A judge for the US District Court for the Northern District of Texas ruled Tuesday that some of the Affordable Care Act‘s nondiscrimination rules based on gender identity and termination of pregnancy violate providers’ religious freedom.

Judge Reed O’Connor found that these rules, included to prevent health care discrimination, violated the Administrative Procedure Act and the Religious Freedom Restoration Act.

This ruling reaffirms the current status quo that religious health care professionals and insurers can decline to provide transgender individuals the health care or insurance coverage they require based on gender identity.

This status quo was established by a preliminary injunction in December 2016, weeks before the transition to the Trump administration. That injunction prevented the US Department of Health and Human Services (HHS) from enforcing the nondiscrimination rule. With O’Connor’s new ruling, there is now a permanent injunction in place.

The shift to the Trump administration also led to a change in HHS’s position. Although the agency previously worked to include gender identity and termination of pregnancy discrimination protections in the definition of “on the basis of sex,” in June 2019, HHS proposed a regulatory change to remove this language.