In 2020, the U.S. Supreme Court held in Bostock v. Clayton County that anyone who works at or applies for a job with an employer that has at least 15 employees is protected under federal law against employment discrimination based on sexual orientation or gender identity because such discrimination is on the basis of sex. In May 2021, HHS said it would interpret Section 1557 as extending to sexual orientation and gender identify. Two doctors represented by the America First Legal Foundation filed a putative class action challenging that interpretation. On November 11, 2022, in Neese v. Becerra, the Northern District of Texas held that Bostock does not apply to Section 1557 of the Affordable Care Act, which bars healthcare providers from discriminating on the basis of sex. U.S. District Judge Matthew Kacsmaryk granted summary judgment in the doctors’ favor.