The Trump administration is ready to roll back, and the advocates are gearing up for a fight.
A proposed Rule from the Department of Health and Human Services that would make it easier for doctors to do so.
Coming on the heels of the transgender ban, there are fears the administration could go further and use the proposal as an opportunity to narrow the definition of gender.
The administration said in a recent court filing that new health regulations could be published as soon as next week. The rule is expected to weaken or eliminate anti-discrimination provision enshrined in ObamaCare.
The provision says they are transgender, nor can they denied coverage.
They do not justify their treatment, but they do not give their treatment.
Advocates, meanwhile, say that the proposal could jeopardize the gains made in making sure.
Harper Jean Tobin, director of policy at the National Center for Transgender Equality, said: "The proposal is likely to send a strong signal to the endogenous people."
The rule "does not mean that overnight transgender people can not get health care, but it wants to be a steady drip of allowing more discrimination," Tobin said.
Chase Strangio, attorney at the American Civil Liberties Union (ACLU), said access to health care can be a life or death circumstance, and the rule could have "catastrophic effects" if it is finalized.
Once the proposal is released, a public comment period will follow. After that, a final rule will be issued.
As for what comes next, Strangio said ACLU has had two years to prepare for that.
As soon as possible, "Strangio said. "We can expect many legal challenges to any final rule."
President TrumpDon Trump Trump calls Sri Lankan prime minister following church bombings Ex-Trump lawyer: Mueller knew Trump had to call for a 'witch hunt' for 'political reasons' MORE repeatedly pledged support for the LGBTQ community on the campaign trail in 2016. But advocates say the president's words increasingly ring hollow, and his administration has been steadily eroding protections for transgender individuals.
For example, the military's transgender ban took effect earlier this month, despite objections from advocacy groups and medical experts. And the Supreme Court on Monday said it would hear this case on three cases concerning sovereignty to transgender identity.
Additionally, the Justice Department has argued that it does not protect employees from discrimination based on gender identity. Former Attorney General Jeff SessionsJefferson (Jeff) Beauregard SessionsAnd the winner of the Robert Mueller Sweepstakes is – Vladimir Putin The Memo: Mueller's Depictions Wants Fuel Trump Fear Collins: Mueller's report includes 'an unflattering portrayal' of Trump MORE in 2017 wrote a memo saying the law "does not encompass discrimination based on gender identity per se."
The existing health care rule was first issued in 2016, six years after the 2010 Affordable Care was signed into law. Who receive federal money from denying treatment or coverage to anyone based on sex, gender identity or termination of pregnancy.
Individuals, as long as those services were the same ones given to other patients.
That rule was challenged in court by a group of Christian providers called the Franciscan Alliance. They argue that they are disagreeing with those services on moral or medical grounds.
A federal judge in Texas agreed with that argument, issuing a nationwide injunction in late 2016 that is still in effect. The ruling said Congress had outlawed discrimination based on "the biological differences between males and females" but not transgender status.
The new proposed rule has been published at the White House Office of Management and Budget for more than one year.
Obama's non-discrimination statute is the law, even if it has been put on hold.
In a court filing earlier this month, the administration said it would likely be a lawyer in Texas.
Luke Goodrich, senior counsel with the Becket Fund for Religious Liberty and a Lead Attorney for the Plaintiffs, said the provider would be better served by a ruling from the judge. He said they just want to make sure their religious protections are upheld.
Katie Keith, a health care consultant and professor at Georgetown Law, said, "It's going to be hard for people to understand their health care rights" while the confusion continues.
Tobin, of the National Center for Transgender Equality, said the uncertainty is having a harmful effect.
"At a time when the administration is trying to overturn the entire Affordable Care Act, at a time when the transgender ban in military is taking effect, transgender people are scared for their ability to get the care they need, and that their providers know they need, "Tobin said.
Goodrich argues that providers are not transacting patients just because they are transgendered as long as the doctors are giving transition-related care or "being pressured to perform abortions."
He said the plaintiffs have been transgendering people for years and would not stop doing that because they provide care for everyone. That's not what the lawsuit is about in our view. "
Transgender advocates are concerned the administration wants to use the lawsuit as an excuse to redefine gender.
The New York Times last year reported that the Department of Health and Human Services (HHS) proposed a narrower definition of gender.
No rules have been issued, but advocates say administration officials have been telegraphing their views.
The HHS memo is a "blueprint" for discrimination, and the non-discrimination proposal is a major part of it, Tobin said.