Biden Admin Abused Its Power, Tried to Redefine ‘Sex’ in Section 1557

The Biden administration has a documented history of overstepping its authority. One of the more egregious examples was how it misused federal law to try to force doctors to perform abortions, colluded with big banks to monitor groups with disfavored views, and coerced social media companies to censor ideas the administration dislikes.

In one of the most damaging examples of federal overreach, the Biden administration attempted to redefine “sex” to include gender identity in both Title IX and Section 1557 of the Affordable Care Act (ACA), more commonly known as Obamacare. This not only put Americans in danger but also violated a number of constitutional rights.

What is Section 1557 of the Affordable Care Act?

In 2010, President Barack Obama signed the ACA into law.

Included in the ACA is a nondiscrimination provision known as Section 1557. It applies to all healthcare providers who receive federal financial assistance, including private practices and hospitals that accept funds from Medicare, Medicaid, and/or the Children’s Health Insurance Program (CHIP). This encompasses virtually every healthcare entity in the country.

Section 1557 of the ACA prohibits healthcare providers from discriminating on the basis of race, national origin, sex, age, or disability. Although the provision has been in effect since 2010, the Biden administration issued a new rule 14 years later that unilaterally tried to change its meaning.

The Biden administration flouted the Constitution

In May 2024, the U.S. Department of Health and Human Services (HHS) issued a new regulation redefining “sex” in Section 1557 of the ACA to include “gender identity.” This was a grave abuse of power by the Biden administration that would have had devastating consequences.

First, HHS does not have the authority to unilaterally change the meaning of federal law. The ACA never mentions “gender identity,” and it repeatedly references sex using biologically binary language. This makes it clear that the ACA never meant for the word “sex” to mean gender identity in Section 1557. But the Biden administration’s mandate unilaterally attempted to change the meaning of Section 1557, which the executive branch has no power to do. Only Congress can pass and amend laws.

Second, HHS’s reckless and illegal changes to Section 1557 would have harmed both children and adults. The redefinition of sex to include gender identity would have forced health-care providers to act against their sound medical judgment and perform harmful, potentially sterilizing procedures on children and adults who want to appear as the opposite sex, even if the procedures violate state law.

The Biden administration claimed that doctors who heal must also hurt. Under the rule change, doctors who use medication to treat premature puberty would have been forced to prescribe puberty blockers for gender dysphoria. And if doctors perform mastectomies to treat breast cancer, they would have been forced to perform mastectomies on healthy women who want to appear like men.

In addition, the regulation violated the First Amendment by forcing doctors to express messages they do not agree with. It forced healthcare providers to lie to patients by referring to them using pronouns that do not match their sex, saying that a male is a female and vice versa, and saying that men can get pregnant.

States and medical practices that decline to adhere to the Biden administration’s radical redefinition of sex would have faced significant financial penalties and loss of federal funding, and doctors faced steep penalties and could have lost their ability to care for Medicaid, Medicare, and CHIP patients, taking them away from the low-income patients who need them most.

Thankfully, legal challenges to the Biden administration’s overreach began soon after HHS finalized the rule in May 2024. In Tennessee v. Becerra (now Tennessee v. Kennedy), a Mississippi federal court stayed the rule’s gender-identity provisions nationwide just before they were to take effect in July 2024. Courts in two other cases also blocked parts of the rule that summer: a Florida federal court enjoined it within Florida in Florida v. HHS, and a Texas federal court issued a nationwide stay in Texas v. Kennedy.

Following the 2024 election, the Trump administration took a different course. In February 2025, HHS’s Office for Civil Rights rescinded separate Biden-era guidance on “gender-affirming care,” citing court decisions rejecting the claim that Section 1557 covers gender identity. In May 2025, HHS released a review of the evidence on pediatric gender dysphoria treatments, which found the evidence of benefit to be of very low quality. And when the Mississippi court vacated some of the rule’s gender-identity provisions in October 2025, HHS did not appeal. Other parts of the rule remain in place.

In layman’s terms, the Trump administration was willing to acknowledge biological reality in a way the Biden administration was unable—or unwilling—to do. And that spells great news for women and girls. But the fight is not over.

We’re seeking to protect the truth about biology

Doctors take an oath to do no harm, but the Biden administration’s attempted changes to Section 1557 of the ACA would have compelled doctors to violate this oath. The mandate was both wrong and unlawful, and Alliance Defending Freedom filed multiple lawsuits challenging HHS’s reckless actions.

McComb Children’s Clinic v. Kennedy

McComb Children’s Clinic has served the city of McComb, Mississippi, for over 50 years. Its patients reside in a medically underserved region of the state, and about 75 percent rely on Medicaid or CHIP to pay for their care.

If the children’s clinic cannot participate in these programs, it would no longer be financially viable. But according to the Biden administration, if the clinic had wanted to continue participating in the programs, it had to change its policies to reject biological reality, reeducate its employees, refer for puberty blockers for children who want to appear as a gender different from their sex, and more.

Caregivers shouldn’t be forced to harm their patients for any reason, especially as a condition of receiving federal financial assistance. ADF attorneys filed a lawsuit on behalf of McComb Children’s Clinic challenging the HHS mandate. Unfortunately, a federal district court dismissed the lawsuit. However, ADF attorneys filed an appeal and made oral arguments in October 2026. The children’s clinic is asking for all provisions—including a “sex stereotypes” gender-identity provision—to be vacated.

Timeline

• May 2024: McComb Children’s Clinic sued then-HHS head Xavier Becerra over proposed Section 1557 changes.
• October 2025: Tennessee v. Kennedy vacated the gender-identity provisions, but left certain other clauses, such as the “sex stereotypes” provision.
• February 2026: The district court dismissed the case, and the clinic appealed shortly thereafter.
• October 2026: Oral arguments were heard at the U.S. Court of Appeals for the 5th Circuit.

State of Florida v. U.S. Department of Health and Human Services

Florida passed a law protecting children from harmful, irreversible drugs and surgeries aimed at making them appear as a gender different from their biological sex. But the Biden administration tried claiming that its mandate redefining sex in Section 1557 overrode state law and forces doctors to perform these dangerous procedures.

In addition, the rule would’ve forced insurance plans to pay for the procedures. States like Florida that seek to protect their citizens from life-altering drugs and surgeries face significant financial penalties and loss of federal funding.

ADF attorneys represent the Catholic Medical Association (CMA), the nation’s largest association of Catholic healthcare professionals. The provisions still left over in the mandate would force CMA members to perform dangerous procedures in violation of sound medical judgment, and it prevented them from explaining the many harms—including sterilization—that these procedures can cause.

We’ve joined the state of Florida in filing a lawsuit against the Biden administration’s HHS for its unlawful and harmful new rule. In July 2024, a federal district court ruled that the administration’s rewrite of Section 1557 is illegal. Combined with another federal court’s ruling in a separate case, the court’s decision halted the new rule nationwide while the lawsuit proceeds. And in November 2025, opening briefs were filed with an appeals court. The U.S. Court of Appeals for the 11th Circuit dismissed the case, ruling that another case resolved the issue.

Timeline

• May 2024: Florida, with ADF attorneys, filed a complaint seeking an injunction to halt the remnants of the Biden-era Section 1557 redefinition.
• July 2024: The district court granted a preliminary injunction.
• November 2025: Opening briefs were filed at the 11th Circuit after the case was originally closed following the 2024 election.
• September 2026: The 11th Circuit dismissed the case.

State of Missouri v. Kennedy

In ADF’s third lawsuit challenging the Biden administration’s health-care rule, we represent the American College of Pediatricians and have joined seven states, including Missouri and Utah, in challenging the rule.

HHS’s Biden-era mandates are threatening to punish doctors who don’t comply with the administration’s mandate by imposing substantial financial penalties and excluding them from federally funded healthcare programs such as Medicare. These punishments would effectively prevent health-care providers from caring for those who most need their help.

Conclusion

Doctors and other healthcare professionals are best equipped to inform their patients about the potential effects of certain procedures. But the Biden administration attempted to force doctors to perform procedures they disagree with and prevent them from even explaining the risks to the patients they are treating. The federal government has no right to tell doctors they must perform harmful, life-altering procedures on people who want to appear as the opposite sex. The Biden administration’s blatant federal overreach violated the Constitution and put patients in danger.