RECOMMENDED FOR PUBLICATION

Pursuant to Sixth Circuit I.O.P. 32.1(b)

File Name: 24a0220p.06

UNITED STATES COURT OF APPEALS

FOR THE SIXTH CIRCUIT

CHRISTIAN HEALTHCARE CENTERS, INC. (23-1769); 

SACRED HEART OF JESUS PARISH, GRAND RAPIDS,

JERRY HATLEY, ROBIN HATLEY, JOSEPH BOUTELL,

RENEE BOUTELL, PETER UGOLINI, and KATIE UGOLINI

(23-1781); ST. JOSEPH PARISH ST. JOHNS (23-1860),

Plaintiffs-Appellants,

v.

DANA NESSEL, et al.,

Defendants-Appellees.

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Nos. 23-1769/1781/1860

Appeal from the United States District Court 

for the Western District of Michigan at Grand Rapids.

Nos. 1:22-cv-00787; 1:22-cv-01214; 1:22-cv-01154—Jane M. Beckering, District Judge.

Argued: June 11, 2024

Decided and Filed: September 20, 2024

Before: WHITE, STRANCH, and MURPHY, Circuit Judges.

_________________

COUNSEL

23-1769

ARGUED: Bryan D. Neihart, ALLIANCE DEFENDING FREEDOM, Scottsdale, Arizona, for 

Appellant. Kimberly K. Pendrick, OFFICE OF THE MICHIGAN ATTORNEY GENERAL, 

Detroit, Michigan, for Appellees. ON BRIEF: Bryan D. Neihart, Jonathan A. Scruggs, 

ALLIANCE DEFENDING FREEDOM, Scottsdale, Arizona, John J. Bursch, ALLIANCE 

DEFENDING FREEDOM, Washington, D.C., for Appellant. Kimberly K. Pendrick, Heather S. 

Meingast, Tonya C. Jeter, OFFICE OF THE MICHIGAN ATTORNEY GENERAL, Detroit, 

Michigan, for Appellees. Steven W. Fitschen, NATIONAL LEGAL FOUNDATION, 

Chesapeake, Virginia, Frederick W. Claybrook, Jr., CLAYBROOK LLC, Washington, D.C., 

>
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 2

Randall L. Wenger, INDEPENDENCE LAW CENTER, Harrisburg, Pennsylvania, Miles E. 

Coleman, Adam B. McCoy, NELSON MULLINS RILEY & SCARBOROUGH LLP, 

Greenville, South Carolina, Erin N. Kniffin, ETHICS & PUBLIC POLICY CENTER, 

Washington, D.C., for Amici Curiae.

23-1781

ARGUED: Cody S. Barnett, ALLIANCE DEFENDING FREEDOM, Lansdowne, Virginia, for 

Appellants. Kimberly K. Pendrick, OFFICE OF THE MICHIGAN ATTORNEY GENERAL, 

Detroit, Michigan, for Appellees. ON BRIEF: Cody S. Barnett, ALLIANCE DEFENDING 

FREEDOM, Lansdowne, Virginia, John J. Bursch, ALLIANCE DEFENDING FREEDOM, 

Washington, D.C., Ryan J. Tucker, Katherine L. Anderson, ALLIANCE DEFENDING 

FREEDOM, Scottsdale, Arizona, for Appellants. Kimberly K. Pendrick, OFFICE OF THE 

MICHIGAN ATTORNEY GENERAL, Detroit, Michigan, Cassandra A. Drysdale-Crown, 

Heather S. Meingast, OFFICE OF THE MICHIGAN ATTORNEY GENERAL, Lansing, 

Michigan, for Appellees. Steven W. Fitschen, NATIONAL LEGAL FOUNDATION, 

Chesapeake, Virginia, Randall L. Wenger, INDEPENDENCE LAW CENTER, Harrisburg, 

Pennsylvania, Miles E. Coleman, Adam B. McCoy, NELSON MULLINS RILEY & 

SCARBOROUGH LLP, Greenville, South Carolina, for Amici Curiae.

23-1860

ARGUED: William J. Haun, THE BECKET FUND FOR RELIGIOUS LIBERTY, 

Washington, D.C., for Appellant. Kimberly K. Pendrick, OFFICE OF THE MICHIGAN 

ATTORNEY GENERAL, Detroit, Michigan, for Appellees. ON BRIEF: William J. Haun, 

Lori H. Windham, Nicholas R. Reaves, Richard C. Osborne, THE BECKET FUND FOR 

RELIGIOUS LIBERTY, Washington, D.C., for Appellant. Kimberly K. Pendrick, Tonya C. 

Jeter, OFFICE OF THE MICHIGAN ATTORNEY GENERAL, Detroit, Michigan, Heather S. 

Meingast, OFFICE OF THE MICHIGAN ATTORNEY GENERAL, Lansing, Michigan, for 

Appellees. Stephen J. van Stempvoort, MILLER JOHNSON, Grand Rapids, Michigan, for 

Amicus Curiae.

STRANCH, J., delivered the opinion of the court in which WHITE, J. and MURPHY, J., 

joined. MURPHY, J. (pp. 34–37), delivered a separate concurring opinion.

_________________

OPINION

_________________

JANE B. STRANCH, Circuit Judge. In these three related cases, Plaintiffs—Christian 

Healthcare Centers, a medical service ministry; Sacred Heart of Jesus, a Catholic school joined 

by several of the school’s parents; and St. Joseph Parish St. Johns, a Catholic parish operating a 

school—challenge aspects of Michigan’s antidiscrimination laws. They allege that Michigan’s 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 3

laws chill their speech and conduct in violation of the First and Fourteenth Amendments. The 

district court dismissed each case for want of standing, reasoning that no Plaintiff had shown that 

Michigan’s laws arguably proscribed its speech or conduct and that, in the alternative, there was 

no credible threat that Michigan would enforce its laws against any Plaintiff. 

We agree only in part. Michigan’s laws arguably forbid several of Plaintiffs’ pleaded 

activities. And although the threat of enforcement analysis is more nuanced, we conclude that 

two Plaintiffs—Christian Healthcare and Sacred Heart—have plausibly established a credible 

threat that Defendants will enforce against them at least some of the challenged provisions of 

Michigan’s laws. Finally, we leave to the district court the task of evaluating Plaintiffs’ requests 

for injunctive relief in the first instance. All told, the district court’s decisions are AFFIRMED 

IN PART, REVERSED IN PART, AND REMANDED. 

I. BACKGROUND

A. Michigan’s Laws

Each Plaintiff challenges aspects of Michigan’s Elliot-Larsen Civil Rights Act (ELCRA). 

Mich. Comp. Laws § 37.2101 et seq. Christian Healthcare and Sacred Heart also challenge 

aspects of the state’s Equal Accommodations Act (EAA). Mich. Comp. Laws §§ 750.146–147. 

Relevant provisions of these laws and pertinent events concerning their scope are described 

below. 

1. ELCRA

For just under fifty years, the ELCRA has protected Michiganders from discrimination. 

See Mich. Comp. Laws § 37.2102(1). The ELCRA’s regulations relating to employment, public 

accommodations, education, and publications are relevant here.

First, the ELCRA prohibits an employer from failing to hire, failing to recruit, firing, or 

otherwise discriminating against an individual because of enumerated protected characteristics. 

Id. § 37.2202(1)(a). Employers also may not use hiring applications that elicit information 

about, or express a preference based on, any protected characteristic. Id. § 37.2206(2)(a), (c). 

Second, the law prohibits any person from denying an individual the “full and equal enjoyment” 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 4

of any goods, services, or facilities “of a place of public accommodation or public service” based 

on the same characteristics. Id. § 37.2302(a). Third, it prevents educational institutions from 

discriminating with respect to educational benefits, admission, or the institution’s terms and 

conditions because of specified characteristics. Id. § 37.2402(a)–(b). Educational institutions 

also may not attempt to solicit information about these characteristics for admission purposes. 

Id. § 37.2402(c). Fourth, the ELCRA regulates publication of statements concerning its 

substantive provisions: Employers, places of public accommodation, and educational institutions 

may not publish statements indicating preferences based on protected characteristics. See id. 

§ 37.2206(1) (employers); id. § 37.2302(b) (public accommodations); id. § 37.2402(d) 

(educational institutions).

The ELCRA also contains language qualifying its application. Most broadly, it is not to 

“be construed as preventing the [Michigan Civil Rights] [C]ommission from securing civil rights 

guaranteed by law.” Id. § 37.2705(1). Additionally, employers may inquire about protected 

characteristics or express a preference based on those characteristics where “permitted” to do so 

“by applicable federal law,” id. § 37.2206(2); places of public accommodation may be exempted 

from the ELCRA’s regulations “where permitted by law,” id. § 37.2302; and educational 

institutions may inquire about protected characteristics in admissions decisions if “required by 

federal law, rule, or regulation,” id. § 37.2402(c). The ELCRA’s education provisions “related 

to religion” do not apply to religious schools. Id. § 37.2403. Employers may also apply for an 

exemption from the ELCRA’s employment regulations if a certain protected characteristic “is a 

bona fide occupational qualification,” or BFOQ, “reasonably necessary to the normal operation 

of the business.” Id. § 37.2208. This BFOQ exemption can be either (1) obtained by application 

to Michigan’s Civil Rights Commission (the Commission), which is empowered to investigate 

the application and approve exemptions for up to five years, or (2) asserted as an affirmative 

defense in later proceedings. Id.; see Mich. Admin. Code R. 37.25.

The ELCRA and Michigan’s administrative code set out the Act’s enforcement 

procedures. Any “person”—a statutorily defined term including Michigan and its subagencies, 

see Mich. Admin. Code R. 37.2(p)—who is “aggrieved by unlawful discrimination” may submit 

an ELCRA complaint to Michigan’s Department of Civil Rights (the Department). 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 5

Id. R. 37.4(1). Certain commissioners, directors, and agents authorized by the Commission may 

also file complaints on the public’s behalf. Id. R. 37.4(2). The Department is empowered to 

investigate filed complaints, including by collecting evidence and requiring witness testimony 

that is “pertinent to a complaint.” Mich. Comp. Laws § 37.2602(c)–(d); see also Mich. Admin. 

Code R. 37.4(10), 37.14(1). The Department will issue a charge if, “after investigation,” it 

“determines that there are sufficient grounds” to do so. Id. R. 37.6(1). A person or entity 

charged with discrimination must “file a written verified answer”; if they do not, the charge’s 

allegations are considered admitted. Id. R. 37.11(1), (6). If after a hearing the Commission 

determines that the ELCRA was violated, it may order monetary and equitable remedies. 

See Mich. Comp. Laws § 37.2605. 

The ELCRA has always prohibited discrimination based on sex, religion, and several 

other characteristics. In 2018, the Commission adopted Interpretive Statement 2018-1. 

Through that Statement, the Commission resolved that the ELCRA’s phrase “discrimination 

because of . . . sex” included discrimination based on sexual orientation or gender identity, and 

instructed the Department to begin processing complaints alleging discrimination on these bases. 

See Michigan Civil Rights Commission, Interpretive Statement 2018-1 (May 21, 2018), 

https://perma.cc/D32M-9LMJ.

In 2019, two businesses under investigation for alleged ELCRA discrimination regarding 

gender and sexual orientation sued the Department in Michigan state court. See Rouch World, 

LLC v. Dep’t of C.R., 987 N.W.2d 501, 505–06 (Mich. 2022). In a July 2022 decision, the 

Michigan Supreme Court held that the ELCRA prohibited sexual orientation-based 

discrimination. See id. at 519. After Rouch World, Michigan amended the ELCRA to codify 

protections against discrimination based on sexual orientation or gender identity. In the amended 

ELCRA, effective as of February 13, 2024, each of the regulations outlined above explicitly bars 

discrimination because of “sexual orientation” and “gender identity or expression.” See Mich. 

Comp. Laws §§ 37.2102, 37.2202, 37.2206, 37.2302, 37.2402.
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 6

2. EAA

Michigan’s Equal Accommodations Act guarantees Michiganders “full and equal 

accommodations” at “all . . . places of public accommodation,” subject to “conditions and 

limitations established by law.” Mich. Comp. Laws § 750.146. The Act prohibits any owner, 

operator, or employee of a place of public accommodation from (1) denying the accommodations 

of her facilities based on a person’s protected characteristic or (2) publishing communications or 

advertisements stating that she will do so. Id. § 750.147. Violations of the EAA are punishable 

both as criminal misdemeanors and through civil actions brought by an injured party. Id. Sex 

and religion are among the enumerated characteristics protected by the Act. Id.

B. Plaintiffs and Their Activities

1. Christian Healthcare Centers

Christian Healthcare is a Michigan nonprofit that operates a membership-based medical 

service ministry in which patients receive a package of services in return for a monthly fee. The 

organization integrates Christian faith and prayer into its purpose, mission, and activities. 

Although Christian Healthcare “currently treats and has recently treated” transgender 

patients and has received requests to use pronouns aligned with the gender of those patients, it 

has not and will not accede to such requests. Instead, Christian Healthcare either uses pronouns 

that “accord with the person’s biological sex” at birth or works to find “an appropriate and 

respectful accommodation,” which often involves referring to these patients using first or last 

names. Additionally, although Christian Healthcare would provide hormones for certain medical 

conditions, it would not provide hormones to facilitate gender transitions. It recruits and retains 

only employees who can profess belief in traditional Christianity, abstain from same-sex 

relationships and non-marital sex, and agree that sex is an immutable biological reality. 

Employees must affirm a series of statements articulating these beliefs yearly. 

Finally, Christian Healthcare desires to post both its Membership Agreement and 

Employment Application online. Appendices to the Membership Agreement explain that 

(1) Christian Healthcare’s employees ascribe to the organization’s previously described faith-
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 7

based practices, (2) Christian Healthcare will not provide certain medical procedures, including 

hormones to facilitate gender transition, that conflict with its faith, and (3) Christian Healthcare 

will not use pronouns that do not accord with a person’s biological sex at birth. The 

Employment Application requires prospective employees to state whether they identify as a 

Christian and if they are in full agreement with each tenet of the Christian Healthcare Statement 

of Faith. The Statement of Faith, in turn, asks signatories to affirm, among other things, a belief 

in the inerrancy of the Bible and an understanding that human beings may not alter their 

biological sex. Christian Healthcare further wishes to post on its “Career Opportunities” 

webpage an application link explaining that any applicants must affirm on a yearly basis not only 

the organization’s Statement of Faith, but also its Values Declaration, Statement of Marriage and 

Human Sexuality, Philosophy of Wellness and Healthcare, and Code of Conduct. These 

additional statements reaffirm Christian Healthcare’s commitment to religious-centered 

healthcare and opposition to same-sex relationships and gender transition. When it filed its 

complaint, Christian Healthcare was looking to fill a Biblical Counselor position; applicants for 

the position would be required to agree with these statements.

Christian Healthcare has averred that but for the laws it challenges, it would post these 

documents immediately. Until shortly before it initiated its lawsuit, the organization had posted 

a previous version of its Membership Agreement and a link to the Employment Application on 

its website. 

2. Sacred Heart of Jesus Parish

Sacred Heart of Jesus Parish is located on the west side of Grand Rapids, Michigan. The 

parish operates Sacred Heart Academy (or “Sacred Heart” for short), a classical Catholic prekindergarten through twelfth-grade school. Although it accepts non-Catholic students, the 

school primarily exists to support parents in passing on the Catholic faith through an intentional 

Catholic community and culture. Six parents of children at Sacred Heart are also Plaintiffs in 

Sacred Heart’s lawsuit. 

Sacred Heart recruits, hires, and retains only employees who can support, live, and model 

the Catholic faith and doctrine. On an annual basis, it requires all employees to sign a Faculty 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 8

Memorandum of Understanding through which employees affirm that they will not engage in or 

support sexual activity outside of marriage, same-sex marriage or sexual activity, or what the 

memo terms “transgenderism.” Employees also must annually affirm an Oath of Fidelity to 

Catholic doctrine, which includes a promise to maintain observance of ecclesiastical laws. 

Sacred Heart teaches students that biological sex is immutable, sorts students by biological sex 

into single-sex “houses,” and requires students to wear uniforms, use restrooms, and play on 

sports teams according to their biological sex at birth. Although Sacred Heart has students with 

gender dysphoria, it will not use pronouns inconsistent with a person’s biological sex. 

Sacred Heart also wishes to post several items on its website. One is a statement by 

Sacred Heart’s Pastor explaining that the school will continue to require students and employees 

to follow its view of Catholic doctrine, including in the areas of marriage and human sexuality. 

Specifically, the statement notes that Sacred Heart teaches its students that every “man and 

woman[] should acknowledge and accept his [or her] sexual identity,” that “procreative,” 

heterosexual marriage is the only appropriate form in which to express sexuality, and that the 

school will not “affirm any sexual identities that violate Catholic doctrine.” Additionally, Sacred 

Heart wishes to publicly advertise job applications for an art teacher and athletic coach. These 

advertisements would explain, as past applications have, that the applicant must be a “practicing 

Catholic whose public life is lived in conformity with the moral teachings of the Church,” and be 

able to sign the Memorandum of Understanding and Oath of Fidelity described above. 

3. St. Joseph Parish St. Johns

St. Joseph is a Catholic parish in St. Johns, Michigan, that operates a Catholic elementary 

school. The school’s mission is “to assist parents in the spiritual, social, and intellectual 

development of their child within the framework of Catholic teachings and moral values.” 

St. Joseph will only hire employees and enlist volunteers who will “not teach, advocate, 

model, or in any way encourage beliefs or behaviors that are contrary to the teaching of the 

Catholic Church.” It requires students and teachers to use uniforms, pronouns, bathrooms, and 

other single-sex spaces that accord with biological sex at birth; sports teams are also segregated 

based on birth sex. In addition, parents must agree that students may not act in an openly 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 9

hostile manner toward Catholic doctrine. St. Joseph opens its facilities in several ways to the 

public—its Mass is open to all, it allows sports leagues to use its fields and gymnasium, it 

participates in a “shared time” arrangement with local public-school teachers who teach in St. 

Joseph classrooms, and it plans to bring in private tutors for the public-school students who 

attend its parish. It expects the public who will use its facilities to “respect the Catholic 

environment.” 

Finally, St. Joseph has stated that it wishes to advertise a job opening for a first-grade 

teacher that would note, as past advertisements have noted, that an applicant must be a 

“practicing Catholic with the ability to infuse Catholic faith and teaching throughout the 

curriculum.” It also provides a Code of Conduct to employees and volunteers specifying that 

recipients cannot “teach, advocate, model, or in any way encourage beliefs or behaviors that are 

contrary to the teaching of the Catholic Church.” Finally, St. Joseph suggests that other 

statements it makes—including statements about homosexuality or transgender status, or other 

declarations concerning proper attire and roles for members of each sex—could run afoul of 

Michigan law. 

C. Procedural History

In August 2022, Christian Healthcare filed a lawsuit alleging that the ELCRA and the 

EAA violated the First and Fourteenth Amendments of the United States Constitution both 

facially and as applied to itself. It also moved to preliminarily enjoin Defendants, Michigan’s 

Attorney General and various Department and Commission members, from enforcing the 

challenged aspects of the two laws. Sacred Heart sued in December 2022, alleging the same 

First and Fourteenth Amendment violations both facially and as applied, and likewise sought a 

preliminary injunction. Finally, St. Joseph filed its active complaint on April 7, 2023. Its 

complaint differed from Christian Healthcare’s and Sacred Heart’s because it did not challenge 

the EAA and alleged only as-applied constitutional violations.1 All three cases were filed in the 

Western District of Michigan. 

1Although Christian Healthcare and Sacred Heart challenged the pre-amendment (but post-Interpretive 

Statement) ELCRA, while St. Joseph challenged the amended Act, it is undisputed that the Department has been 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 10

In each case, Defendants moved to dismiss for lack of subject matter jurisdiction under 

Federal Rule of Civil Procedure 12(b)(1). Defendants also opposed Christian Healthcare’s and 

Sacred Heart’s motions for injunctive relief. 

The district court granted each motion to dismiss. Starting with Christian Healthcare’s 

case, in a March 2023 decision, the court recognized that to have standing to bring a 

pre-enforcement challenge, a plaintiff must demonstrate that (1) the challenged statutes arguably 

proscribe its intended conduct and (2) there is a credible threat that the laws will be enforced 

against the plaintiff. The court found that Christian Healthcare failed to make either required 

showing. As a result, it granted Defendants’ motion to dismiss. In August 2023, the district 

court entered separate orders dismissing Sacred Heart’s and St. Joseph’s cases for lack of subject 

matter jurisdiction by finding that each Plaintiff had failed to satisfy the same criteria for preenforcement standing.2

 In the Christian Healthcare and Sacred Heart cases, the district court also 

indicated in footnotes that absent dismissal, it likely would have denied each Plaintiff’s motion 

for a preliminary injunction. 

Christian Healthcare appeals the dismissal of its case and several ancillary orders. It 

requests reversal of the district court’s standing determination and the entry of injunctive relief. 

Sacred Heart likewise asks us to reverse the district court’s jurisdictional dismissal and to grant 

injunctive relief. And St. Joseph requests that we reverse the district court’s decision in its case 

and instruct the district court that declaratory and injunctive relief are warranted. 

processing complaints alleging discrimination based on sexual orientation and gender identity since the Commission 

adopted Interpretive Statement 2018-1 in May 2018. The amended ELCRA merely codifies the Interpretive 

Statement’s understanding of the ELCRA. 

2

In all three cases, the district court also indicated that had it not dismissed each complaint for lack of 

standing, it would have dismissed on ripeness grounds. We have explained, however, that “in the pre-enforcement 

First Amendment context, the line between Article III standing and ripeness has evaporated” because the doctrines 

both pose largely “the same question: have plaintiffs established a credible threat of enforcement?” Miller v. City of 

Wickliffe, 852 F.3d 497, 506 (6th Cir. 2017) (cleaned up); see Winter v. Wolnitzek, 834 F.3d 681, 687 (6th Cir. 

2016). We therefore address the credibility of enforcement below without an additional ripeness analysis. See infra

Part II(A)(2).
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 11

II. ANALYSIS

A. Standing

For a federal court to exercise subject matter jurisdiction over a case, a plaintiff must 

have standing to sue. State ex rel. Tenn. Gen. Assembly v. U.S. Dep’t of State, 931 F.3d 499, 507 

(6th Cir. 2019). This requirement flows from “Article III of the Constitution,” which “limits the 

jurisdiction of federal courts to ‘Cases’ and ‘Controversies.’” Susan B. Anthony List v. Driehaus, 

573 U.S. 149, 157 (2014) (quoting U.S. Const. art. III, § 2). We review dismissals for lack of 

standing de novo. Ames v. LaRose, 86 F.4th 729, 731 (6th Cir. 2023).

To establish Article III standing, a plaintiff must allege (1) an injury in fact that is both 

(2) caused by the defendant’s conduct and (3) redressable by a favorable court decision. 

Driehaus, 573 U.S. at 157–58. The plaintiff “bears the burden of establishing these elements . . . 

with the manner and degree of evidence required at the successive stages of the litigation.” 

Lujan v. Defs. of Wildlife, 504 U.S. 555, 561 (1992). A plaintiff’s burden at the pleading stage is 

to plausibly assert standing. See Ass’n of Am. Physicians & Surgeons v. FDA, 13 F.4th 531, 

543–44 (6th Cir. 2021). 

Standing is plausible in a pre-enforcement challenge when the plaintiff pleads “when, to 

whom, where, or under what circumstances” its injury will occur. Seattle Pac. Univ. 

v. Ferguson, 104 F.4th 50, 59 (9th Cir. 2024) (quoting Unified Data Servs., LLC v. FTC, 39 

F.4th 1200, 1211 (9th Cir. 2022)); see Ass’n of Am. Physicians, 13 F.4th at 543–44. Because 

“standing is not dispensed in gross,” TransUnion LLC v. Ramirez, 594 U.S. 413, 431 (2021), a 

“plaintiff must establish standing for each claim he presses and each statutory provision he 

challenges.” Oklahoma v. United States, 62 F.4th 221, 233 (6th Cir. 2023). And if a plaintiff 

cannot establish standing for any claim, a court must dismiss the case for lack of subject-matter 

jurisdiction. See State ex rel. Tenn. Gen. Assembly, 931 F.3d at 519.

Because Defendants pursue a facial jurisdictional challenge to Sacred Heart’s and St. 

Joseph’s complaints, we treat the allegations in those pleadings as true. See Ass’n of Am. 

Physicians, 14 F.4th at 543–44. And although the parties have litigated the jurisdictional 

challenge to Christian Healthcare’s complaint as factual, we likewise accept the veracity of 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 12

Christian Healthcare’s pleading because the parties do not dispute the “relevant facts” for 

purposes of the motion to dismiss. See Memphis Biofuels, LLC v. Chickasaw Nation Indus., 585 

F.3d 917, 919 (6th Cir. 2009).

These cases involve standing’s injury-in-fact element. An alleged injury is 

constitutionally sufficient only if it is “actual or imminent, not ‘conjectural’ or ‘hypothetical.’” 

Driehaus, 573 U.S. at 158 (quoting Lujan, 504 U.S. at 560). Allegations of future injury, 

specifically, must be “certainly impending” such that there is a “‘substantial risk’ that the harm 

will occur.” Id. (quoting Clapper v. Amnesty Int’l USA, 568 U.S. 398, 410, 414 n.5 (2013)). 

One difficult and “recurring issue” is “determining when the threatened enforcement of a 

law creates an Article III injury.” Id. In Driehaus, the Supreme Court explained that a plaintiff 

“subject to such a threat” need not wait for “an actual arrest, prosecution, or other enforcement 

action” to challenge the law. Id. Instead, a threat of enforcement is “sufficiently imminent” to 

constitute an injury in fact if the plaintiff alleges (1) an intent “to engage in a course of conduct” 

arguably “affected with a constitutional interest,” (2) that this conduct is arguably “proscribed by 

a statute,” and (3) that there is “a credible threat” of the statute’s enforcement against the 

plaintiff. Id. at 159 (quoting Babbitt v. Farm Workers, 442 U.S. 289, 298 (1979)).

Defendants concede the first element of this test, and we agree that each Plaintiff has 

alleged an intent to engage in conduct arguably affected with a constitutional interest. That 

leaves two questions: whether Plaintiffs have plausibly alleged that (1) their “intended future 

conduct is ‘arguably . . . proscribed by the statute’ they wish to challenge,” id. at 162 (quoting 

Babbitt, 442 U.S. at 298) (brackets omitted), and (2) there is a “substantial” or “credible threat of 

enforcement” of the statute against them, id. at 164, 167. 

1. Arguable Proscription

Conduct is arguably proscribed by a statutory provision if, on “a plausible interpretation 

of the statute,” the conduct is forbidden. Kentucky v. Yellen, 54 F.4th 325, 337 (6th Cir. 2022). 

We proceed by mapping each Plaintiff’s pleaded conduct onto Michigan’s laws.
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 13

a. Plaintiffs’ Conduct, ELCRA, and the EAA

Employment. Each Plaintiff is a covered employer under the ELCRA. See Mich. Comp. 

Laws § 37.2201(a). Christian Healthcare requires all employees to sign yearly belief statements. 

Both current and prospective employees must affirm that Jesus Christ led a “sinless life,” that 

“human beings are not at liberty to alter their biological sex,” and that sexual activity may occur 

only within marriages between one man and one woman. In additional statements, employees 

are required to aver “Jesus Christ as Lord and Savior over all areas of life” and affirm that they 

will “strive to apply biblical discernment in matters related to marriage, family, and human 

sexuality consistent with the Statement on Marriage and Human Sexuality.” The Statement on 

Marriage and Human Sexuality, in turn, requires employees to agree that homosexuality, gay 

marriage, and attempts to change one’s sex are inconsistent with biblical commands, and to 

affirm that the employee will not use pronouns inconsistent with a patient’s biological sex at 

birth or facilitate a patient’s attempt to alter their sex. When it filed its complaint, Christian 

Healthcare was seeking to fill a Biblical Counselor position; applicants for the position would 

have to be in “full agreement” with these statements.

Sacred Heart “annually requires all employees to” both “sign its memorandum of 

understanding” on Catholic doctrine and “to publicly swear an oath of fidelity to Catholic 

doctrine, including on marriage and sexuality.” By signing the Memorandum of Understanding, 

each employee “agrees that as a condition of employment” she will “not advocate, encourage, or 

counsel beliefs or practices that are inconsistent with the Catholic faith,” which the 

Memorandum defines to include “same-sex sexual activity[,] preparing for or entering into a 

same-sex marriage,” and “engaging in or supporting . . . transgenderism, or sex reassignment.” 

And by additionally swearing the Oath of Fidelity, each employee promises to “follow and foster 

the common discipline of the entire Church” and to “maintain the observance of all ecclesiastical 

laws.” In proposed public advertisements for its open art teacher and coach positions, Sacred 

Heart would state that any applicant must be a “practicing Catholic whose public life is lived in 

conformity with the moral teachings of the Church” who is willing “to sign the ‘Faculty 

Memorandum of Understanding’ and swear the ‘Oath of Fidelity.’” 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 14

St. Joseph requires all employees to be practicing Catholics and to sign a Code of 

Conduct affirming that they will “exemplify the moral teachings of the Catholic Church” in their 

“personal and professional” lives. Additionally, under updated hiring guidelines, St. Joseph 

alleges that any applicant—including for its first-grade teacher position, which was open at the 

time its active complaint was filed—would be asked whether they could “uphold the teachings of 

the Catholic Church in [their] public and private life.” Finally, St. Joseph’s standard 

advertisement for open positions states that any candidate “should be a practicing Catholic with 

the ability to infuse Catholic faith and teaching throughout the curriculum.” 

By favoring Christians and those who can readily agree with statements connected to the 

Christian faith, each Plaintiff’s employment practices represent discrimination “because of 

religion.” Mich. Comp. Laws § 37.2202(a). Additionally, each Plaintiff has alleged that it 

“elicits or attempts to elicit information concerning the religion” of prospective employees, 

which is proscribed by a separate ELCRA provision. Id. § 37.2206(2)(a).

Christian Healthcare further requires employees and applicants to affirm statements 

critical of homosexuality, gay marriage, and alteration of biological sex, while Sacred Heart 

mandates that employees and applicants not encourage same-sex sexual activity or sex 

reassignment. The Supreme Court has described penalties on “homosexual conduct” as an 

“invitation” to engage in discrimination against “homosexual persons,” Lawrence v. Texas, 539 

U.S. 558, 575 (2003), and the same at least arguably follows for the issue of gender identity. As 

a result, Christian Healthcare’s and Sacred Heart’s employment requirements arguably 

discriminate against gay and transgender employees and prospective employees “because of . . . 

sexual orientation [and] gender identity.” Mich. Comp. Laws § 37.2202(1)(a). St. Joseph’s 

complaint, by contrast, lacks any assertion that employees or prospective employees have ever 

been or will ever be asked about sexual orientation or gender identity. As a result, St. Joseph has 

not alleged any conduct that arguably represents employment discrimination based on those 

characteristics.

Public Accommodations and Education. The ELCRA defines a place of public 

accommodation as “an educational . . . [or] health . . . facility, or institution of any kind . . . 

whose goods, services, facilities, privileges, advantages, or accommodations are extended, 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 15

offered, sold, or otherwise made available to the public.” Mich. Comp. Laws § 37.2301(a). The 

EAA also applies to “places of public accommodation” but does not define this term. See id. 

§ 750.146. We conclude that each Plaintiff is arguably covered by the public-accommodation 

laws. See Kentucky, 54 F.4th at 337. The ELCRA also defines an “educational institution” to 

which its educational provisions apply as “a public or private” educational entity, Mich. Comp. 

Laws § 37.2401; those provisions inarguably apply to Sacred Heart and St. Joseph unless they 

fall within an exception. 

Relevant to these provisions, Christian Healthcare will not use a transgender patient’s 

preferred pronouns, and will instead use either pronouns that accord with birth sex or alternative 

forms of address like first or last names. Similarly, Sacred Heart will not “affirm any 

individual’s ‘preferred pronouns’ inconsistent with biological sex” at birth, and St. Joseph 

“teaches and practices” that “personal pronouns” must be used in accordance with each person’s 

“biological sex.” Christian Healthcare has additionally pleaded that although it will provide 

hormones for certain medical conditions, it will not provide hormones to facilitate gender 

transitions. Sacred Heart and St. Joseph have alleged that they require students to wear 

uniforms, use restrooms and other single-sex spaces, and play on sports teams that accord with 

biological sex. Finally, St. Joseph has alleged that it allows the use of its facilities for sports 

leagues, participates in a “shared time” arrangement with local public school teachers who teach 

in St. Joseph classrooms, and plans to bring in private tutors—and that when it opens its spaces 

in these ways, it expects the public to “respect the Catholic environment.” 

These policies at least arguably deny to transgender individuals the privilege, enjoyed by 

cisgender individuals, of using pronouns, dressing, using restrooms, and playing on sports teams 

in accordance with their gender identity. See Mich. Comp. Laws § 37.2302(a) (proscribing the 

denial of “the full and equal enjoyment of the . . . privileges” of a place of public 

accommodation); id. § 750.147 (similar); id. § 37.2402(b) (proscribing discrimination in the 

“privileges of the [educational] institution” against any student or prospective student because of 

that student’s protected characteristics); see also Rouch World, 987 N.W.2d at 513 (reasoning 

that discrimination occurs when a person or entity “intentionally treat[s] individuals differently 

because of” a protected characteristic). Indeed, Michigan through its Attorney General has 
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previously taken a litigating position in at least one amicus brief that several of these activities 

can constitute discrimination under federal antidiscrimination law. And although Sacred Heart 

and St. Joseph, as religious institutions, are not subject to the ELCRA’s educational regulations 

“related to religion,” id. § 37.2403, that exemption would arguably not apply to policies treating 

individuals differently based on other protected characteristics, such as gender identity. In sum, 

each Plaintiff has alleged an intent to engage in activities that arguably constitute prohibited 

discrimination based on transgender status as defined by the accommodation and education 

provisions of Michigan’s laws.

Publication. Each Plaintiff has provided certain specific statements that it alleges it 

would publish but for the regulations it challenges. Christian Healthcare desires to post its 

Membership Agreement and Employment Application online. Appendices to the Membership 

Agreement explain, among other things, that the organization will not provide hormones to 

facilitate gender transition or use pronouns that do not accord with a person’s biological sex at 

birth. The Employment Application (and other links that Christian Healthcare desires to post on 

its “Career Opportunities” webpage) would reference statements affirming the organization’s 

belief in the inerrancy of the Bible, faith in Jesus Christ, opposition to same-sex marriage and 

gender transition, and unwillingness to provide procedures that conflict with these beliefs. 

Sacred Heart alleges that it would post (1) its Pastor’s statement explaining the school’s 

commitment to requiring students and employees to follow its view of Catholic doctrine, 

including in the areas of marriage and human sexuality, and its refusal to “affirm any sexual 

identities that violate Catholic doctrine,” and (2) job applications that would require applicants to 

be practicing Catholics and to affirm that they would not encourage same-sex relationships or 

transgender-related activity. Finally, St. Joseph pleads that it wishes to (1) advertise job 

openings that would require applicants to be practicing Catholics capable of infusing Catholic 

faith into their work, and (2) require clergy, employees, and volunteers to abide by the Code of 

Conduct’s requirement not to “teach, advocate, model, or in any way encourage beliefs or 

behaviors that are contrary to the teaching of the Catholic Church.” Because it does not affect 

our conclusion on standing, we assume without deciding that St. Joseph’s distribution of the 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 17

Code of Conduct to employees and volunteers arguably constitutes publication within the 

ELCRA’s meaning. See Mich. Comp. Laws §§ 37.2206(2)(c), 37.2302(b).

All three of the Plaintiffs’ job postings explicitly seek out Christians and thereby 

constitute “post[ed] . . . statement[s] . . . relating to employment . . . that indicate[] a preference 

. . . based on religion.” Mich. Comp. Laws § 37.2206(1). Christian Healthcare’s and Sacred 

Heart’s employment applications also arguably constitute “discrimination[] based on . . . sexual 

orientation [and] gender identity” because they reference the need for a prospective employee to 

oppose same-sex marriage and gender transition. Id. Christian Healthcare’s proposed public 

statements on hormones and pronouns arguably constitute “post[ed] . . . statement[s]” indicating 

that certain “privileges” of public accommodations will not be made available to individuals 

“because of . . . gender identity,” id. § 37.2302(b); Sacred Heart’s proposed letter indicating that 

the school will not affirm certain sexual identities or permit same-sex relationships arguably 

constitutes discrimination based on gender identity and sexual orientation both in its role as a 

public accommodation, see id. §§ 37.2302(b), 750.147, and as an educational institution, see id. 

§ 37.2402(d). Finally, St. Joseph’s Code of Conduct—which applies to both employees and 

volunteers—arguably constitutes a publication indicating a religious preference in employment 

and in a place of public accommodation. See id. §§ 37.2206(1), 37.2302(b). 

St. Joseph additionally suggests that the publication clause of the ELCRA’s publicaccommodation provision proscribes certain additional oral statements it makes. The ELCRA’s 

text, however, does not allow any place of public accommodation to “[p]rint, circulate, post, 

mail, or otherwise cause to be published a [discriminatory] statement, advertisement, notice, or 

sign.” Id. § 37.2302(b). This provision can only be reasonably read to proscribe written 

communications—those that can be printed, circulated, posted, or mailed—rather than oral 

statements. See Fischer v. United States, 144 S. Ct. 2176, 2183–85 (2024) (holding that the term 

“otherwise” in a federal statute is often determined with reference to “guidance from whatever 

examples come before it”). Oral communications are not arguably proscribed by this provision.

In summary, both Christian Healthcare and Sacred Heart have sufficiently alleged an 

intent to publicize employment-related statements arguably constituting discrimination based on 

religion, sexual orientation, and gender identity, which are arguably proscribed by the 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 18

publication clause of the ELCRA’s employment provision. They also intend to publicize 

statements arguably constituting gender-identity-based discrimination that are arguably 

proscribed by the publication clauses of the ELCRA’s public-accommodation provision and by 

the EAA; Sacred Heart’s statements also arguably constitute sexual-orientation-based 

discrimination. Because Sacred Heart is a school, its statements are also arguably proscribed by 

the publication clause of the ELCRA’s education provision. Finally, St. Joseph has sufficiently 

alleged an intent to publicize statements arguably constituting discrimination based on religion, 

which are arguably proscribed by the publication clauses of the ELCRA’s employment and 

public-accommodation provisions.

b. Relevance of Exemptions

Defendants do not dispute Plaintiffs’ factual claims regarding the core coverage of the 

ELCRA and the EAA. Instead, they point to limiting language in both laws. Both statutes, 

Defendants note, contain language instructing that they should not be applied where doing so 

would otherwise violate applicable law. See Mich. Comp. Laws § 37.2705(1) (requiring that the 

ELCRA not be construed to prevent the “securing” of “civil rights guaranteed by law”); 

id. § 37.2206 (permitting employers to inquire about or express a preference based on protected 

characteristics where “permitted” to do so “by applicable federal law”); id. § 37.2302 (allowing, 

“where permitted by law,” exemptions from the ELCRA’s public-accommodation regulations); 

id. § 37.2402(c) (permitting educational institutions to inquire about protected characteristics in 

admissions decisions if “required by federal law, rule, or regulation”); id. § 750.146 (subjecting 

the EAA to “conditions and limitations established by law”). Defendants argue that because 

these provisions make clear that the ELCRA and the EAA give way to protections created by 

other laws, including the federal Constitution, the challenged statutes do not arguably proscribe 

Plaintiffs’ existing or intended First Amendment-related conduct. 

Defendants’ argument mirrors one raised and rejected in Driehaus. The defendants there

contended that the challenged statute, which prohibited certain false statements, did not arguably 

proscribe proposed speech that the plaintiffs believed to be true. Driehaus, 573 U.S. at 152, 163. 

But the Supreme Court held that where the law at issue swept broadly and “cover[ed] the subject 

matter of [the plaintiffs’] intended speech,” it arguably proscribed that speech notwithstanding 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 19

any potential defense based on the speech’s alleged truthfulness. Id. at 162. Here, the ELCRA 

and the EAA’s exemptions reflect the intention of Michigan’s legislature that its 

antidiscrimination laws be applied with reference to other legal protections and defenses. But as 

in Driehaus, the language of exemptions within the ELCRA and the EAA is not so clear that it 

renders the laws obviously inapplicable to Plaintiffs’ conduct—as is necessary to defeat 

standing.

As for Defendants’ reliance on the BFOQ exemption for employment discrimination 

based on characteristics “reasonably necessary to the normal operation of the business,” see 

Mich. Comp. Laws § 37.2208, that exemption is relevant only to the claims challenging the 

ELCRA’s employment provisions. Even as to those claims, without knowing what facts would 

be presented to support a BFOQ application regarding a specific position, let alone how the 

Commission would evaluate those facts, we cannot conclude that the ELCRA’s BFOQ 

exemption categorically removes Plaintiffs from the scope of its employment regulations. 

Finally, Michigan caselaw also supports the arguable application of the state’s 

antidiscrimination laws to Plaintiffs’ conduct. Michigan’s courts have sometimes held that 

defenses based on religious exercise are sufficient to defend against ELCRA actions. See, e.g., 

Assemany v. Archdiocese of Detroit, 434 N.W.2d 233, 234, 238 (Mich. Ct. App. 1988). But such 

defenses are not always successful. See, e.g., McLeod v. Providence Christian Sch., 408 N.W.2d 

146, 147, 150–52 (Mich. Ct. App. 1987). Rather than demonstrating that Plaintiffs’ conduct is 

certainly exempt from the ELCRA and the EAA, these cases reinforce that in some situations, 

Michigan’s laws can apply to religiously motivated conduct. Even Defendants’ briefing, which 

explains that they cannot disavow enforcement of the laws against Plaintiffs’ existing and 

intended conduct because the applicability of any exemption is a “fact dependent” question, 

suggests that it is not “clear, based on the statute alone,” whether Plaintiffs’ conduct is 

proscribed by the challenged laws. Kentucky, 54 F.4th at 337. Based on governing precedent 

and the parties’ representations, the exemptions in the ELCRA and the EAA do not render the 

laws clearly inapplicable to Plaintiffs’ speech and conduct.
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 20

2. Credible Threat of Enforcement

Although a plaintiff need not expose itself to actual arrest or prosecution to bring a preenforcement challenge to a statute, see Driehaus, 573 U.S. at 158, “mere allegations of a 

‘subjective chill’ on protected speech are insufficient to establish an injury-in-fact.” McKay 

v. Federspiel, 823 F.3d 862, 868–69 (6th Cir. 2016) (quoting Berry v. Schmitt, 688 F.3d 290, 296 

(6th Cir. 2012)). Beyond chilled speech—which Plaintiffs have plainly alleged here—several 

factors inform our analysis of whether a threat of enforcement is sufficiently credible to support 

a claim for pre-enforcement prospective relief: 

(1) “a history of past enforcement against the plaintiffs or others”; (2) 

“enforcement warning letters sent to the plaintiffs regarding their specific 

conduct”; (3) “an attribute of the challenged statute that makes enforcement easier 

or more likely, such as a provision allowing any member of the public to initiate 

an enforcement action”; and (4) the “defendant’s refusal to disavow enforcement 

of the challenged statute against a particular plaintiff.”

Online Merchs. Guild v. Cameron, 995 F.3d 540, 550 (6th Cir. 2021) (quoting McKay, 823 F.3d 

at 869). “These McKay factors are not exhaustive, nor must each be established.” Id.; see also 

Fischer v. Thomas, 52 F.4th 303, 307 (6th Cir. 2022) (noting that the McKay factors are not “a 

laundry list”). At bottom, our inquiry distills to whether “surrounding factual circumstances” 

plausibly suggest a credible fear of enforcement. Universal Life Church Monastery Storehouse 

v. Nabors, 35 F.4th 1021, 1034 (6th Cir. 2022). 

a. Enforcement History

The first McKay factor is whether there is “a history of past enforcement” of the statute 

“against the plaintiffs or others.” 823 F.3d at 869. A threat of enforcement is most credible 

“when the same conduct has drawn enforcement actions or threats of enforcement in the past.” 

Plunderbund Media, LLC v. DeWine, 753 F. App’x 362, 367 (6th Cir. 2018) (emphasis added) 

(quoting Kiser v. Reitz, 765 F.3d 601, 609 (6th Cir. 2014)); see also Driehaus, 573 U.S. at 

164 (noting that “past enforcement against the same conduct is good evidence that the threat of 

enforcement is” credible). However, to establish standing, a plaintiff need not always show that 

the statute has been enforced previously against the precise conduct it wishes to undertake. See 

Block v. Canepa, 74 F.4th 400, 410-11 (6th Cir. 2023).
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 21

The parties agree that there has been no past enforcement of the ELCRA or the EAA 

against the Plaintiffs themselves. And Christian Healthcare and Sacred Heart have identified no 

relevant history of the EAA’s enforcement against anyone. Plaintiffs allege general facts 

regarding the past enforcement of the ELCRA: that the Department handled more than 12,000 

ELCRA complaints submitted against businesses and public accommodations between 2011 and 

2022, including nearly 4,000 from 2020–2022, and that it processed 73 complaints alleging 

discrimination based on sexual orientation or gender identity in the 18 months after Interpretive 

Statement 2018-1’s adoption. Finally, Plaintiffs point to the Department’s actions and litigation 

in Rouch World as a specific example of ELCRA enforcement regarding these categories of 

discrimination. 

Through motions for judicial notice or to supplement the appellate record, Christian 

Healthcare and Sacred Heart attempt to raise additional facts regarding enforcement actions that 

occurred after each Plaintiff’s complaint was filed. Sacred Heart and St. Joseph likewise note 

post-complaint events in their appellate briefing. “Standing,” however, “is to be determined as 

of the time the complaint is filed.” Ohio v. Yellen, 53 F.4th 983, 994 (6th Cir. 2022) (quoting 

Lynch v. Leis, 382 F.3d 642, 647 (6th Cir. 2004)). This rule “admits of no . . . exception; if a 

plaintiff lacks standing at the time the action commences,” it is not entitled “to a federal judicial 

forum.” Friends of the Earth, Inc. v. Laidlaw Env’t Servs. (TOC), Inc., 528 U.S. 167, 191 

(2000). Plaintiffs’ argument to the contrary relies on cases involving mootness, an issue not 

presented here. See, e.g., Fellowship of Christian Athletes v. San Jose Unified Sch. Dist. Bd. of 

Educ., 82 F.4th 664, 683 (9th Cir. 2023) (en banc). Accordingly, our equitable discretion to take 

judicial notice or to expand the record, see Abu-Joudeh v. Schneider, 954 F.3d 842, 848 (6th Cir. 

2020), does not permit the use of post-complaint events to retroactively generate standing. We 

therefore deny Christian Healthcare’s and Sacred Heart’s motions for judicial notice or to 

supplement the appellate record. See No. 23-1769 ECF 19, 43, 64; No. 23-1781 ECF 22, 37, 47.

Turning back to the pleaded facts, they demonstrate that although Michigan, its 

subagencies, and certain Commission-authorized individuals may file ELCRA complaints 

and thereby start the enforcement process, see Mich. Admin. Code R. 37.2(p), 37.4(1)–(2), 

citizen-initiated complaints are the method by which the Department’s ELCRA investigations 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 22

and enforcement proceedings are initiated in practice. See, e.g., Rouch World, 987 N.W.2d at 

505. The allegations also suggest that the Department actively enforces the ELCRA, including 

its prohibitions of discrimination based on sexual orientation and gender identity. Even though 

Plaintiffs have not provided the most probative evidence—a history of specific enforcement 

actions against their proposed conduct—the evidence that Michigan “does prosecute violations 

of” the ELCRA is relevant to the credibility of enforcement. See Block, 74 F.4th at 410 

(emphasis omitted). Additionally, given the short duration of the ELCRA’s application to sexual 

orientation and gender claims, “it makes sense that there would be at best limited evidence of a 

history of enforcement” in those categories. Online Merchs., 995 F.3d at 550. 

b. Warning Letters

It is undisputed that no “enforcement warning letters” have been “sent to the plaintiffs 

regarding their specific conduct.” McKay, 823 F.3d at 869. 

c. Statutory Attributes

The third factor asks whether there is “an attribute of the challenged statute that makes 

enforcement easier or more likely, such as a provision allowing any member of the public to 

initiate an enforcement action.” Id. As discussed, the ELCRA permits any “person” who is 

“aggrieved by unlawful discrimination” to file a complaint. Mich. Admin. Code R. 37.4(1). 

Statutes that allow “any person” to “file a complaint” make enforcement more likely because the 

law’s initiation is not limited to “a prosecutor or an agency.” Driehaus, 573 U.S. at 164; 

see Platt v. Bd. of Comm’rs on Grievances & Discipline of Ohio Sup. Ct., 769 F.3d 447, 452 

(6th Cir. 2014). 

By contrast, the EAA may be enforced only by Michigan’s Attorney General and through 

private civil lawsuits. See Mich. Comp. Laws § 750.147. Sacred Heart suggests that the EAA’s 

private right of action should be treated, like a citizen-complaint provision, as a statutory 

attribute increasing the risk of enforcement. But injuries (and potential injuries) are 

only constitutionally sufficient where a plaintiff can “tie his injury ‘to [a] defendant.’” In re E. I. 

du Pont de Nemours & Co. C-8 Pers. Inj. Litig., 87 F.4th 315, 320 (6th Cir. 2023) (quoting Fox 

v. Saginaw County, 67 F.4th 284, 293 (6th Cir. 2023)); see also TransUnion LLC, 594 U.S. at 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 23

423 (holding that to have standing, the plaintiff must have suffered an injury caused by a 

defendant in the case). The Supreme Court has explained that where a private defendant does 

not intend to sue a plaintiff under a given law, that plaintiff “cannot establish ‘personal injury 

fairly traceable to [that defendant’s] allegedly unlawful conduct.’” Whole Woman’s Health 

v. Jackson, 595 U.S. 30, 48 (2021) (quoting California v. Texas, 593 U.S. 659, 668–69 (2021)). 

Any threat of injury from the civil-enforcement aspect of the statute is not traceable to the 

defendants here, and does not represent a statutory attribute increasing the risk of enforcement by 

these defendants.

d. Disavowal

The final McKay factor considers a defendant’s “refusal to disavow enforcement of the 

challenged statute.” 823 F.3d at 869. Because “the issue of disavowal” is intertwined with 

factual determinations, it can be “nuanced.” Id. at 870. For instance, an entity’s assertion that 

it intends to enforce its laws in the abstract—and not against the specific conduct that the 

plaintiff plans to undertake—does not meaningfully increase the risk of enforcement. See Davis

v. Colerain Township, 51 F.4th 164, 174 (6th Cir. 2022). But where a defendant refuses to 

disavow enforcement “against a particular plaintiff” with respect to the plaintiff’s specific 

conduct, our precedent treats enforcement as more credible. McKay, 823 F.3d at 869. 

Defendants have not disavowed enforcement against the specific conduct that the 

Plaintiffs allege they want to undertake, contending that disavowal is impossible because the 

“religious freedom inquiry” is “fact dependent.” It is indeed unrealistic to expect a defendant to 

disavow a law’s enforcement as applied to “fluid and future facts” that are unclear at this time. 

Hoye v. City of Oakland, 653 F.3d 835, 859 (9th Cir. 2011). By contrast, refusing to disavow is 

less understandable—and enforcement more credible—where there is not “a single additional 

fact that would be required to adjudicate the present action.” Braidwood Mgmt. v. EEOC, 70 

F.4th 914, 929 (5th Cir. 2023). We turn now to applying these rules to each Plaintiff’s specific 

claims. 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 24

e. Evaluating Plaintiffs’ Claims

Because a plaintiff must plausibly assert standing “for each claim he presses and each 

statutory provision he challenges,” Oklahoma, 62 F.4th at 233, we evaluate Plaintiffs’ claims 

independently, starting with Christian Healthcare and Sacred Heart’s challenges to the Attorney 

General’s potential enforcement of the EAA. Neither Plaintiff has alleged a single fact about the 

Attorney General’s enforcement of the EAA, let alone her enforcement as applied to 

discrimination based on sexual orientation or gender identity. No warning letter has been issued 

to either Plaintiff regarding the law. The Attorney General also has disavowed ever threatening 

anyone with a criminal action under the EAA, and she could find no caselaw showing that any of 

her predecessors has ever brought a criminal prosecution under this law. Unlike the ELCRA, the 

EAA also contains no citizen-complaint provision raising the likelihood of enforcement. And 

although Michigan’s Attorney General has declined to disavow the EAA’s enforcement, she has 

publicly opined that the EAA is “not applicable to Sacred Heart” because the law’s text 

specifically covers only “public educational institutions” rather than private ones. Mich. Comp. 

Laws § 750.146. And she has found it “unclear” whether the EAA covers Christian Healthcare 

because the law also does not specifically mention medical facilities. At day’s end, “some 

combination” of the McKay factors are typically required to demonstrate a credible threat of 

enforcement. Online Merchs., 995 F.3d at 550 (quoting McKay, 823 F.3d at 869); see also 

Davis, 51 F.4th at 174 (noting that refusal to disavow is “just one data point among many on the 

question whether a credible threat of enforcement exists”). The “factual circumstances” here are 

not sufficient to “show that a fear of prosecution” under the EAA “is plausible.” Nabors, 35 

F.4th at 1034. Accordingly, we affirm the district court’s dismissal of Christian Healthcare’s and 

Sacred Heart’s EAA claims.

The ELCRA analysis is more nuanced. Plaintiffs’ pleadings and briefing reveal 

Defendants’ failure to disavow enforcement, some enforcement history, and a key statutory 

aspect—the citizen-complaint provision—making enforcement more credible. On the other 

hand, there have been no warning letters issued to Plaintiffs or allegations that the Department 

has previously enforced the ELCRA against Plaintiffs’ specific conduct. With factors pointing 

both directions, the question of Plaintiffs’ standing to challenge the ELCRA appears close.
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 25

Plaintiffs disagree, asking us to jettison the fact-bound approach embodied by the McKay 

factors and to instead assume a credible threat of enforcement through an “enforcement 

presumption.” We have, however, repeatedly and recently applied McKay in pre-enforcement 

challenges—it is settled circuit law. See, e.g., Kareem v. Cuyahoga Cnty. Bd. of Elections, 

95 F.4th 1019, 1022–23 (6th Cir. 2024); Fischer, 52 F.4th at 307; Online Merchs., 995 F.3d at 

550. McKay, moreover, was drawn from the Supreme Court’s language in Driehaus, which 

relied on a fact-intensive analysis that established the factors we consider. See Driehaus, 573 

U.S. at 164–65. The McKay factors properly apply here.

In these cases, “applying the law of standing cannot be made easy.” FDA v. All. for 

Hippocratic Med., 602 U.S. 367, 384 (2024). They are particularly difficult because Plaintiffs’ 

pleadings indicate that Defendants generally do not initiate ELCRA enforcement actions on their 

own; the Department instead responds to citizen complaints. Thus, enforcement credibility 

hinges on the answers to two questions: (1) How likely is anyone to file a complaint against a 

Plaintiff for its conduct, and (2) if such a complaint were filed, what is the likelihood that 

Defendants’ actions in response would cause a cognizable injury? We turn to the specific claims 

in each case.

Christian Healthcare

Christian Healthcare asserts standing to challenge potential enforcement of the ELCRA’s 

public-accommodation provision, employment provision, and the publication clauses of each. 

Assessing the likelihood of a complaint based on Christian Healthcare’s pronoun, hormone, and 

employment policies, or the publication of those policies, is challenging, and best undertaken 

“by comparing the allegations of the particular complaint to those made in prior standing cases.” 

All. for Hippocratic Med., 602 U.S. at 384 (quoting Allen v. Wright, 468 U.S. 737, 751–52 

(1984)). 

The Supreme Court has stated its “reluctance to endorse standing theories that rest on 

speculation about the decisions of independent actors.” Clapper, 568 U.S. at 414. Where 

standing turns on the actions of a non-governmental third party—here, a citizen filing a 

complaint alleging discrimination that would, in turn, initiate the ELCRA investigatory 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 26

process—the plaintiff must show that the third party will likely act “in predictable ways.” All. 

for Hippocratic Med., 602 U.S. at 383 (quoting California v. Texas, 593 U.S. 659, 675 (2021)). 

A similar question regarding third-party behavior was presented in a case involving a wedding 

website designer’s standing to challenge Colorado’s antidiscrimination law. See 303 Creative 

LLC v. Elenis, 6 F.4th 1160, 1173–75 (10th Cir. 2021), rev’d on other grounds, 600 U.S. 570 

(2023). In 303 Creative, the plaintiff intended to personally design custom wedding websites but 

did not want to offer her design services for same-sex weddings. Id. at 1169–70. Relying on the 

typical reluctance of courts to assume facts regarding third-party conduct, Colorado argued that 

standing was precluded because it required “guesswork” regarding whether a gay couple would 

actually seek the plaintiff’s services and then “file a charge of discrimination” through the 

statute’s citizen-complaint provision. See id. at 1173 (cleaned up). The Tenth Circuit rejected 

that position, finding it not “imaginary or speculative” that a complaint (and enforcement) would 

result from the plaintiff’s proposed conduct. Id. (quoting Driehaus, 573 U.S. at 165). Although 

the Supreme Court did not provide a fulsome standing analysis, it accepted the Tenth Circuit’s 

conclusions on that issue. See 303 Creative, 600 U.S. at 581–83.

The analysis of 303 Creative indicates that where an entity (a) broadcasts to the public 

speech or conduct that is arguably proscribed by a state antidiscrimination law, (b) any member 

of the public can file a complaint, and (c) factual circumstances do not otherwise indicate that a 

complaint is unlikely, it is plausible that a complaint will be filed regarding the publicized speech 

or conduct. 

Applying that framework, Christian Healthcare has alleged an intention to arguably 

violate the ELCRA’s public-accommodation provision by stating on its website that it will not 

use preferred pronouns or provide hormones to facilitate gender transition. It is at least plausible 

that an “aggrieved” person, Mich. Admin. Code R. 37.4, would file a complaint stating that the 

public-accommodation publication provision had been violated because Christian Healthcare had 

“post[ed] . . . a statement” indicating that its full “services” and “privileges” would not be 

provided to a transgender patient. Mich. Comp. Laws § 37.2302(b). And it is also plausible that 

such a person would ask Christian Healthcare to confirm that it would not offer hormones to 

facilitate gender transition or use preferred pronouns—and then, upon confirmation, file a 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 27

complaint alleging they had been denied service. Id. § 37.2302(a). In fact, Christian 

Healthcare’s complaint suggests that it “has served and currently serves patients who identify as 

transgender.” And the complaint adds that it has not used these patients’ preferred pronouns, 

instead calling them by “their preferred first or last names.” Put into the language of the 

governing standards, it is plausible that Christian Healthcare would face a complaint related to 

its conduct that arguably violates the substantive and publication clauses of the ELCRA’s 

public-accommodation provisions. Id. § 37.2302.

As for its challenge to the ELCRA’s employment provision and the publication clause of 

that provision, Christian Healthcare has averred that absent the ELCRA, it would “immediately 

begin publicizing” its Biblical Counselor position, which was open when Christian Healthcare 

filed its complaint. It alleges such publication would state that any prospective employee would 

have to be “in full agreement with” the Statement of Faith’s assertions regarding, among other 

things, the immutability of sex and disapproval of same-sex activity and relationships. Christian 

Healthcare has further alleged an intent to solicit applications online for “un-posted positions” 

with a link to its Employment Application—which, in turn, requires applicants to state whether 

they agree with the Statement of Faith. An aggrieved person could plausibly file a complaint that 

each posting “indicates a preference,” “elicits or attempts to elicit information,” and “expresses a 

preference” based on sexual orientation and gender identity. Mich. Comp. Laws § 37.2206(1), 

(2)(a), (2)(c). And if Christian Healthcare informed a potential applicant that it intended to 

enforce its requirements for a position related to sexual orientation and gender identity, it is 

plausible that the person would file a complaint alleging that she had been discriminated against 

“with respect to employment” because of those characteristics. Id. § 37.2202(1)(a). 

303 Creative’s reasoning, however, does not support the plausibility of a complaint 

resulting from several of Christian Healthcare’s other activities. For instance, because 

requirements for currently filled positions are not communicated to the public, the only people 

who could be aggrieved by those requirements are persons serving in the positions. Christian 

Healthcare has not alleged that any employee belongs to a category—as a non-Christian, gay 

person, or transgender individual—to which Christian Healthcare’s relevant preferences apply, 

has ever indicated any intent to engage in conduct proscribed by Christian Healthcare’s 
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employment rules, or has ever complained about those rules. Similarly, although the 

Membership Agreement and Employment Application express religious preferences to the 

public, Christian Healthcare states that the documents were posted on its website until recently 

without complaint—even though the ELCRA has always prohibited religious-based 

discrimination. Hypothesizing that a current employee would complain about employment rules, 

or that anyone would complain that Christian Healthcare has engaged in religious discrimination, 

would require too much “speculation about . . . third parties” acting contrary to past practice. 

See Dep’t of Com. v. New York, 588 U.S. 752, 768 (2019). Where no one has ever complained 

about Christian Healthcare’s religious discrimination and no employee has suggested discomfort 

with employment rules, the “factual circumstances” suggest that a complaint on these bases is 

exceedingly unlikely. Nabors, 35 F.4th at 1034. Drawing on “judicial experience and common 

sense,” we decline to theorize a complaint regarding these activities. Ashcroft v. Iqbal, 556 U.S. 

662, 679 (2009).

Turning to the likelihood of injury in the event a complaint is submitted, Defendants have 

not disavowed enforcement of any potential complaint alleging discrimination based on 

Christian Healthcare’s activities. The Department’s position that it lacks sufficient facts to 

disavow enforcement as to Christian Healthcare’s proposal to solicit applications for “un-posted” 

positions is appropriate. As our precedent emphasizes, government officials are not required to 

disavow enforcement of statutes “in the abstract.” Davis, 51 F.4th at 174. The Department’s 

unwillingness to do so regarding unspecified employment roles does not suggest a credible threat 

of enforcement.

In contrast, because Christian Healthcare has amply described their pronoun and hormone 

policies, requirements for the Biblical Counselor position, and the proposed communications 

about each item, there do not appear to be any “additional fact[s] that would be required to 

adjudicate” the Department’s response to a complaint related to these activities. Braidwood 

Mgmt., 70 F.4th at 929. Nor have Defendants provided sufficient details concerning the 

ELCRA’s enforcement to determine that the statutory process reduces the risk of injury. For 

example, it is unclear exactly what, if any, standards Michigan applies to determine whether 

a person was “aggrieved by unlawful discrimination” such that she could submit a complaint. 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 29

See Mich. Admin. Code R. 37.4(1). The Department has not clarified where or how it considers 

defenses—including constitutional defenses—in its investigative and adjudicatory process, or 

how it would view a respondent’s assertion of a constitutional right to not participate in an 

investigation. See Seattle Pac. Univ., 104 F.4th at 57–58. And a charge’s issuance upon 

“sufficient grounds,” Mich. Admin. Code R. 37.6(1), does not provide clear guidance regarding 

what conduct qualifies. 

Discovery has not yet commenced, and our conclusions regarding standing “would have 

little bearing on the question of standing if a more developed factual record” casts doubt on 

whether Christian Healthcare “faces a credible threat of enforcement.” Emilee Carpenter, LLC 

v. James, 107 F.4th 92, 99 (2d Cir. 2024). But at this pleading stage, it is plausible that a 

complaint would lead to a cognizable injury. Christian Healthcare has thus established standing 

to challenge the ELCRA’s public-accommodation provision, employment provision, and the 

publication clauses of each provision.

Finally, because we find that Christian Healthcare has established standing, we deny as 

moot its appeal of the district court’s denials of its motion for reconsideration and to supplement 

the record on reconsideration. 

Sacred Heart

The credible threat analysis is substantially similar for Sacred Heart. Relevant to Sacred 

Heart’s challenges to the ELCRA’s public-accommodation provision, education provision, and 

the publication clauses of each, it has alleged that (a) it will not affirm transgender students’ 

preferred pronouns, (b) it separates “houses,” restrooms, uniforms, and sports teams by 

biological sex at birth, and (c) but for the ELCRA, it would post a statement on its website 

stating that “a person’s sexual identity is determined at conception” and that the school does not 

support sexuality outside of opposite-sex relationships. Through these allegations, Sacred Heart 

has sufficiently asserted its intent to publicize speech and conduct to the public that are arguably 

proscribed by the gender and sexual-orientation clauses of the ELCRA’s public accommodation 

and education provisions. See Mich. Comp. Laws §§ 37.2302, 37.2402. It is plausible that a 

member of the public would file a complaint with the Department regarding Sacred Heart’s 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 30

activities. Indeed, Sacred Heart has alleged that it has students with gender dysphoria. And 

given Defendants’ choice not to disavow enforcement or otherwise indicate how they would 

view such a complaint, it is credible that enforcement would follow.

For its challenge to the ELCRA’s employment provision and the publication clause of 

that provision, Sacred Heart has alleged that it seeks to hire an art teacher and an athletic coach, 

and that but for the ELCRA, it would post advertisements for the positions stating that any 

applicant must be willing to sign the Faculty Memorandum of Understanding and Oath of 

Fidelity. These documents require applicants to agree not to encourage same-sex sexual activity, 

same-sex relationships, or transgender-related behavior and activity. Taken together, Sacred 

Heart has sufficiently alleged an intent to publicly post speech and employment policies arguably 

proscribed by the gender and sexual-orientation clauses of the ELCRA’s employment provision 

and that provision’s publication clause. See Mich. Comp. Laws §§ 37.2202, 37.2206. Based on 

the ELCRA’s citizen-complaint provision and Defendants’ refusal to disavow enforcement, 

Sacred Heart plausibly faces a credible threat of enforcement.3 In sum, Sacred Heart has 

established standing to challenge the ELCRA’s public accommodation, employment, and 

education provisions, and the publication clauses of each provision. 

St. Joseph

St. Joseph challenges the ELCRA’s public accommodation, employment, and education 

provisions, as well as the publication clauses of each provision. It alleges an intent to engage in 

conduct that, as described above, is arguably proscribed by the ELCRA’s prohibitions of 

discrimination based on gender identity or sexual orientation. For instance, it teaches that 

students must use pronouns that align with biological sex at birth, requires students to follow 

sex-specific uniform, sports team, and other policies, and expects the public to use its facilities in 

accordance with birth sex. And St. Joseph alleges that the “moral teachings” with which 

3For the same reasons as Christian Healthcare, Sacred Heart has not plausibly shown that any current 

employee would complain about its employment practices, or that anyone would complain about its publications 

regarding religious practice. It therefore has not established standing through these pleaded activities. See Dep’t of 

Com., 588 U.S. at 768.
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 31

teachers and volunteers must agree include “the Church’s teaching on gender, sexuality, and 

marriage between one man and one woman.” 

St. Joseph, however, has not alleged that it intends to communicate or currently 

communicates its beliefs or policies regarding gender identity or sexual orientation to the public. 

For example, although St. Joseph has explained its “expectation” that the public will use its 

spaces in accordance with biological sex at birth, it has not alleged that its sex-specific rules are 

ever communicated outwardly. Similarly, although St. Joseph alleges that “moral teachings” in 

the Code of Conduct given to teachers and volunteers include teachings regarding gender 

identity and sexual orientation, the Code does not reference these items. 

Without an allegation that its policies regarding gender identity and sexual orientation are 

ever publicly communicated, members of the public would be unaware of St. Joseph’s policies 

that arguably discriminate on those bases. Perhaps St. Joseph’s teachers, students, and parents 

may learn about these policies when the school “teaches and practices” differences in biological 

sex—although St. Joseph has been vague about exactly how this occurs. See Spokeo, Inc. 

v. Robins, 578 U.S. 330, 338 (2016) (noting that it is the plaintiff’s burden to “clearly . . . allege 

facts demonstrating” standing (internal citation omitted)). Unlike Christian Health and Sacred 

Heart, however, St. Joseph makes no allegation that it has ever provided any services to 

transgender individuals or individuals with gender dysphoria. In fact, St. Joseph has not alleged 

that any teacher, student, or parent (a) is either gay or transgender, (b) intends to participate in 

conduct proscribed by St. Joseph’s beliefs and policies, or (c) has ever complained about those 

policies. Absent such allegations, any ELCRA complaint based on these categories is too 

hypothetical to support St. Joseph’s standing.

St. Joseph has also alleged that it intends to publicly communicate its religious 

preferences through (1) a job posting requiring any applicant to be a practicing Catholic, and 

(2) the Code of Conduct, which requires signatories to align their behavior with the Catholic 

Church. But these precise religious beliefs have been communicated in the past without drawing 

any kind of inquiry, let alone an ELCRA complaint. Given that the ELCRA has always 

prohibited religion-based discrimination, there is no plausible explanation as to why documents 

that have not drawn a complaint of religious discrimination in the past would suddenly draw one 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 32

in the future. St. Joseph’s entire case, moreover, is directed at the amended ELCRA’s provisions 

regarding sexual orientation and gender identity—not the law’s longstanding prohibition on 

religious discrimination. 

In sum, St. Joseph’s pleadings and briefing do not establish the necessary factual 

predicate to plausibly conclude that anyone would file a complaint regarding its proposed speech 

and conduct. Because there is also no plausible threat that Defendants will enforce the ELCRA 

absent a complaint, we affirm the dismissal of St. Joseph’s case.

B. Injunctive Relief

Because the district court dismissed Christian Healthcare’s and Sacred Heart’s cases for 

lack of standing, it was not empowered to consider the entry of injunctive relief. See State ex rel. 

Tenn. Gen. Assembly, 931 F.3d at 519. Christian Healthcare and Sacred Heart nonetheless ask 

this court to enter that relief before remanding the cases. We are, however, “a court of review, 

not first view.” Taylor v. City of Saginaw, 11 F.4th 483, 489 (6th Cir. 2021) (quoting United 

States v. Houston, 792 F.3d 663, 669 (6th Cir. 2015)). In line with that principle, we “generally 

‘cannot consider an issue not passed on below.’” St. Marys Foundry, Inc. v. Emps. Ins. of 

Wausau, 332 F.3d 989, 995 (6th Cir. 2003) (quoting Hormel v. Helvering, 312 U.S. 552, 556 

(1941)). 

It is appropriate to permit the district court to balance the relevant injunction factors—

likelihood of success on the merits, danger of irreparable harm, balance of the equities, and the 

public interest—in the first instance. See James B. Oswald Co. v. Neate, 98 F.4th 666, 672 

(6th Cir. 2024). Evaluation of the cases’ merits will require a thoughtful and detailed analysis 

that may differ by Plaintiff and by claim. Cf. Emilee Carpenter, 107 F.4th at 99–101, 107–13 

(rejecting the defendants’ motion to dismiss a plaintiff’s free speech claim, but granting the 

motion to dismiss free association, free exercise of religion, establishment clause, vagueness, and 

overbreadth claims). The district court will also need to determine whether each Plaintiff has 

made the “‘clear showing’ that [it] is ‘likely’ to establish each element of standing” necessary to 

receive a preliminary injunction, Murthy v. Missouri, 144 S. Ct. 1972, 1986 (2024) (quoting 

Winter v. Nat. Res. Def. Council, Inc., 555 U.S. 7, 22 (2008))—a higher threshold than the one 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 33

applicable at the pleading stage. And balancing the injunction factors is a task we are better 

equipped to review than perform. See Platt, 769 F.3d at 453–54 (discussing the discretion 

afforded to a district court’s weighing of the injunction factors).

In remanding the motions, we emphasize that although the district court stated in 

footnotes that it would have rejected Christian Healthcare’s and Sacred Heart’s injunction 

motions had it reached them, that conditional conclusion does not constitute law of the case 

because the court dismissed the cases for want of standing. See State ex rel. Tenn. Gen. 

Assembly, 931 F.3d at 519. Starting from a clean slate, the district court should undertake a full 

analysis of Plaintiffs’ motions for injunctive relief.

III. CONCLUSION

“As important as the question[s] we decide today are ones we do not.” Harrington 

v. Purdue Pharma L.P., 144 S. Ct. 2071, 2087 (2024). We express no view regarding the merits 

of any claim, the appropriate resolution on remand of the motions for preliminary relief, or what 

conclusions might be warranted concerning any issue after discovery. We hold only that (a) no 

Plaintiff has established standing to challenge the EAA, (b) Christian Healthcare has plausibly 

established standing to challenge the ELCRA’s public-accommodation provision, employment 

provision, and the publication clauses of each provision, (c) Sacred Heart has plausibly 

established standing to challenge the same provisions, the ELCRA’s education provision, and the 

publication clause of that provision, and (d) St. Joseph has failed to plausibly establish standing. 

The district court’s orders are AFFIRMED IN PART, REVERSED IN PART, AND 

REMANDED for further proceedings consistent with this opinion. 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 34

_________________

CONCURRENCE

_________________

MURPHY, Circuit Judge, concurring. I agree that we should reverse in part because 

Christian Healthcare Centers and Sacred Heart of Jesus Parish have alleged enough in their 

complaints to plead their standing under Article III of the Constitution. I write to flag a 

distinction between this standing question and a merits question that the parties must eventually 

confront.

Christian Healthcare and Sacred Heart seek to engage in specific activities and speech, 

but they fear that the Michigan Department of Civil Rights will find that these activities and 

speech violate Michigan’s Elliott-Larsen Civil Rights Act (ELCRA). Christian Healthcare, a 

faith-based medical provider, will not refer to transgender patients by the pronouns associated 

with their gender identities and instead seeks to use the patients’ “preferred first or last names.” 

Christian Healthcare Compl., R.1, PageID 51–52. Christian Healthcare also refuses to offer 

treatment to help patients “transition to the opposite biological sex[.]” Id., PageID 52. And it 

seeks to fill an open Biblical Counselor position using hiring criteria that require applicants to 

abide by religiously motivated standards of conduct. Id., PageID 23–24, 55. Lastly, Christian 

Healthcare seeks to post its Membership Agreement and Employment Application online. Id., 

PageID 11, 49, 54–55.

Sacred Heart, a parish-run school, does not want to “affirm” the gender identity of 

students and staff if that identity conflicts with their biological sex. Sacred Heart Compl., R.1, 

PageID 16. So it will not use “‘preferred pronouns’ inconsistent with biological sex[.]” Id. It 

also separates its students based on biological sex for such things as restroom usage and sports 

participation. Id., PageID 15–16. Sacred Heart next seeks to fill specific positions (an art 

teacher and athletic coach) using religiously motivated hiring criteria. Id., PageID 37–38, 49. 

And it seeks to post certain statements on its website about its faith-based rules for students and 

staff. Id., PageID 38, 43.
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 35

Christian Healthcare and Sacred Heart sued to eliminate the uncertainty over whether the 

Department may lawfully enforce the challenged provisions of ELCRA against their specifically 

proposed conduct and speech. They sought both a declaratory judgment that the feared 

enforcement would violate the First and Fourteenth Amendments and an injunction barring this 

enforcement. We now hold that they have plausibly alleged their standing to raise these claims.

Yet the parties should not overread this holding. To establish standing to raise a 

constitutional challenge to a law’s enforcement, litigants need only show that the law “arguably” 

prohibits their “intended future conduct[.]” Susan B. Anthony List v. Driehaus, 573 U.S. 149, 

162 (2014) (emphasis added) (quoting Babbitt v. United Farm Workers Nat’l Union, 442 U.S. 

289, 298 (1979)). In my view, the Department’s refusal to disclose its position on how ELCRA 

applies to the specifically alleged conduct and speech goes a long way toward meeting this 

requirement. As my colleagues note, the Department has not identified “a single additional fact 

that would be required” for it to take a position on whether ELCRA applies to the specific 

conduct and speech. Braidwood Mgmt. v. EEOC, 70 F.4th 914, 929 (5th Cir. 2023). Yet I find 

its current position vague and contradictory. The Department asserts that Christian Healthcare’s 

and Sacred Heart’s proposed activities do not even arguably fall within ELCRA, but it then 

refuses to say that it will not enforce the law against the same activities. If the conduct and 

speech do not even arguably fall within the law, how could the Department in good faith try to 

enforce the law against that conduct and speech? Given that these cases remain at the pleading 

stage, I would resolve this Department-created uncertainty in the light most favorable to the 

plaintiffs’ standing. See Universal Life Church Monastery Storehouse v. Nabors, 35 F.4th 1021, 

1031 (6th Cir. 2022). Again, though, we decide only that ELCRA arguably prohibits Christian 

Healthcare’s and Sacred Heart’s proposed activities—not that it does prohibit those activities. 

And I see many arguments as to why ELCRA permits them.

That fact leaves an order-of-operations question unclear. After a court finds that a party 

has standing to pursue a constitutional challenge because a state law arguably covers its conduct, 

when (and how) should the court decide whether the law actually covers the conduct? I would 

think federal courts must reach this state-law question as part of the merits analysis. The courts 

should not resolve a significant constitutional question about whether a state official may enforce 
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 36

a state law against certain conduct based on the mere assumption that the state law applies to that 

conduct. See Virginia v. Am. Booksellers Ass’n, 484 U.S. 383, 393 (1988). Rather, basic 

principles of constitutional avoidance suggest that the state statutory question should come 

before the federal constitutional question. See Braidwood, 70 F.4th at 940 n.60; see also Nw. 

Austin Mun. Util. Dist. No. One v. Holder, 557 U.S. 193, 205 (2009). Indeed, even if both 

parties agree on the statutory question, I have suggested that courts have discretion to reject such 

stipulations about the meaning of a law. See Calcutt v. FDIC, 37 F.4th 293, 339 (6th Cir. 2022) 

(Murphy, J., dissenting).

But who “wins” if the district court finds that Christian Healthcare’s and Sacred Heart’s 

proposed conduct and speech fall outside ELCRA? I see two possible scenarios. On the one 

hand, plaintiffs often argue in the alternative that a statute does not apply to their conduct and 

that, if the statute does apply, its enforcement would violate the Constitution. See, e.g.,

Braidwood, 70 F.4th at 921. This strategy gives them “two shots” at achieving their end goal. 

Cf. Jeffrey S. Sutton, 51 Imperfect Solutions 7–8 (2018). An injunction against enforcement of a 

law on statutory grounds or on constitutional grounds will give plaintiffs the same relief—just 

under different legal theories. And the declaratory remedy exists just as much to allow courts to 

resolve questions about the meaning of a statute as it does to resolve questions about the meaning 

of the Constitution. See MedImmune, Inc. v. Genetech, Inc., 549 U.S. 118, 126–30, 135–36 

(2007); Edwin Borchard, Declaratory Judgments 341–49 (1934). That is why the Fifth Circuit 

could resolve a somewhat similar suit against a federal agency’s enforcement of a federal law 

without reaching any constitutional questions. See Braidwood, 70 F.4th at 940 n.60. Here, 

however, Christian Healthcare and Sacred Heart seem to assert only constitutional claims—not 

alternative claims that the state law does not even reach their conduct. Perhaps this choice 

follows from looming sovereign-immunity issues over whether a federal court may enjoin state 

officials (or even issue declaratory relief against them) on state-law grounds. See Pennhurst 

State Sch. & Hosp. v. Halderman, 465 U.S. 89, 106 (1984); Williams ex rel. J.E. v. Reeves, 954 

F.3d 729, 739–41 (5th Cir. 2020); Benning v. Bd. of Regents of Regency Univs., 928 F.2d 775, 

778 (7th Cir. 1991); but cf. Maryville Baptist Church, Inc. v. Beshear, 957 F.3d 610, 612–14 (6th 

Cir. 2020) (per curiam).
No. 23-1769/1781/1860 Christian Healthcare Ctrs., et al. v. Nessel, et al. Page 37

On the other hand, government officials sometimes defend against constitutional 

challenges on the ground that a challenged law does not cover the plaintiffs’ conduct. See Am. 

Booksellers Ass’n, 484 U.S. at 393–97; Majors v. Abell, 317 F.3d 719, 723 (7th Cir. 2003). If 

true, the plaintiffs’ constitutional claims would seemingly fail not because their constitutional 

theories lack merit but because the relevant statute does not reach their conduct. So there is 

nothing to enjoin or declare illegal. In some sense, then, that litigation loss might qualify as a 

real-world win for the plaintiffs too. The law is not enjoined. But it also does not apply to the 

conduct that they want to undertake. Cf. Friends of George’s, Inc. v. Mulroy, 108 F.4th 431, 

435–37 (6th Cir. 2024).

At day’s end, it seems to me that courts must somehow decide this state-law question 

ahead of the federal constitutional one. The Department, Christian Healthcare, and Sacred Heart 

thus must at some point disclose their positions on the actual (not just arguable) meaning of 

ELCRA.