A coalition of 23 Democratic attorneys general sued the Trump administration on Monday, July 20, over the Department of Health and Human Services’ final rule allegedly stripping transgender, nonbinary and gender-nonconforming patients of their rights to nondiscrimination in the medical field, as reported by Law360.

Led by attorneys general from Massachusetts, New York, and California, the coalition also includes Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Michigan, Minnesota, Nevada, New Jersey, New Mexico, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Wisconsin and the District of Columbia, according to The Hill.

The HHS final rule, released June 12, rolled back an Obama-era distinction between sex and gender in the Affordable Care Act. That definition required health care providers to treat patients according to their gender identity regardless of biological sex. The HHS said the agency will now enforce sex discrimination protections “according to the plain meaning of ‘sex’ as male or female and as defined by biology,” which the attorneys general allege allows medical providers to discriminate against those whose gender identity doesn’t align with their biological sex.

In their complaint, the attorneys general argue that the HHS rule, “published in the midst of the global COVID-19 pandemic, will impose unjustifiable barriers to health care on vulnerable populations at a time when access to care is as crucial as ever.”

The attorneys general seek to immediately halt the rule, according to The Wall Street Journal.

The lawsuit maintains that a recent Supreme Court case, Bostock v. Clayton County, invalidates the HHS rule. The court decided on June 15 that most employers cannot fire their employees for identifying as gay or transgender  at work, as reported by Law360. In the majority opinion written by Trump appointee Judge Neil Gorsuch, the court ruled that “it is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex.”

The attorneys general say that Bostock v. Clayton County interprets Title VII of the Civil Rights Act as applying to sexual orientation and gender identity, not just biological sex. The HHS final rule now conflicts with that interpretation and, according to the lawsuit, is therefore unlawful.

"The 2020 rule is of a piece with the Trump administration's rhetoric and policies, which have long reflected a deep animus toward the LGBTQ community and transgender people in particular," they wrote. "From the first days of the administration, the White House and federal agencies, including HHS, have engaged in a sustained effort to reverse civil rights protections for this community."

The HHS final rule also allows medical providers to refuse to perform abortions if they have a religious objection and releases health insurance companies from a requirement to provide explanations of coverage in multiple languages, which advocates and the attorneys general say limits the rights of those not proficient in English.