The Trump administration has proposed a new rule that would roll back sex discrimination protection for transgender people in health services.

In the proposed rule issued on Friday, the United States Health and Human Services Department (HHS) said laws banning sex discrimination in healthcare don’t apply to people’s “gender identity”. LGBT groups have long warned that such a move could lead to denial of needed medical care.

It is the second rule this month the agency has put forward to allow healthcare providers to deny services to them.

The landmark Affordable Care Act, also known as Obamacare, passed during the administration for Barack Obama. It extended civil rights protections in healthcare to gender identity and the termination of a pregnancy. The agency’s Office of Civil Rights said it posted a proposed rule to roll back those provisions of the law.

“When Congress prohibited sex discrimination, it did so according to the plain meaning of the term, and we are making our regulations conform,” Roger Severino, head of the Office of Civil Rights, said on a call with reporters.

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HHS said it has not enforced the protections since December 2016 after a federal court found they conflicted with a separate existing law.

Typically after HHS proposes a rule, there is a 60-day comment period before the measure is finalized.

‘Conscience rule’

Earlier this month, the Office of Civil Rights released a final “conscience rule” allowing doctors, nurses and other healthcare workers to opt out of participating in or referring procedures with which they disagree, such as abortions, sterilisations and the treatment of gay and transgender patients. The administration of President Donald Trump, including HHS, has also sought to restrict access to abortion.

LGBT advocacy groups and Democratic-controlled states have decried the Trump administration’s efforts to erode protections for lesbian, gay, bisexual, transgender and queer citizens.

“This move by the Trump administration is nothing less than an act of violence against those whose healthcare needs have historically been ignored, neglected, and dismissed,” Louise Melling, deputy legal director of the American Civil Liberties Union, said in a statement.

Two dozen US states and municipalities sued the Trump administration earlier this week to stop the enforcement of the rule, which is almost certain to be challenged in court.

Severino, of the civil rights office, said the agency will still enforce civil rights protections on the basis of race, colour, national origin, disability, age, and sex.