Seven Republican-led states have initiated a federal lawsuit in St. Louis against the Biden administration, targeting recent amendments to the Affordable Care Act intended to safeguard transgender individuals from medical discrimination.

The states of Missouri, Utah, North Dakota, South Dakota, Iowa, Idaho, and Arkansas, supported by the conservative American College of Pediatricians, lodged four distinct complaints. These claims focus on both procedural and substantive issues but primarily center around ideological opposition to gender-affirming care, particularly for minors.

The lawsuit asserts, “The U.S. Department of Health and Human Services, under Section 1557 of the Affordable Care Act, forces doctors to perform, refer for, or affirm harmful gender-transition procedures and mandates states to fund these risky procedures in state health plans. This radical mandate will hurt children.”

These rule modifications draw from the 1972 Title IX civil rights protections and were slated to be enacted last week. They prevent insurers and healthcare providers from denying care based on an individual’s sex assigned at birth, gender identity, or gender as recorded. Specifically, the rules prohibit denying gender transition and gender-affirming care based on a person’s assigned sex or gender identity.

The plaintiff states argue that these changes infringe upon free speech rights and undermine Congress’s legislative authority. They seek a federal injunction to halt the enforcement of these rules. The complaint states, “The rule is an overbroad restriction on speech, encompassing a significant amount of First Amendment-protected speech and expression. This overbreadth chills the speech of healthcare entities that engage in private discourse regarding gender and sex.”

The lawsuit also addresses cultural concerns, such as transgender individuals using bathrooms aligning with their gender identity and the use of preferred pronouns. The plaintiffs request the court block enforcement of any rule mandating them to “allow members of one sex into the private spaces or sex-specific programs of the other sex in their facilities,” “speak in ways that inaccurately refer to a patient’s sex, such as in pronoun usage,” or “affirm ‘gender-transition’ efforts while being unable to voice their full opinions to patients.”

This lawsuit follows a series of legal challenges to the Biden administration’s initiatives to enhance LGBTQ protections. Recently, U.S. District Judge Louis Guirola Jr. in Mississippi placed a temporary hold on the same rule changes, interpreting Title IX as applying to biological sex but not gender identity.

Furthermore, three federal judges have separately ruled against expanded Title IX protections for LGBTQ students in various states, thereby enjoining these protections in 14 red states and one Oklahoma middle school. Judges John Broomes of Kansas and Terry Doughty of Louisiana, both Trump appointees, alongside Kentucky’s Danny Reeves, a Bush appointee, presided over these rulings.