A federal judge in Mississippi on Wednesday struck down a Biden-era rule extending anti-discrimination healthcare protections to transgender people.

Judge Louis Guirola Jr. of the U.S. District Court for the Southern District of Mississippi – a George W. Bush appointee – ruled in favor of a coalition of 15 GOP-led states that sued to overturn the rule, the Hill reports.

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The Biden administration’s interpretation of sex-based discrimination protections to include sexual orientation and gender identity in the list of protected characteristics in certain health programs and activities under the Affordable Healthcare Act (Obamacare) caused outcry on the right when implemented in 2024, causing them to sue so that health care providers wouldn’t be obligated to treat LGBTQ+ people equally.

In his ruling, the judge explicitly states that discrimination against people based on their gender identity is now legal.

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The Department of Health and Human Services “exceeded its authority by implementing regulations redefining sex discrimination and prohibiting gender identity discrimination,” Guirola ruled.  

The decision is a major setback for the transgender community, already the object of a wave of discriminatory legislation in red states and under attack by the Trump administration on multiple fronts.

The rightwing lawsuit was led by Tennessee Attorney General Jonathan Skrmetti, who scored a major victory earlier this year when the U.S. Supreme Court upheld a ban on gender-affirming care for minors in his state.

“Our fifteen-State coalition worked together to protect the right of health care providers across America to make decisions based on evidence, reason, and conscience. This decision restores not just common sense but also constitutional limits on federal overreach,” Skrmetti said after the ruling.

The lawsuit centered on provisions in Section 1557 of the Affordable Care Act, which were updated to conform to rules around other antidiscrimination laws, including Title VI of the Civil Rights Act of 1964 and Title IX of the Education Amendment of 1972.

The Biden administration’s final rule, released in 2024, mandated that health insurers doing business through government plans and other organizations that receive federal health funding must provide the same services universally, including gender-affirming care. That is, if a procedure is covered when provided to cis people, then it must be covered when it’s provided to trans people as a form of gender-affirming care. So if an insurer covers hysterectomies for cis women, it also has to cover them for trans men.

In 2016, the Obama administration advanced similar rules intended to prevent insurers and health care providers from denying the same services to all patients, including those seeking gender-affirming care. But Trump turned those protections back in his first term, redefining Title IX protections to apply only to race, color, national origin, “biological sex,” age, or disability.

After taking office in 2021, President Biden reinstated and expanded the definition.

Guirola ruled based on an “originalist” interpretation of Title IX, stating that a statute “cannot be divorced from the circumstances existing at the time it was passed.” The word “sex” is not defined in Title IX, Guiroloa wrote, so the court must interpret the term according to its meaning in or around 1972, when the statute was enacted. At that time, he said, “sex” was defined as the reproductive distinction between male and female.  

While the decision is a setback in the broader fight for transgender rights, the consequence is more symbolic than practical. The rule had yet to take effect.

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