Recent court decisions and newly proposed regulations by the Department of Health and Human Services (HHS) have stoked long-simmering conflicts between the federal government and religiously affiliated health-care providers and employers. Early skirmishes suggest that someday the Supreme Court may need to resolve these disputes.

Through a New Proposed Rule Making (NPMR) published in August, HHS has made clear that under the antidiscrimination provisions of the Affordable Care Act (ACA), health-care providers may not exclude gender transitions or abortions from the services that they offer. Also, bolstered by a recent Supreme Court decision, the NPMR prohibits employers from excluding gender transitions from the health benefits that they offer their employees.