In response to the Biden administration's new rule interpreting the prohibition on sex discrimination under Section 1557 of the Affordable Care Act to include "gender identity," Terry Schilling, the president of American Principles Project (APP), expressed strong opposition. Schilling slammed the move, stating, "Just days after the Biden administration gutted protections for women and girls in Title IX, they have now moved to inject radical gender ideology into hospitals and medical centers nationwide."

Schilling continued by highlighting the potential consequences of the rule, stating, "Healthcare providers will be forced to provide sex-change drugs and surgeries to all comers, including minors, or be forced out of business. Insurers will be compelled to cover these practices. And individual doctors, nurses, and other practitioners will be pressured to facilitate sex changes or else risk career-ending lawsuits, even if it goes against their conscience and best medical judgment."

Furthermore, Schilling criticized the rule as an invasion of politics into medicine, emphasizing the prioritization of ideology over science and biology. He expressed concern over the impact of the transgender industry on individuals, including children, and called for Democrats to be held accountable for these policies. Schilling highlighted the importance of addressing this issue in the upcoming elections and urged Republicans to combat what he referred to as extremism in healthcare.