The Fifth Circuit Court of Appeals heard arguments Thursday in a lawsuit brought by nearly 20,000 religious physicians challenging the Department of Health and Human Services rule they say requires doctors to perform gender transition procedures against their conscience.

President Joe Biden‘s administration is seeking the federal appeals court to lift a lower court order that protected Christian doctors from having to perform gender transition treatment under the Affordable Care Act. The administration contends the court order, which applies solely to the Christian medical group behind a 2016 lawsuit, is contestable because the rule they initially challenged is no longer in effect.