by Rev. Mark Creech
RevMarkCreech.org
Important cultural battles are increasingly being fought not in legislatures or churches, but in courtrooms. Judges are being asked to decide questions that strike at the heart of how Americans understand human identity, religious liberty, and the limits of government authority.
Two legal developments in North Carolina during the past week illustrate this growing reality. One involves whether taxpayers must fund gender-transition medical procedures through the State Health Plan. The other concerns an employee’s right to follow her religious convictions in the face of a workplace vaccine mandate.
At first glance, these cases may appear unrelated. Yet together, they reveal something significant about the moment we are living in. Both highlight the growing tension between modern cultural claims about identity and the historic American commitment to freedom of conscience.
The Fight Over Transgender Coverage in the State Health Plan
The first case involves the North Carolina State Health Plan, which provides insurance coverage to approximately 740,000 state employees, teachers, retirees, and their dependents.
For many years, the plan excluded coverage for gender-transition procedures such as hormone therapy and surgical interventions. That exclusion became the focus of a lawsuit known as Kadel v. Folwell. Plaintiffs argued that denying coverage for these treatments constitutes unlawful discrimination.
The litigation has been moving through the courts for several years. In 2022, a federal judge ruled in favor of the plaintiffs and ordered the State Health Plan to cover treatments for gender dysphoria. The decision was later affirmed by the U.S. Court of Appeals for the Fourth Circuit.
However, the legal landscape shifted after the U.S. Supreme Court issued its ruling in United States v. Skrmetti in 2025, a case that reshaped how courts analyze state policies related to gender-transition treatments.
Because of that decision, earlier rulings were vacated, and the case was sent back to the lower court for reconsideration. Then, just this week, a federal judge in Raleigh temporarily halted further proceedings pending guidance from another Fourth Circuit case, Anderson v. Crouch, which raises similar legal questions.
For now, the issue remains unresolved. But the eventual outcome could determine whether state health plans across the region must cover gender-transition procedures under federal law.
A Religious Liberty Case from the COVID Era
The second case highlights a very different issue, but one equally important for people of faith.
The U.S. Equal Employment Opportunity Commission recently announced that UNC Health Rex in Raleigh agreed to pay $150,000 to settle a lawsuit involving a COVID-19 vaccine mandate.
According to the EEOC, a hospital employee who worked remotely requested a religious exemption from the vaccine requirement in 2021. The employee had previously been granted a religious exemption from the flu vaccine but was denied all four exemption requests for the COVID-19 vaccine mandate. After refusing the vaccine, she was terminated.
The EEOC argued that the hospital violated federal law by failing to accommodate the employee’s sincerely held religious beliefs.
Under Title VII of the Civil Rights Act of 1964, employers must provide reasonable accommodations for employees’ religious convictions unless doing so would impose an “undue hardship” on the employer’s business.
Rather than continue litigation, UNC Health Rex agreed to settle the case.
Why These Cases Matter
Although these two disputes involve different policy questions, they point to a broader cultural and legal struggle that Christians cannot ignore.
In the State Health Plan case, courts may ultimately determine whether taxpayers must fund medical procedures based on the belief that biological sex can be medically altered to match a person’s internal sense of gender.
Christians believe that God created humanity male and female (Genesis 1:27), and that this distinction is not accidental or fluid, but part of the Creator’s intentional design. Policies that treat biological sex as something that can be medically redefined, therefore, raise serious theological and moral concerns for people of faith.
The UNC Rex case highlights another dimension of the same cultural tension. It shows how easily religious convictions can come into conflict with institutional policies. In this instance, an employee’s desire to live according to her faith led to her termination and ultimately required federal intervention to vindicate her rights.
Two Different Visions of Rights
At the heart of these disputes lies a deeper disagreement about what rights mean, from whence they come, and how they should be protected.
Many modern legal claims are based on the idea that individuals have a right to define their own identity and that institutions should affirm and accommodate those personal definitions. Increasingly, those claims are being presented as civil rights issues that must be enforced by law.
At the same time, Christians assert a different kind of right – God-given rights – the freedom to live according to the moral and spiritual convictions handed down in the Word of God. These rights are not granted by the government but by God. The government, therefore, is to protect them vigorously. Any government that presumes to overrule the rights given by God places itself in dangerous opposition to the very source of human freedom.
A Moment for Christian Vigilance
For Christians, this cultural moment calls for vigilance.
Believers should not assume that freedoms long protected in American law will remain secure without thoughtful defense. At the same time, Christians must speak with both conviction and grace about the truths that shape their understanding of human nature, creation, and conscience.
The Apostle Paul reminded believers that “we wrestle not against flesh and blood, but against principalities, against powers, against the rulers of the darkness of this world” (Ephesians 6:12, KJV).
Legal battles may take place in courtrooms, but the deeper struggle is spiritual and cultural.
The cases unfolding in North Carolina are reminders that the defining questions of our time are not merely political. They concern truth, freedom, and the nature of humanity itself.
For people of faith, these are questions that cannot be ignored.
