Big Sky Times

Montana Attorney General Austin Knudsen filed a lawsuit Tuesday against the Biden administration's new rule, which mandates states and healthcare providers to offer or finance "gender-transition" treatments for adults and children or risk losing federal funding. This marks the 50th lawsuit Knudsen has filed against the current administration.

The Department of Health and Human Services (HHS) issued the rule, "Nondiscrimination in Health Programs and Activities," under Section 1557 of the Patient Protection and Affordable Care Act (ACA). The rule requires healthcare providers to perform gender-transition medical activities for individuals seeking such treatments. However, Section 1557 does not explicitly authorize the federal government to compel these procedures.

"This is another attempt by the Biden administration to force the left’s radical gender ideology on Americans. Healthcare providers should not be forced to perform dangerous and life-altering experimental procedures under the threat of losing the federal funding they rely on to keep their doors open. And the states should not be compelled to foot the bill for treatments that are leaving people, even children, with irreversible damage," said Attorney General Knudsen. "Biden has once again overstepped his authority and I will not stand by while he continues his assault on the Constitution and our Montana values."

Knudsen contends in his lawsuit that this final rule exceeds its authority under Section 1557, Title IX, and the United States Constitution. He seeks a court ruling declaring it unlawful and preventing its enforcement.

Initially, Section 1557 prohibited any federally funded health program from discriminating based on sex as defined by Title IX. The new rule interprets "sex" discrimination as including discrimination based on "gender identity." Consequently, Montana and other states would need to fund controversial drugs and surgeries for those seeking gender transitions.

The rule could have significant financial implications for Montana's medical system, which receives approximately two billion dollars annually in federal aid from HHS. The new stipulations threaten this aid if Montana does not comply with offering gender-transition treatments.

Healthcare providers might face a dilemma between violating state law or losing federal funding. In 2023, Montana passed Senate Bill 99, which prohibits surgical procedures addressing minors' perception of differing gender identities from their biological sex. Although SB 99 has been preliminarily enjoined by a state district judge, Montana has appealed that decision.

This represents the fourth attempt by a presidential administration to alter Section 1557 through regulatory changes; previous attempts have been overturned by courts.

"The fourth time is not the charm. HHS’s latest attempt to refashion the medical profession to match its views on 'gender identity' and 'gender-affirming care' again exceeds its authority under Section 1557, Title IX, and the United States Constitution, and it must be set aside," states Knudsen's lawsuit.

Montana filed this lawsuit jointly with Texas.