U.S. Federal Courts
Justice Department appeals federal judge’s ACA ruling
Decision impacts PrEP, other preventative health services
Justice Department attorneys filed a notice of appeal Friday with the 5th U.S. Circuit Court of Appeals on behalf of the Department of Health and Human Services after U.S. District Judge Reed O’Connor ruled that employers cannot be forced to cover specified preventive health care services under the Affordable Care Act.
Thursday’s ruling means that more than 150 million Americans on employer-sponsored health plans will lose some cost-free coverage for immunizations, contraception, cancer screenings and PrEP.
O’Connor’s ruling struck down the recommendations that have been issued by the U.S. Preventive Services Task Force regarding the preventive care treatments provisions required by the ACA directing insurers provide at no cost to the patient.
White House Press Secretary Karine Jean-Pierre released a statement on the Justice Department decision to appeal:
“The president is glad to see the Department of Justice is appealing the judge’s decision, which blocks a key provision of the Affordable Care Act that has ensured free access to preventive health care for 150 million Americans. This case is yet another attack on the Affordable Care Act, which has been the law of the land for 13 years and survived three challenges before the Supreme Court.
Preventive care saves lives, saves families money, and protects and improves our health. Because of the ACA, millions of Americans have access to free cancer and heart disease screenings. This decision threatens to jeopardize critical care.
The administration will continue to fight to improve health care and make it more affordable for hard-working families, even in the face of attacks from special interests.”
AIDS Healthcare Foundation President Michael Weinstein decried O’Connor’s ruling saying:
“Stripping away access to preventive care will hurt tens of millions of Americans. These services are essential, and eliminating them will have dangerous consequences. While we expect this unconstitutional ruling ultimately will fail, the decision creates uncertainty and is a threat to public health.
“With this devastating ruling, a Trump-appointed judge placed the health of millions of Americans in extreme danger, based on an extremist political agenda. Undermining screenings and treatment for cancer, blood pressure, pregnancy, and mental health doesn’t just hurt individuals — it damages the health of the entire country,” California state Sen. Scott Wiener said.
“The effect of this decision on HIV prevention will be disastrous. In recent years, we’ve made incredible progress reducing the number of new HIV infections, largely because hundreds of thousands of people are now taking PrEP, an HIV prevention drug proven to be essentially 100 percent effective. This decision reverses that progress by allowing health plans to charge patients through the nose for this life-saving medication, raising barriers to access for the communities of LGBTQ people and people of color most at risk. Judge O’Connor will soon have thousands of new HIV cases on his conscience,” Wiener added.
Equality California, the nation’s largest statewide LGBTQ civil rights organization, released the following statement from Executive Director Tony Hoang in response to a ruling from O’Connor:
“Judge Reed O’Connor, already having attempted to invalidate the Affordable Care Act as a whole in 2018, has once again issued a ruling that puts the lives of Americans in danger. Preventive care is essential in helping to screen for potential severe health conditions and attempt to mitigate them — this ruling affects screenings for cancer, diabetes, STDs, cardiovascular disease, and so much more.
More than 150 million Americans currently have private insurance with coverage for preventive care under the ACA, yet a partisan judge in Texas is attempting to single handedly rollback access to these basic health care services. Equality California is committed to ensuring that these critical preventive services remain in place for the health of all Americans. We expect an appeal of this decision immediately.
Thankfully, most health plans in California are unaffected by today’s ruling because existing state law already requires health plans regulated in California to cover preventive services without cost sharing. Today’s ruling may affect a small subset of employer-sponsored health plans that are not regulated by the state.
Equality California is proud to be sponsoring legislation with Assemblymember Rick Chavez Zbur and Insurance Commissioner Ricardo Lara, AB (Assembly Bill) 1645, which will strengthen existing law and go even further to ensure that Californians have access to essential preventive services, including STD screening and PrEP for HIV prevention. While right-wing judges and politicians are attempting to roll back our rights and inflict harm on LGBTQ+ people, California will continue doubling down to protect the health and safety of our communities.”
Read the notice of appeal here:
Cuba
Trans parent charged with kidnapping, allegedly fled to Cuba with child
Cuban authorities helped locate Rose Inessa-Ethington
Federal authorities have charged a transgender woman with kidnapping after she allegedly fled to Cuba with her 10-year-old child.
An affidavit that Federal Bureau of Investigation Special Agent Jennifer Waterfield filed in U.S. District Court for the District of Utah on April 16 notes the child is a “biological male who identifies as a female” and “splits time living with divorced parents who share custody” in Cache County, Utah.
Waterfield notes the child on March 28 “was supposed to be traveling by car to” Calgary, Alberta, “for a planned camping trip with his transgender mother, Rose Inessa-Ethington, Rose’s partner, Blue Inessa-Ethington, and Blue’s 3-year-old child.”
The affidavit notes the group instead flew from Vancouver, British Columbia, to Mexico City on March 29. Waterfield writes the Inessa-Ethingtons and the two children then flew from Mérida, Mexico, to Havana on April 1.
The 10-year-old child called her biological mother on March 28 after they arrived in Canada. The custody agreement, according to the affidavit, required Rose Inessa-Ethington to return the child to her former spouse on April 3.
“Interviews of MV [Minor Victim] 1’s family members provided significant concerns for MV 1’s well-being, as MV 1 was born a male, however, identifies as a female child, which is largely believed to be due to manipulation by Rose Inessa-Ethington,” reads the affidavit. “Concerns exist that MV 1 was transported to Cuba for gender reassignment surgery prior to puberty.”
The affidavit indicates authorities found a note in the Inessa-Ethingtons’ home with “instruction from a mental health therapist located in Washington, D.C., including instruction to send the therapist the $10,000.00 and instructions on gender-affirming medical care for children.”
The affidavit does not identify the specific “mental health therapist” in D.C.
A Utah judge on April 13 ordered Rose Inessa-Ethington to “immediately” return the child to her former spouse. The former spouse also received sole custody.
“Your affiant believes that due to the extensive planning and preparation exhibited by both Rose Inessa-Ethington and Blue Inessa-Ethington to isolate MV 1 and take MV 1 to Havana, Cuba, without notifying or requesting permission from MV 1’s mother indicates they are likely not planning to return to the United States,” wrote Waterfield.
The affidavit notes Cuban authorities found the Inessa-Ethingtons and the child.
A press release the U.S. Attorney’s Office for the District of Utah issued notes the Inessa-Ethingtons “were deported from Cuba” on Monday “with the assistance of the FBI.”
The couple has been charged with International Parental Kidnapping. The Inessa-Ethingtons were arraigned in Richmond, Va., on Monday. The press release notes a federal court in Salt Lake City will soon handle the case.
The New York Times reported the child is now back with their biological mother.
“We are grateful to law enforcement for working swiftly to return the child to the biological mother,” said First Assistant U.S. Attorney Melissa Holyoak of the District of Utah in the press release.
The case is unfolding against the backdrop of increased tensions between Washington and Havana after U.S. forces on Jan. 3 seized now former Venezuelan President Nicolás Maduro and his wife, Cilia Flores.
President Donald Trump shortly after he took office in January 2025 issued an executive order that directed the federal government to only recognize two genders: male and female. A second White House directive banned federally-funded gender-affirming care for anyone under 19.
The U.S. Supreme Court last year in the Skrmetti decision upheld a Tennessee law that bans gender-affirming care for minors.
Cuba’s national health care system has offered free sex-reassignment surgeries since 2008.
Activists who are critical of Mariela Castro, the daughter of former President Raúl Castro who spearheads LGBTQ issues as director of Cuba’s National Center for Sexual Education, have previously told the Washington Blade that access to these procedures is limited. The Blade on Wednesday asked a contact in Havana to clarify whether Cuban law currently allows minors to undergo sex-reassignment surgery.
Puerto Rico
The ‘X’ returns to court
1st Circuit hears case over legal recognition of nonbinary Puerto Ricans
Eight months ago, I wrote about this issue at a time when it had not yet reached the judicial level it faces today. Back then, the conversation moved through administrative decisions, public debate, and political resistance. It was unresolved, but it had not yet reached this point.
That has now changed.
Lambda Legal appeared before the 1st U.S. Court of Appeals in Boston, urging the court to uphold a lower court ruling that requires the government of Puerto Rico to issue birth certificates that accurately reflect the identities of nonbinary individuals. The appeal follows a district court decision that found the denial of such recognition to be a violation of the U.S. Constitution.
This marks a turning point. The issue is no longer theoretical. A court has already determined that unequal treatment exists.
The argument presented by the plaintiffs is grounded in Puerto Rico’s own legal framework. Identity birth certificates are not static historical records. They are functional documents used in everyday life. They are required to access employment, education, and essential services. Their purpose is practical, not symbolic.
Within that framework, the exclusion of nonbinary individuals does not stem from a legal limitation. Puerto Rico already allows gender marker corrections on birth certificates for transgender individuals under the precedent established in Arroyo Gonzalez v. Rosselló Nevares. In addition, the current Civil Code recognizes the existence of identity documents that reflect a person’s lived identity beyond the original birth record.
The issue lies in how the law is applied.
Recognition is granted within specific categories, while those who do not identify within that binary structure remain excluded. That exclusion is now at the center of this case.
Lambda Legal’s position is straightforward. Requiring individuals to carry documents that do not reflect who they are forces them into misrepresentation in essential aspects of daily life. This creates practical barriers, exposes them to scrutiny, and places them in a constant state of vulnerability.
The plaintiffs, who were born in Puerto Rico, have made clear that access to accurate identification is not symbolic. It is a basic condition for moving through the world without contradiction imposed by the state.
The fact that this case is now being addressed in the federal court system adds another layer of significance. This is not a pending policy discussion or a legislative proposal. It is a constitutional question. The analysis is not about political preference, but about rights and equal protection under the law.
This case does not exist in isolation.
It unfolds within a broader context in which debates over identity and rights have increasingly been shaped by the growing influence of conservative perspectives in public policy, both in the United States and in Puerto Rico. At the local level, this influence has been reflected in legislative discussions where religious arguments have begun to intersect with decisions that should be grounded in constitutional principles. That intersection creates tension around the separation of church and state and has direct consequences for access to rights.
Recognizing this context is not an attack on faith or religious practice. It is an acknowledgment that when certain perspectives move into the realm of public authority, they can shape outcomes that affect specific communities.
From within Puerto Rico, this is not a distant debate. It is a lived reality. It is present in the difficulty of presenting identification that does not match one’s identity, and in the consequences that follow in workplaces, schools, and government spaces.
The progression of this case introduces the possibility of change within the applicable legal framework. Not because it resolves every tension surrounding the issue, but because it establishes a legal examination of a practice that has long operated under exclusion.
Eight months ago, the conversation centered on ongoing developments. Today, there is already a judicial finding that identifies a violation of rights. What remains is whether that finding will be upheld on appeal.
That process does not guarantee an immediate outcome, but it shifts the ground.
The debate is no longer theoretical.
It is now before the courts.
Maryland
4th Circuit dismisses lawsuit against Montgomery County schools’ pronoun policy
Substitute teacher Kimberly Polk challenged regulation in 2024
A federal appeals court has ruled Montgomery County Public Schools did not violate a substitute teacher’s constitutional rights when it required her to use students’ preferred pronouns in the classroom.
The 4th U.S. Circuit Court of Appeals in a 2-1 decision it released on Jan. 28 ruled against Kimberly Polk.
The policy states that “all students have the right to be referred to by their identified name and/or pronoun.”
“School staff members should address students by the name and pronoun corresponding to the gender identity that is consistently asserted at school,” it reads. “Students are not required to change their permanent student records as described in the next section (e.g., obtain a court-ordered name and/or new birth certificate) as a prerequisite to being addressed by the name and pronoun that corresponds to their identified name. To the extent possible, and consistent with these guidelines, school personnel will make efforts to maintain the confidentiality of the student’s transgender status.”
The Washington Post reported Polk, who became a substitute teacher in Montgomery County in 2021, in November 2022 requested a “religious accommodation, claiming that the policy went against her ‘sincerely held religious beliefs,’ which are ‘based on her understanding of her Christian religion and the Holy Bible.’”
U.S. District Judge Deborah Boardman in January 2025 dismissed Polk’s lawsuit that she filed in federal court in Beltsville. Polk appealed the decision to the 4th Circuit.
