AUSTIN, Texas — Five states have filed a legal challenge against the Obama administration over its recently-released healthcare rules, which some believe might be used to force doctors to perform sex change operations or other services that may violate their conscience.

Texas, Wisconsin, Kentucky, Nebraska and Kansas are all a part of the suit, as well as the Christian Medical and Dental Association and the Roman Catholic Franciscan Alliance.

“[The requirement] discards independent medical judgment and a physician’s duty to his or her patient’s permanent well-being and replaces them with rigid commands,” the complaint reads, according to the Associated Press.

As previously reported, the rules pertain to language in the Affordable Care Act (ACA), otherwise known as Obamacare, and affects all hospitals that accept Medicare or Medicaid, as well as those directly funded by HHS. (Read in full here.)

The government asserts that the rules build upon the Civil Rights Act of 1964 and the Education Amendments of 1972, which the Obama administration has interpreted in recent months as applying to “gender identity.”

“Section 1557 builds on prior federal civil rights laws to prohibit sex discrimination in health care,” the document reads. “The final rule requires that women be treated equally with men in the health care they receive and also prohibits the denial of health care or health coverage based on an individual’s sex, including discrimination based on pregnancy, gender identity, and sex stereotyping.”

“The final rule also requires covered health programs and activities to treat individuals consistent with their gender identity,” it notes.

The department provide the examples that “a covered entity may not deny, based on an individual’s identification as a transgender male, treatment for ovarian cancer where the treatment is medically indicated” and if “an issuer or state Medicaid agency denies a claim for coverage for a hysterectomy that a patient’s provider says is medically necessary to treat gender dysphoria,” the case will be investigated.

The site Modern Healthcare also outlines that the rules could require that hospitals provide sex change operations and other treatments related to switching one’s gender identity.

“The rule does not explicitly require insurers to cover gender-transition treatments such as surgery. But insurers could face questions if they deny medically necessary services related to gender transition for a man who identifies as a woman, or a woman who identifies as a man,” it explains.

HHS says that in such cases, “[i]n evaluating whether it is discriminatory to deny or limit a request for coverage for a particular service for an individual seeking the service as part of transition-related care, … OCR will start by inquiring whether and to what extent coverage is available when the same service is not related to gender transition.”

“[T]ransgender people can now enter bathrooms or hospital wards consistent with their gender identity,” Modern Healthcare also notes. There are questions surrounding whether males who identify as females will be placed in shared rooms with female patients.

The Becket Fund for Religious Liberty says that it is especially concerned that doctors might be required to perform sex change operations on young children.

“No doctor should be forced to perform a procedure that he or she believes will harm a child,” senior counsel Lori Windham said in a statement announcing the suit. “Decisions on a child’s medical treatment should be between families and their doctors, not dictated by politicians and government bureaucrats.”

Doctors “have taken an oath to put the needs of each patient first and do no harm. But this regulation violates doctors’ ability to exercise both their best medical judgment and their religiously-inspired desire to care for society’s most vulnerable,” the Becket Fund says. “It will also cost healthcare providers and taxpayers nearly $1 billion.”

But the Transgender Legal Defense and Education Fund says that the concerns are unwarranted.

“The only thing a doctor is obliged to do is treat all patients, including trans patients, with dignity and respect and to make treatment decisions free from bias,” Executive Director Jillian Weiss told the Associated Press. “If a doctor has a sound, evidence-based, medical reason to delay transition care for a specific patient, that would be respected under the regulations.”

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