Discovery of a 74-page legal memorandum attached to a court filing from a consortium of 30 sexual rights groups last year revealed that HHS has promised to revise its mandates on health plan coverage and performance to include surgical abortion, cross-sex hormones, gender-transition surgeries, gender-affirming cosmetic surgeries and voice modification – along with a host of expanded services dealing with fertility treatments, contraception, abortifacients and sterilizations.

It is believed that sometime in April, HHS could announce the proposed regulations, which would not only disallow religious exemptions but would have a broad cost and compliance impact on all U.S. employers.

"The memo prepared by the Leadership Conference provides the best forecast of what the new regulation will say. We don't know for sure what the regulation will say but there is good reason to believe that it will be quite similar to the memo signed on by 30 sexual rights activist groups including Planned Parenthood," said attorney Martin Nussbaum of Nussbaum Speir Gleason in Colorado Springs, Colorado, a legal firm which advises the Catholic Benefits Association.

The association provides legal advocacy and litigation in defense of the First Amendment rights for its membership of over 1,000 Catholic employers, including 60 dioceses and archdioceses, numerous religious orders, colleges and universities, hospitals and other ministries.

The Leadership Conference, based in Washington, is a coalition of some 200 member organizations advocating for civil and human rights for women, the LGBTQ community, immigrants and workers and the disabled community.
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The proposed HHS regulations would apply to implementation of an Affordable Care Act provision that includes a prohibit on discrimination based on sex. It will likely apply to all health care providers, clinics, nursing homes, hospitals, group health insurers and third-party administrators of self-funded plans.

"And if the new regulation applies to all of those groups, it will effectively apply to all employers with a health plan," Nussbaum told Catholic News Service. "The proposed regulation would also apply to all contractors of the previous groups, including my law firm. For Catholic hospital chains it is hard to imagine how broad that group is."

Last year a number of Catholic health care organizations filed a lawsuit challenging the Biden administration's so-called "transgender mandate" requiring that doctors and hospitals perform gender-transition procedures on any patient despite any moral or medical objections of the doctor or health care facility.

A federal court blocked the mandate last August, granting the plaintiffs' request for a permanent injunction. It permanently enjoined HHS, HHS Secretary Xavier Becerra and all HHS-related divisions, agencies and employees "from interpreting or enforcing Section 1557 of the Affordable Care Act," which became law in 2016.

Section 1557 prohibits discrimination on the basis of race, color, national origin, age, disability or sex – including pregnancy, sexual orientation and gender identity – in covered health programs or activities.

In 2020, the Trump administration put in place a final rule that eliminated the general prohibition on discrimination based on gender identity and also adopted abortion and religious freedom exemptions for health care providers. But the courts blocked this rule change.

In 2021, shortly after he was inaugurated, President Joe Biden issued an executive order declaring his administration would apply in all areas – including the AC