A federal judge in Texas has struck down a provision of the Affordable Care Act that bars hospitals and other health care providers from discriminating against patients based on gender identity.
Related: The state of transgender health care
U.S. District Judge Reed O'Connor wrote in the decision that Section 1557 of the ACA, which the Obama administration only implemented in May, likely violates the religious freedom of health care providers.
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O'Connor ruled against transgender rights in a separate case last year over whether bathroom access in public schools, siding with 11 states which had sued the Obama administration over a rule requiring schools to allow students to use the bathroom corresponding with their gender identity.
The suit against the ACA rule was brought by Franciscan Alliance, a Catholic hospital that argued that requiring its staff to take patients seeking transition-related treatment would lead them to an "impermissible material cooperation with evil."
There is compelling evidence that transgender people regularly encounter resistance to requests for transition care from medical providers. A 2010 survey of 7,000 transgender people reported that a fifth had been refused care due to their gender identity, although awareness of gender identity and support for transgender rights has increased significantly in the past six years.
The Obama administration did not indicate whether it planned to contest the ruling in the two weeks before Donald Trump takes office.
Even if the rule is dead, transgender people who are turned away by doctors can still sue, Emily Prince, a trial attorney who advocates on behalf of transgender rights, tells BuzzFeed.
"Now it's a matter of finding lawyers and dividing up resources; the worst cases will still be addressed, but the smaller (but still significant) cases won't be handled," Prince says. "The ruling doesn't change the law, it makes it more inaccessible."
Compared to most other Republicans, Trump's stated positions on LGBT rights are relatively liberal. During the GOP primary last year, Trump said that he thought North Carolina erred in putting in place a controversial law requiring people to use restrooms based on their biological sex, a statement for which he was pilloried, in vain, by primary opponent Ted Cruz.
However, LGBT rights advocates have pointed out that Trump's administration is so far full of devoted opponents of same-sex marriage and transgender rights.
The most prominent example is soon-to-be Vice President Mike Pence, who has consistently opposed LGBT rights throughout his political career and who oversaw the implementation of a controversial law in Indiana that allowed businesses to withhold services to LGBT people, although he later signed into law an amendment to the legislation that was intended to provide some protections for LGBT people.
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