This blog is originally appeared at LGBTQ Nation.

Texas and its GOP allies are “utilizing LGBTQ issues as a wedge,” civil rights advocates warn.

In May, the U.S. Department of Health and Human Services established a rule recognizing gender dysphoria as a disability under federal anti-discrimination laws, aligning with the findings of most courts over the past decade. This rule signaled to states that discrimination against transgender individuals in areas like employment, education, health care, child care, and housing could breach federal disability protections, with the Biden administration ready to defend it.

Now, a lawsuit spearheaded by Texas Attorney General Ken Paxton has 17 states seeking to have the rule completely overturned, including several provisions unrelated to transgender issues. Notably, this coalition consists of 15 states that have enacted restrictions on gender-affirming care and have adopted various anti-trans measures.

The states’ objections to the new federal rule include concerns about the time, money, and resources required to accommodate employees with gender dysphoria. This includes using appropriate pronouns, eliminating sex-specific dress codes, and allowing access to gender-aligned restrooms and locker rooms. Nebraska’s attorney general worries that the state’s restrictions on gender-affirming care could expose it to disability rights complaints and federal investigations. Meanwhile, South Dakota claims the rule effectively creates a new category of potentially disabled individuals whose gender care would need to be covered by Medicaid.

However, gender dysphoria is just one aspect of the comprehensive 130-page federal rule. It also includes protections for disabled parents in child welfare cases and ensures that hospitals do not use disability status to decide who receives care during crises, such as equipment shortages in a pandemic. Additionally, the rule adds Long Covid to the list of conditions that may be recognized as disabilities and enhances protections against unnecessary institutionalization, mandating that care be provided in the least restrictive environment, preferably within the community.

Striking down the entire rule would have significant repercussions for disabled Americans and other marginalized groups who depend on federal agencies to interpret long-standing laws that protect their rights, explains Mia Ives-Rublee, senior director of the Disability Justice Initiative at the Center for American Progress. “LGBTQ issues are being used as a wedge,” Ives-Rublee says. “The real attack is on the regulatory process of the federal government, and this will affect nearly every interaction disabled individuals have with the services and supports they rely on.”

The new rule addresses two federal laws aimed at protecting people with disabilities. The Rehabilitation Act of 1973 prohibits discrimination based on disability by the federal government, federal contractors, and—through Section 504—by organizations or employers receiving federal funds. The Americans with Disabilities Act (ADA), enacted in 1990, expanded these protections to cover most aspects of public life, such as education, public accommodations, and transportation. Both laws define a disability as “a physical or mental impairment” that “substantially limits” major life activities.

At the time the Rehabilitation Act and ADA were passed, gender dysphoria was not a recognized medical condition, and both laws explicitly excluded conditions like “transvestism, transsexualism,” and “gender identity disorders not resulting from physical impairments” from their definition of disability. However, over time, courts and medical professionals have recognized that many individuals who experience a mismatch between their gender identity and the one assigned at birth suffer significant psychological distress and negative impacts on their daily lives. In 2013, gender dysphoria was added to the Diagnostic and Statistical Manual of Mental Disorders.

Since then, individual lawsuits—the primary way the ADA is enforced—have helped shape legal precedent that views gender dysphoria as a protected health condition, with courts increasingly seeing its exclusion from disability protections as discriminatory. Ben Klein, senior director of litigation and HIV law at GLBTQ Legal Advocates and Defenders, notes that the exclusion of gender dysphoria was “rooted in clear bias,” a concept that judges easily recognize.

In 2022, the 4th Circuit Court of Appeals became the first federal appeals court to rule that gender dysphoria could be considered a disability under federal disability protection laws. The court’s decision centered on the distinction that gender dysphoria’s impact on daily life separates it from the ADA’s definition of gender identity disorder. (The U.S. Supreme Court declined to review the case in June 2023, allowing the ruling to stand.) Other federal courts have reached similar conclusions, recognizing that gender dysphoria is distinct from gender identity disorder, or that it arises from a physical impairment due to a mismatch between a person’s body and their gender identity—something that can be addressed through gender-affirming care.

When finalizing its updated rule—the first administrative update to Section 504 in 50 years—the Department of Health and Human Services cited this evolving body of case law, which it said has “shifted the legal landscape of disability discrimination protections.” But the states involved in the Texas-led lawsuit, filed quietly in September, appear uninterested in these legal developments.

The lawsuit focuses on the ADA’s original exclusionary language, arguing that what is now understood as gender dysphoria should still be classified as a gender identity disorder under the law. “The Biden Administration is again abusing executive power to sidestep federal law and impose unscientific, unfounded gender ideology on the public,” Texas Attorney General Ken Paxton said in a press release announcing the suit. “Texas is suing because HHS lacks the authority to unilaterally redefine statutory definitions and classify ‘gender dysphoria’ as a disability.”

Beyond the gender dysphoria issue, the lawsuit also raises concerns about the “new regulatory burdens” and “significant costs” the rule could impose on state Medicaid programs. States like Alaska, Montana, and Nebraska argue that the rule’s “least restrictive setting” requirement will be difficult to implement due to shortages of healthcare workers and the unique geographical challenges of their regions.

Klein and Ives-Rublee pointed out that both the Rehabilitation Act and the ADA were intentionally written in broad terms, allowing for ongoing reinterpretation and refinement by federal agencies as scientific and public understandings of disability evolved. When the ADA was enacted, Klein notes, transgender identities were pathologized. “One of the ADA’s primary goals is to combat discrimination and dispel myths and stereotypes, particularly surrounding stigmatized health conditions,” he explains. “Gender dysphoria is a prime example of a stigmatized health condition.”

The current Texas case is merely one front in the broader strategy employed by GOP officials to advance their anti-trans agenda. As previously reported, many Republican attorneys general—often from the same states involved in the Paxton lawsuit—are threatening major medical associations with criminal investigations for advocating for transgender youth’s access to gender-affirming care.

Ives-Rublee cautions that the Texas lawsuit is part of a larger, coordinated effort to undermine federal agencies’ authority to interpret civil rights laws, including protections for pregnant workers and access to reproductive healthcare. This extensive conservative initiative aims to weaken the administrative state and has gained momentum following a series of Supreme Court rulings last term, one of which diminished courts’ deference to federal agency interpretations of ambiguous laws.

Since the gender dysphoria lawsuit was filed in the federal district court in Lubbock, Texas, any appeal will be heard by the 5th Circuit Court of Appeals, known for its sharply conservative rulings in recent legal history. If the 5th Circuit sides with the states in this case, it could create a legal conflict with the 4th Circuit’s ruling, potentially compelling the Supreme Court—dominated by a far-right supermajority—to intervene. “I am almost 100 percent sure this is their intention,” Ives-Rublee asserts.