Judge Louis Guirola Jr. sided with a coalition of 15 states on Wednesday against a Department of Health and Human Services (HHS) rule put forward in 2024 redefining unlawful sex discrimination under Title IX and the Affordable Care Act (ACA) to include discrimination on the basis of “gender identity.” The rule would have specifically required health care providers to provide sex change drugs and surgeries to transgender-identifying patients and would have forced states to fund the procedures through their Medicaid programs.
Guirola granted a summary judgment in favor of the coalition of states, ruling that HHS “exceeded its authority by implementing regulations redefining sex discrimination and prohibiting gender identity discrimination.”
“Agencies do not have unlimited power to accomplish their policy preferences until Congress stops them; they have only the powers that Congress grants through a textual commitment of authority,” wrote Guirola, an appointee of President George W. Bush. “Neither Defendants nor this Court have authority to reinterpret or expand the meaning of ‘sex’ under Title IX.”
The Mississippi district court first blocked the rule on July 3, 2024 and prohibited HHS from enforcing the rule related to “gender identity discrimination.” The HHS under former President Joe Biden appealed to the the U.S. Court of Appeals for the Fifth Circuit.
When President Donald Trump began his second term, HHS decided to cancel its appeal, and President Trump subsequently issued two executive orders demanding the federal government expel gender ideology from all agencies (see orders here and here). The coalition of states then asked the lower court to issue a summary judgment declaring the HHS rule unlawful.
HHS under Health Secretary Robert F. Kennedy Jr. asked the court for a cross-motion to dismiss based on ripeness, which Guirola declined to do. Instead, the judge issued a strong rebuttal questioning why HHS would want to leave the rule on the books or allow a gender identity-based policy to remain, in violation of Trump’s executive orders.
“Defendants argue that the hardship element of ripeness is not satisfied because ‘Plaintiffs cannot credibly assert, in spite of the President’s executive orders, that they face any threat of compliance costs or loss of federal funds under the Rule.’ Defs.’ This argument is by no means persuasive,” Guirola wrote.
He noted that the executive orders require HHS to “remove all… regulations… that promote or otherwise inculcate gender ideology” and to “take all appropriate actions to end the chemical and surgical mutilation including regulatory and sub-regulatory actions, which may involve… section 1557 of the Patient Protection and Affordable Care Act.” Guirola wrote that HHS has not “delineated any efforts they have made to comply with the President’s directives,” and instead has only stated that the rule “remains under consideration at HHS” due to the change in presidential administration. He wrote:
Furthermore, some of Defendants’ arguments and actions in this case indicate that they are considering preserving at least some of the gender-identity provisions in the Rule. For example, Defendants continue to argue that the Rule should not be subjected to judicial review unless or until HHS begins an enforcement action against Plaintiffs. They further argue that the Rule’s gender identity provisions should not be vacated; they seek to limit the scope of any vacatur; and they oppose entry of a declaratory judgment.
If Defendants intended to comply with the President’s Executive Orders, they could have filed a motion for voluntary remand so that HHS could rescind or amend the Rule.
Since the Rule has not yet gone into effect, Defendants also could have filed a motion for a stay… that they could rescind the Rule, or they could have changed their position in this case due to the Executive Orders, but they chose not to do so.
Guirola said if he had decided to grant the agency’s request to dismiss the case, the rule would have no longer been blocked and states would have been without protection from the rule and statutorily mandated to comply with it.
“Defendants would no longer be enjoined from enforcing the Rule, and private citizens would be permitted to initiate civil proceedings against Plaintiffs for gender-identity discrimination,” he added, noting that state’s concerns and claims are “not premature, abstract, or contingent.”
“The promise of HHS ‘consideration’ offers little comfort or protection from, as noted below, an overreach of executive authority,” he continued. “The Rule is in place, and the threat of enforcement and legal action is real. Therefore, this lawsuit is ripe for a decision. Defendants’ Cross-Motion to Dismiss is denied.”
READ MORE: Supreme Court Upholds Tennessee Law Banning Sex Changes for Minors
Tennessee Attorney General Jonathan Skrmetti, who recently secured a massive victory at the Supreme Court enabling states to ban sex changes for minors, celebrated the nationwide victory. His office noted that the court’s final judgment “not only eliminates [the rule], it makes it more difficult for future administrations to revive them.”
“When Biden-era bureaucrats tried to illegally rewrite our laws to force radical gender ideology into every corner of American health care, Tennessee stood strong and stopped them,” Skrmetti said in a statement. “Our fifteen-state coalition worked together to protect the right of healthcare 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, and I am proud of the team of excellent attorneys who fought this through to the finish.”
Mississippi Attorney General Lynn Fitch said she is “proud to stand with my colleagues from across the country as we fight to undo the Biden administration’s extremist political agenda.”
“The Biden administration attempted to import its radical theories on gender identity into ObamaCare, forcing healthcare providers to perform surgeries or prescribe drugs even if it violated their best medical judgment,” Fitch said in a statement.
Tennessee, along with Mississippi, led a broad coalition of states in the lawsuit, including Alabama, Georgia, Indiana, Kansas, Kentucky, Louisiana, Nebraska, Ohio, Oklahoma, South Carolina, South Dakota, Virginia, and West Virginia.
The case is Tennessee v. Robert F. Kennedy, Jr., No. 1:24-cv-161 in the U.S. District Court for the Southern District of Mississippi Southern Division.
Katherine Hamilton is a political reporter for Breitbart News. You can follow her on X @thekat_hamilton.
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