Fifteen states are suing the U.S. Department of Health and Human Services after the agency created a new rule that would alter the Affordable Care Act’s ban on discrimination based upon sex to also include “gender identity.”

The policy would would force medical providers to perform surgeries and administer hormone drugs to both children and adults for the purpose of gender transition without taking into account the guidance of doctors.

Additionally, medical providers must allow patients into sex-segregated spaces, such as parts of a hospital reserved only for omen patients, on the basis of their gender identity rather than their biological sex. Healthcare workers would be required to use gender-affirming pronouns and would face punishment if they use biologically accurate pronouns.

Alabama Attorney General Steve Marshall announced his office joined the lawsuit to block the new rule from going into effect.

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“Despite repeated failed attempts, Biden’s Administration continues to illegally mandate that medical providers provide gender-transition procedures or face harsh penalties. Alabama and our coalition partners will not stand for this radical and unconstitutional behavior,” said Marshall.

“In healthcare of all places, the reality of biological sex matters. The need to protect vulnerable children from sterilizing transitioning procedures matters.”

“Of all the Biden Administration’s misguided efforts, its campaign to replace biological sex with radical gender-identity theory may be the most pernicious because it is so obviously harmful and so obviously untrue.”

Marshall said the new rule could have a major impact on Alabama, which currently restricts the provision of gender-transition interventions of minors and prohibits the use of public funds to pay for these procedures.

Covered entities found non-compliant with the new mandate risk the loss of significant federal funding—including the loss of billions of dollars in state Medicaid funding designed to assist low-income individuals—and exposure to civil liability through private lawsuits.

In 2016, President Obama tried to implement an almost identical proposal. It was eventually struck down by the U.S. Supreme Court.

Alabama was joined in the lawsuit by Georgia, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Nebraska, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Virginia, and West Virginia.

Austen Shipley is a staff writer for Yellowhammer News. You can follow him on X @ShipleyAusten