The Affordable Care Act (ACA) was developed to protect everyone's right to access safe and affordable medical care without being excluded for discriminatory reasons. However, on 31 December 2016, US District Judge Reed O'Connor ruled over a section of the ACA, Section 1557, which prevents doctors from discriminating against their patients on the basis of gender identity or women who have had abortions.

The lawsuit was brought before Judge O'Connor - specifically because of his history opposing transgender rights - by Texas attorney general Ken Paxton and eight other states who argued that this statute of the ACA violates the religious freedom of healthcare providers, forcing them to perform an abortion or a gender transition surgery.

But this false argument has led to the ruling that doctors can refuse a patient due to their personal religious beliefs. Therefore, if a doctor has religious beliefs that do not agree with abortions or recognise transgender identities, he or she has the right to refuse treating the patient.

This goes against the Hippocratic oath - to do no harm - as refusing to treat certain patients due to personal beliefs certainly seems harmful, even more so as this ruling may just introduce a system of discrimination.

As Donald Trump's inauguration approaches in less than two weeks, this ruling becomes worrisome especially when Trump promised to disintegrate the ACA. His cabinet is also made of people who support white supremacist rhetoric and are against LGBTQ rights.

A need to educate healthcare providers about rights of targeted groups

19% of trans people have been refused care because of their gender and 28% have been harassed in medical settings, according to a study conducted by the National Centre for Transgender Equality, causing many trans people to avoid going to the doctor when they are ill.

Progressive laws that deem such discrimination illegal, have been passed under the Obama administration, and rightly so as only such reform can change an unequal society. O'Connor's ruling is just reversing progress and an affront to equal rights.

Many trans and women health clinics in the US have filled a gap in health services for women, trans and LGBT people in the country. The informed physicians provide catered medical care, including trans related treatment, abortions and treat patients regardless of cost or insurance coverage.

However these clinics only exist in large metropolitan cities, making it hard for women and trans people in other parts of the country to receive appropriate treatment. Therefore Section 1557 is vital as it legally protects the targeted groups seeking medical treatment from discrimination by federal-funded providers.

"Rulings such as these elevate the continued and urgent need to educate healthcare providers and the public about the healthcare and human rights of our transgender community," says Kimberleigh Joy Smith, a senior director of community health planning and policy at Callen Lorde Community Health Center (CLCHC) in New York.

There have been similar protections that were passed on a local level - trans healthcare is covered under Medicaid in New York.

ACLU to challenge O'Connor's ruling

Fortunately, the American Civil Liberties Union (ACLU) has challenged the ruling and has a "fully briefed motion to intervene in this case", which is currently reviewed by a district court.

It hopes to overturn the ruling as the argument that has centred around specific transition-related treatments that some transgender people receive, and abortions, can undermine these specific populations' ability to receive any healthcare at all.

But O'Connor's ruling only prevents the federal government from enforcing Section 1557, so states cannot remove federal funding from a medical provider, which would have been the penalty for violating Section 1557.

The law still stands, protects the targeted groups of Americans and their rights to go to court over discrimination. However, with the upcoming Trump administration, they have to prepare themselves for the worst.

"We'll have to wait and see what real impact this has," said Chuck Smith, CEO of Equality Texas. MIMS

Read more:
The challenges of treating transgender patients
What does a Trump presidency mean for pharmaceutical prices?
The 21st Century Cures Act: Will Obama's last healthcare bill be advantageous?
A timeline of key things Donald Trump has said about healthcare and medicine