WASHINGTON — Nearly 50 Congressional representatives have signed a letter to the United States Department of Health and Human Services (HHS) expressing concern that its recently released rules might wrongly require doctors to perform puberty suppression, cross-hormone therapy or plastic surgery against their will, including on children.

“[T]his rule for the first time in history requires doctors to perform gender transition procedures or treatments on patients including children, even if the doctor believes the procedures could be harmful,” reads the correspondence, led by Congressman Joe Pitts, R-Pa. “Never before has the federal government forced doctors to choose between caring for their patients based on their best medical judgment, and complying with federal law.”

As previously reported, the rules pertain to language in the Affordable Care Act (ACA), otherwise known as Obamacare, and affect 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,” HHS wrote in its summary of the guidelines. “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.”

In August, five states filed suit against HHS out of concern that the rules might be used to force doctors to perform sex change procedures or other services that might violate their conscience.

“[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,” read the complaint, filed by the attorneys general of Texas, Wisconsin, Kentucky, Nebraska and Kansas, as well as the Christian Medical and Dental Association and the Roman Catholic Franciscan Alliance.

This month, a number of Congressional representatives echoed the worriment in their letter to HHS, especially in regard to the treatment of children.

“The very guidance cited by HHS to justify this rule includes studies showing that up to ninety-four percent of children who wrestle with gender dysphoria will outgrow the dysphoria naturally and become comfortable in the bodies they were born with,” they wrote. “Children are some of the most vulnerable in our population, and this rule strips doctors of their ability to counsel and advise the best course of medical care in their professional judgment if they believe gender transition procedures to be harmful.”

The Congressmen and women additionally noted that there are no protections included in the rules for physicians’ “medical judgment or [religious] beliefs.”

“[T]he number of doctors and healthcare providers covered by this rule is breathtaking. By HHS’s own estimation, this rule will ‘likely cover almost all licensed physicians,’ which you estimate as totaling over 900,00,” the letter outlined. “This rule will also apply to virtually all hospitals, nursing homes, and health insurers, and many educational institutions of higher learning as well.”

The correspondence therefore presented a number of questions to HHS Secretary Sylvia Burwell for clarification, including whether doctors who treat precocious puberty would be required to prescribe “puberty blocking medication to treat gender dysphoria, even if the doctor’s best medical judgment was that such treatments are always experimental and inappropriate to provide to children to facilitate a gender transition.”

“Assume a doctor’s individual practice is a covered entity, and the doctor regularly provides hysterectomies to women to treat uterine cancer. Would the doctor be required under the rule to provide a hysterectomy to treat gender dysphoria if the patient’s mental health physician determined that the hysterectomy was medically necessary to treat gender dyphoria?” it also asked “Would the doctor be required to perform these procedures even if the doctor had ethical and religious objections to performing a hysterectomy to facilitate a gender transition?”

In addition to Sen. Pitts, the letter is signed by Reps. Steve King, R-Iowa, Tim Huelskamp, R-Kansas, Diane Black, R-Tennessee, Pete Sessions, R-Texas, Vicky Hartzler, R-Missouri, Chris Stuart, R-Utah, and Stevan Pearce, R-New Mexico, among others.

A response is requested by Nov. 14.

Editor’s Note: The Becket Fund for Religious Liberty has created a site about the concerns, which may be viewed here.

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