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A federal judge has blocked the Biden administration from enforcing a mandate on several religious organizations that would have required them to perform gender transition surgeries or abortions.

Judge Reed O'Connor of the U.S. District Court for the Northern District of Texas permanently blocked the Biden administration from applying the mandate to all plaintiffs in the case. Those plaintiffs include the Franciscan Alliance, a Catholic hospital system that operates twelve hospitals in Indiana and Illinois, in addition to numerous other health facilities in those states.

The administration may not enforce the mandate on plaintiffs "in a manner that would require them to perform or provide insurance coverage for gender-transition procedures or abortions," O'Connor wrote in his ruling.

"No doctor should be forced to perform controversial, medically unsupported procedures that are contrary to their conscience and could be deeply harmful to their patients," Luke Goodrich, vice president and senior counsel for religious freedom advocacy group Becket, said in a statement. Becket provided counsel for plaintiffs in the case.

The Obama administration attached a mandate to the Affordable Care Act in 2016 stating that health care providers must perform and provide insurance coverage for gender transition surgery. The mandate interprets the ACA non-discrimination clause, known as Section 1557, to cover transition surgery and does not provide a religious exemption for providers.

The Franciscan Alliance, several other Christian groups, and eight states filed suit against the mandate at the time. The U.S. District Court for the the Northern District of Texas issued a preliminary nationwide injunction against the mandate on December 31, 2016, noting that the mandate "likely violates" the Religious Freedom Restoration Act with respect to the plaintiffs.

A North Dakota court also ruled against the mandate in April of this year, in a lawsuit initially filed by the Catholic Benefits Association in 2016. The association represents Catholic employers and businesses.