


In his order, Judge Reed O'Connor argued laws that would otherwise forbid gender-based discrimination require doctors "to remove the categorical exclusion of transitions and abortions (a condition they assert is a reflection of their religious beliefs and an exercise of their religion) and conduct an individualized assessment of every request for those procedures." In other words, doctors would have to argue on an individual basis their refusal of a patient.

This requirement, O'Connor said, "imposes a burden" on doctors' ability to exercise their religion. 

O'Connor cited 2014's Burwell v. Hobby Lobby ruling, which allowed family-owned corporations to refuse insurance coverage for birth control under the Affordable Care Act if it went against their religious beliefs. 

At the time, the New York Times predicted the 5-4 Supreme Court decision would "[open] the door to many challenges from corporations over laws that they claim violate their religious liberty." And, given O'Connor's interpretation of the decision, it seems the outlet was right.

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Slate's Mark Joseph Stern called O'Connor's ruling "an extreme extension of the dubious logic" behind Burwell v. Hobby Lobby, as it flouts the nondiscriminatory guidelines of the Affordable Care Act and the Department of Health and Human Services. 

Whereas they both include discrimination based on "gender identity" and "termination of pregnancy" under the umbrella of sex discrimination, O'Connor's ruling only acknowledges a more rudimentary definition of gender discrimination — "hostility against a man or woman for being a man or a woman," Stern wrote.

O'Connor also justified his ruling by claiming that individual doctors' refusal to treat trans patients or women who have had abortions does not limit their access to health care and coverage. He argued that the government doesn't seem to be too concerned about specifically trans people's access to health care anyway.

"The government's own health insurance programs, Medicare and Medicaid, do not mandate coverage for transition surgeries; the military's health insurance program, TRICARE, specifically excludes coverage for transition surgeries," O'Connor wrote in his judgment.

O'Connor's ruling, though, will only continue to limit options for trans people and add fuel to the fire in terms of punishing women for their reproductive choices — objectives conservatives have been steadily working toward with the trans bathroom bill in North Carolina and a number of anti-abortion laws in other states.

With his ruling, O'Connor paved the way for even more discrimination on the grounds of religious freedom.