS appealed the injunction, culminating in Friday’s ruling, in which the 5th Circuit sided with the lower court order. 

Reuters contributed to this report

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