The Department of Health and Human Services on Friday proposed to remove gender identity from the class of protected persons in federal nondiscrimination protections in healthcare, rolling back Obama-era protections for transgender patients.

The agency said that new regulations would uphold protections against healthcare discrimination on the basis of sex, race, disability, and age.

Roger Severino, the director of the Office for Civil Rights at the department, said the agency’s tradition of protecting all groups against discrimination and substandard healthcare was “unwavering."

Severino declined to say directly whether the new proposed rule would allow providers to deny care to transgender patients.

"We haven't seen that happen in real life," he said when asked by reporters whether emergency medical providers would be allowed to deny care to people who are transgender.

Severino said certain emergency rooms are covered by the Emergency Medical Treatment and Labor Act, which ensures public access to emergency care. The law mandates that every patient who enters the ER will be stabilized, and the proposed rule does not preempt the federal law, "so I really would not see a conflict," he said.

A portion of Obamacare, Section 1557 , protects against discrimination based on race, color, national origin, disability, and age. The Obama-era rules added protections based on pregnancy, gender identity, and sex stereotyping.

The Obama administration stopped short of specifying whether the rule would force health insurers to pick up the tab for gender transition surgery, or whether doctors would be required to provide it. Instead, the rule allowed people to file civil rights complaints if they believe that they have been treated unfairly, though it doesn't specify whether or not covering specific treatments or procedures would qualify as discrimination.

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The rule stipulated that doctors weren't allowed to deny care to someone on the grounds that the way they act or dress differed from what would be expected. It said that if insurers who receive government funding covered a procedure or treatment for one patient, then they had to cover it for another. If an insurer were to cover a hysterectomy, or removal of the uterus, to treat ovarian cancer for a female patient, then they would need to do the same for a transgender man.

Soon after the rule came out, Christian healthcare groups who said they would be forced to provide gender transition care filed lawsuits. Federal Judge Reed O'Connor, a President George W. Bush nominee, agreed with the plaintiffs, and the Trump administration has said it has to revisit the Obama-era rules because of that decision.

“We are announcing with this proposal that [gender identity] is not included in the definition of ‘on the basis of sex,’” Severino said Friday. “That is the position of HHS, that is the position of the Department of Justice.”

Critics blasted Department of Health and Human Services officials in response to the announcement.

“Transgender and non-binary people experience staggering rates of discrimination from healthcare institutions and providers," Louise Melling, deputy legal director with the American Civil Liberties Union, said in a statement. "They face the denial of medically necessary health care related to gender transition, harassment from medical providers, negligent care, and the refusal of medical service altogether."

Kimberly Leonard contributed.