A federal judge in Texas has vacated an Affordable Care Act (ACA) rule that prohibits discrimination by healthcare professionals and insurers based on sex, gender identity, or pregnancy termination.

The case, Franciscan Alliance v Azar, has been in the US District Court for the Northern District of Texas, under Judge Reed O'Connor, for several years.

O'Connor is the same judge who, in December 2018, struck down the entire ACA as unconstitutional. He has now vacated a rule implementing Section 1557 of the ACA, which prohibits health programs or facilities that receive federal funds from discriminating on the basis of race, color, national origin, age, disability, or sex.

The rule interpreted "sex" as prohibiting discrimination based on sexual orientation or gender identity, an interpretation O'Connor said was contrary to existing law. The Obama administration fashioned the rule to prevent denials of care or coverage of procedures, including those related to transitioning or gender-affirming surgery.

But a group of healthcare providers, religious organizations, and nine states claimed it mandated services be offered in the face of conscience objections or "even if the doctor believes the treatment or hormone therapy could harm the child."

O'Connor sided with the plaintiffs — represented by the Becket Fund for Religious Liberty — that the ACA protections were an overreach and violated the Administrative Procedure Act and Religious Freedom Restoration Act. However, he also granted the River City Gender Alliance and American Civil Liberties Union of Texas their request to intervene as defendants — as the Trump administration has refused to defend the rule. Read more via Medscape