Document ID: ./input/supremecourt_opinions/opinions/19pdf/17-1618_hfci.pdf
Page Number: 88.0

Cite as:  590 U. S. ____ (2020) 

51 

ALITO, J., dissenting 

Such claims present difficult religious liberty issues be-
cause  some  employers  and  healthcare  providers  have 
strong religious objections to sex reassignment procedures, 
and therefore requiring them to pay for or to perform these
procedures  will  have  a  severe  impact  on  their  ability  to 
honor their deeply held religious beliefs.
  Freedom of speech.  The Court’s decision may even affect 
the  way  employers  address  their  employees  and  the  way 
teachers  and  school  officials  address  students.    Under  es-
tablished  English  usage,  two  sets  of  sex-specific  singular 
personal pronouns are used to refer to someone in the third
person  (he, him,  and  his  for  males;  she,  her,  and  hers  for 
females).  But several different sets of gender-neutral pro-
nouns have now been created and are preferred by some in-
dividuals  who  do  not  identify  as  falling  into  either  of  the 
two  traditional  categories.58   Some  jurisdictions,  such  as 

—————— 
claims  of  discrimination  under  ACA,  Title  IX,  and  Equal  Protection
Clause);  Tovar  v.  Essentia  Health,  342  F.  Supp.  3d  947,  952–954  (D 
Minn. 2018) (allowing ACA claim).

Section 1557 of the ACA, 42 U. S. C. §18116, provides: 
“Except as otherwise provided for in this title (or an amendment made
by this title), an individual shall not, on the ground prohibited under title
VI of the Civil Rights Act of 1964 (42 U. S. C. 2000d et seq.), title IX of
the Education Amendments of 1972 (20 U. S. C. 1681 et seq.), the Age 
Discrimination  Act  of  1975  (42  U. S. C.  6101  et  seq.),  or  section  794  of 
title 29, be excluded from participation in, be denied the benefits of, or
be subjected to discrimination under, any health program or activity, any
part of which is receiving Federal financial assistance, including credits,
subsidies,  or  contracts  of  insurance,  or  under  any  program  or  activity 
that is administered by an Executive Agency or any entity established 
under  this  title  (or  amendments).    The  enforcement  mechanisms  pro-
vided for and available under such title VI, title IX, section 794, or such 
Age Discrimination Act shall apply for purposes of violations of this sub-
section.”  (Footnote omitted.) 

58 See, e.g., University of Wisconsin Milwaukee Lesbian, Gay, Bisexual, 
Transgender, Queer Plus (LGBTQ+) Resource Center, Gender Pronouns
(2020), https://uwm.edu/lgbtrc/support/gender-pronouns/ (listing six new
categories of pronouns: (f )ae, (f )aer, (f )aers; e/ey, em, eir, eirs; per, pers;