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

The Biden administration’s interpretation of sex-based discrimination protections to include sexual orientation and gender identity in the list of protected characteristics under certain health programs and activities of the Affordable Care Act (Obamacare) sparked outcry on the political right when implemented in 2024. This opposition led to lawsuits aiming to ensure health care providers would not be obligated to treat LGBTQ+ people equally.

In his ruling, Judge Guirola explicitly stated that discrimination against people based on their gender identity is now legal. He wrote that the Department of Health and Human Services “exceeded its authority by implementing regulations redefining sex discrimination and prohibiting gender identity discrimination.”

This decision marks a major setback for the transgender community, which has already faced a wave of discriminatory legislation in conservative states and multiple attacks under the Trump administration.

The right-wing 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 following the ruling.

The lawsuit centered around provisions in Section 1557 of the Affordable Care Act. These provisions were updated to align with rules in other anti-discrimination laws, including Title VI of the Civil Rights Act of 1964 and Title IX of the Education Amendments of 1972.

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

In 2016, the Obama administration advanced similar rules to prevent insurers and health care providers from denying the same services to all patients, including those seeking gender-affirming care. However, during his first term, President Trump rolled back those protections by redefining Title IX 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 of sex discrimination to include sexual orientation and gender identity.

Judge Guirola’s decision was based on an “originalist” interpretation of Title IX. He argued that a statute “cannot be divorced from the circumstances existing at the time it was passed.” Since the word “sex” is not explicitly defined in Title IX, the court must interpret it according to its meaning around 1972, when the statute was enacted. At that time, “sex” was understood as the reproductive distinction between male and female.

While this ruling represents a symbolic setback in the broader fight for transgender rights, its practical consequences remain limited because the rule had not yet taken effect.
https://www.lgbtqnation.com/2025/10/federal-judge-sides-with-republican-ags-ends-biden-era-health-care-discrimination-protections/