Issue Brief
  1. 42 U.S.C. § 18116.

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  2. 85 Fed. Reg. 37160-37248 (June 19, 2020), https://www.federalregister.gov/documents/2020/06/19/2020-11758/nondiscrimination-in-health-and-health-education-programs-or-activities-delegation-of-authority.

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  3. 84 FedReg. 27846-27895 (June 14, 2019), https://www.federalregister.gov/documents/2019/06/14/2019-11512/nondiscrimination-in-health-and-health-education-programs-or-activities.

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  4. Bostock v. Clayton Cty, Ga., No. 17-1618 (U.S. June 15, 2020), https://www.supremecourt.gov/opinions/19pdf/17-1618_hfci.pdf.

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  5. Asapansa-Johnson Walker v. Azar, No. 20-CV-2834 (FB) (SMG), Memorandum and Order (E.D.NY. Aug, 17, 2020), https://affordablecareactlitigation.files.wordpress.com/2020/08/ajw-pi.pdf.

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  6. Plaintiffs’ list is due on September 15th, and HHS’s response is due on September 22nd.

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  7. Whitman-Walker Clinic v. HHS, No. 20-1630 (JEB), Memorandum Opin. (D.D.C. Sept. 2, 2020), https://affordablecareactlitigation.files.wordpress.com/2020/09/6725227-0-26785.pdf.

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  8. See Table 3.

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  9. Except that provisions requiring changes to health insurance or group health plan benefit design took effect on the first day of the first plan year on or after Jan. 1, 2017. 81 Fed. Reg. 31375-31473, at 31376 (May 18, 2016), https://www.federalregister.gov/documents/2016/05/18/2016-11458/nondiscrimination-in-health-programs-and-activities.

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  10. After HHS, under the Trump Administration, agreed with the plaintiffs that the challenged 2016 regulation was unlawful, the court allowed River City Gender Alliance and the American Civil Liberties Union of Texas to intervene in the case, concluding that HHS would not adequately represent the interests of transgender people, people who have terminated pregnancies, and people who seek reproductive healthcare.

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  11. Flack v. Wisc. Dep’t of Health Servs., no. 18-cv-309-wmc, Opin. and Order (W.D. Wisc. Aug. 16, 2019), https://www.relmanlaw.com/media/cases/501_Flack%20-%20Summary%20Judgment%20Decision%20_8-16-19_.pdf.

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  12. Prescott v. Rady Children’s Hospital – San Diego, 265 F. Supp. 3d 1090 (S.D. Cal. 2017), https://affordablecareactlitigation.files.wordpress.com/2018/09/prescott-2017-09-28-dkt-22-order-granting-in-part-and-denying-in-part-defs-mtd-and-denying-mts-1.pdf.

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  13. Id.

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  14. 85 Fed. Reg. 37160; see also 84 Fed. Reg. at 27848, 27849.

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  15. 85 Fed. Reg. at 37178.

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  16. Id. at 37194.

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  17. 81 Fed. Reg. at 31455.

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  18. Id. at 31460.

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  19. Id. at 31428, 31435.

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  20. 85 Fed. Reg. at 37191.

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  21. Id. at 37180.

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  22. 84 Fed. Reg. at 31429.

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  23. 81 Fed. Reg. at 31429, 31434-31435.

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  24. 85 Fed. Reg. at 37187.

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  25. 81 Fed. Reg. at 31429.

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  26. 84 Fed. Reg. at 27849.

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  27. See, e.g. 85 Fed. Reg. at 37220.

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  28. “Insofar as the application of any requirement under this part would violate, depart from, or contradict definitions, exemptions, affirmative rights, or protections provided by any of the statutes cited in paragraph (a) of this section [including Title IX]. . . such application shall not be required or imposed.”  45 C.F.R. § 92.6 (b).

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  29. The Title IX abortion exemption provides that “[n]othing in this title shall be construed to require or prohibit any person, or public or private entity, to provide or pay for any benefit or service, including the use of facilities related to an abortion. . . .” 20 U.S.C. § 1688.

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  30. The Title IX religious exemption provides that the prohibition of discrimination on the basis of sex “shall not apply to an educational institution which is controlled by a religious organization if the application of this subsection would not be consistent with the religious tenants of such organization.” 20 U.S.C. § 1681 (a)(3).

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  31. HHS specifically references the Coats-Snowe Amendment, the Church Amendments, the Religious Freedom Restoration Act, ACA § 1553, ACA § 1303, the Weldon Amendment, and any related, successor, or similar federal laws or regulations. 45 C.F.R. § 92.6 (b).

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  32. The interaction between these changes, the HHS OCR regulations protecting statutory conscience rights in health care, 84 Fed. Reg. 23170-23272 (May 21, 2019), https://www.federalregister.gov/documents/2019/05/21/2019-09667/protecting-statutory-conscience-rights-in-health-care-delegations-of-authority, and the Emergency Medical Treatment and Active Labor Act is unclear.

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  33. 85 Fed. Reg. at 37192.

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  34. Id.

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  35. Id. at 37193.

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  36. Cf. 81 Fed. Reg. at 31380.

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  37. Cf. prior 45 C.F.R. § 92.2 (b)(2) (providing that “[i]nsofar as the application of any requirement under this part would violate applicable Federal statutory protections for religious freedom and conscience, such application shall not be required”).

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  38. 81 Fed. Reg. at 31380.

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  39. Id.

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  40. Id.; see also Id. at 31397 (noting that the “availability of a religious exemption will depend on an analysis of the particular situation”).

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  41. Id. at 31429.

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  42. Id. at 31434, n.258.

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  43. (emphasis added).

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  44. 85 Fed. Reg. at 37210.

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  45. Id.

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  46. Id.

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  47. Id. at 37176.

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  48. Id.

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  49. Id. at 37204.

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  50. Id. at 37224.

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  51. Id. at 37227-37228.

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  52. Id. at 37203.

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  53. 45 C.F.R. § 92.5 (a); 85 Fed. Reg. at 37202.

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  54. 81 Fed. Reg. at 31428.

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  55.   85 Fed. Reg. at 37173-37174.

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  56. 84 Fed. Reg. at 27850, 27862-27863; see also 85 Fed. Reg. at 37172 (the “plain meaning of ‘healthcare’ differs from insurance”).

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  57. HHS does not consider Medicare Part B payments to be federal financial assistance. See, e.g., 81 Fed. Reg. at 31383; 84 Fed. Reg. at 27863.

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  58. 45 C.F.R. § § 92.4, 92.208; 81 Fed. Reg. at 31396, 31432, 32445; 85 Fed. Reg. at 37226-37227.

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  59. 81 Fed. Reg. at 31446.

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  60. Id. at 31439, n.278, 279.

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  61. Id.

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  62. 85 Fed. Reg. at 37214-37216.

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  63. Id. at 37215.

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  64. Id. at 37199, 37213-4.

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  65. Id. at 37168.

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  66. Id.

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  67. DC slip opin. at 31-32.

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  68. Id. at 12.

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  69. Id.

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  70. Id. at 59-60.

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  71. Id. at 60.

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  72. 81 Fed. Reg. at 31405.

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  73. 84 Fed. Reg. at 27846.

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  74.   85 Fed. Reg. at 37166 (“This final rule. . . does not deny States the ability to provide protections that exceed those required by Federal civil rights laws.“).

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  75. See, e.g., Movement Advancement Project, Healthcare Laws and Policies (accessed Sept. 3, 2020), https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies.

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Tables
  1. Former 45 C.F.R. § § 92.4, 92.206.

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  2. Former 45 C.F.R. § 92.2 (b); New 45 C.F.R. § 92.6.

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  3. HHS specifically references the Coats-Snowe Amendment, the Church Amendments, the Religious Freedom Restoration Act, ACA § 1553, ACA § 1303, the Weldon Amendment, and any related, successor, or similar federal laws or regulations. § 92.6 (b).

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  4. Former 45 C.F.R. § 92.207.

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  5. Former 45 C.F.R. § § 92.206, 92.207.

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  6. Former 45 C.F.R. § 92.207.

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  7. Former 45 C.F.R. § 92.201. New § 92.101

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  8. 45 C.F.R. § 92.8.

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  9. HHS assumes that tagline requirements for Marketplaces, 45 C.F.R. § 155.205 (c)(2)(iii)(A), and Qualified Health Plan Issuers, HHS Notice of Benefits and Payment Parameters for 2016; Final Rule, 80 Fed. Reg. 10750, 10788 (Feb. 27, 2015), also would be “fully repealed because they depend on, or refer to, the Final [1557] Rule for authority for the tagline requirement” but that other CMS tagline requirements for group health plans and health insurance issuers, navigators, non-navigator assistance personnel, Medicaid, Medicaid managed care, CHIP, CHIP managed care, hospitals qualifying for tax-exempt status, and Medicare Advantage (Part C) and Prescription Drug (Part D) plans would remain in effect. 84 Fed. Reg. at 27881.

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  10. Former 45 C.F.R. § 92.202 (b). New § 92.102.

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  11. Former 45 C.F.R. § 92.203 (a). New § 92.103.

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  12. Former 45 C.F.R. § 92.205. New § 92.105.

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  13. Former 45 C.F.R. § 92.7. New 45 C.F.R § 92.5.

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  14. Former 45 C.F.R. § 92.8.

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  15. HHS assumes that tagline requirements for Marketplaces, 45 C.F.R. § 155.205 (c)(2)(iii)(A), and Qualified Health Plan Issuers, HHS Notice of Benefits and Payment Parameters for 2016; Final Rule, 80 Fed. Reg. 10750, 10788 (Feb. 27, 2015), also will be “fully repealed because they depend on, or refer to, the 2016 [1557] Rule for authority for the taglines requirement.” Although these regulations have not yet been amended, HHS clarifies that covered entities do not need to independently comply with them. Instead, compliance with those other regulations is deemed if entities comply with the revised Section 1557 regulation. However, other CMS tagline requirements for group health plans and health insurance issuers, navigators, non-navigator assistance personnel, Medicaid, Medicaid managed care, CHIP, CHIP managed care, hospitals qualifying for tax-exempt status, and Medicare Advantage (Part C) and Prescription Drug (Part D) plans remain in effect. 85 Fed. Reg. at 37230-37231.

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  16. Former 45 C.F.R. § 92.301.

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  17. Former 45 C.F.R. § 92.302.

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  18. 45 C.F.R. § § 92.1, 92.2, 92.4. New § 92.3.

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  19. Former 45 C.F.R. § 92.101.

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  20. 42 C.F.R. § 438.3 (d)(4).

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  21. 42 C.F.R. § 438.206 (c)(2).

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  22. 42 C.F.R. § 440.262.

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  23. 42 C.F.R. § § 460.98 (b)(3), 460.112 (a).

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  24. 45 C.F.R. § 147.104 (e).

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  25. 45 C.F.R. § 155.120 (c)(1).

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  26. 45 C.F.R. § 155.220 (j)(2)(i).

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  27. 45 C.F.R. § 156.200 (e).

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  28. 45 C.F.R. § 156.1230 (b)(2).

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  29. 45 C.F.R. § 86.18.

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  30. HHS specifically references the First Amendment, Title IX’s religious exemptions, the Religious Freedom Restoration Act, the Coats-Snowe Amendment, ACA § 1303, and appropriations riders related to abortion such as the Hyde Amendment, the Helms Amendment, and the Weldon Amendment. 45 C.F.R. § 86.18 (c).

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  31. 45 C.F.R. § 86.31 (b).

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