Dierlam v. Biden et al

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF TEXAS
HOUSTON DIVISION
John J. Dierlam,
Plaintiff,
v.
Donald Trump et al.,
Defendants.
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Civil Action H-25-0123
MEMORANDUM AND RECOMMENDATION
This case has been referred to the undersigned magistrate
judge pursuant to 28 U.S.C. § 636(b)(1). ECF No. 79. Pending
before the court is Plaintiff John Dierlam’s Motion for Preliminary
Injunction, ECF No. 15, and Defendants’ Motion to Dismiss, ECF
No. 30. Because Dierlam lacks Article III standing, the court
recommends that Defendants’ Motion to Dismiss, ECF No. 30, be
GRANTED and that Plaintiff’s Motion for Preliminary Injunction,
ECF No. 15, be DENIED as MOOT.
1. Background
John Dierlam, who is religiously opposed to, among other
things, abortion, contraceptives, and gender affirming care, brings
claims related to the Patient Protection and Affordable Care Act
(ACA) and its corresponding regulations. First Am. Compl. (FAC),
ECF No. 29 at 64–65. Dierlam filed suit against the Department
of 	Health 	and 	Human 	Services 	(HHS), 	Department 	of 	the
Treasury, and Department of Labor along with several individuals
in their official capacities as government actors (collectively, the
Government). Id. at 1.
Dierlam’s 	170-page 	FAC 	covers 	many 	topics. 	Dierlam
discusses 	the 	“unconstitutional 	rise 	of 	fascism 	in 	the 	United
States,” FAC at 23–26, at 17–19, “the corruption of the medical
United States District Court
Southern District of Texas
ENTERED
February 17, 2026
Nathan Ochsner, Clerk
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profession,” id. at 26–30, and the “Leftist Abuse of Science and
Leftist Philosophy,” id. at 36–40. The FAC also contains many
pages of allegations that do not appear to be related in any way to
the 	present 	lawsuit. 	The 	court 	has 	endeavored 	to 	put 	all 	of
Dierlam’s irrelevant allegations to the side and ferret out the
substance 	of 	his 	complaints. 	Having 	done 	so, 	the 	court
understands Dierlam to be complaining about certain changes to
Medicare that HHS implemented by regulation in 2024. He argues
that the regulations HHS promulgated in 2024 violate various
statutes and provisions of the Constitution and that participation
in Medicare would require Dierlam to violate his own religious
beliefs. Id. at 17–21.
Dierlam 	is 	not 	specific 	about 	which 	regulations 	he 	is
attacking. He cites a Notice of Final Rule, which is 182 pages long
and 	which 	altered 	many 	provisions 	of 	the 	Code 	of 	Federal
Regulations. 	See 	Nondiscrimination 	in 	Health 	Programs 	and
Activities, 89 Fed. Reg. 37522 (May 6, 2024) (the Final Rule).
Dierlam states that he “challenge[s] the defendant’s regulations
regarding, Section 1557 of the ACA, ‘minimum essential coverage,’
the Individual Mandate, the Individual Mandate Penalty, the bill
sharing ministries, and all other provisions of the ACA which
touches on any of the counts to follow.” FAC at 7.
Dierlam explains that his Catholic religion forbids even
indirect participation or support of abortion and that doing so
subjects him to penalties including ex-communication from the
Church 	and 	possible eternal damnation. FAC at 	46. 	Dierlam
argues 	that 	various 	provisions 	of 	the 	current 	regulatory
framework would place him in violation of his religious beliefs
were he to participate in Medicare. For example, Dierlam alleges
that three contraceptive methods that Medicare covers can also be
used as abortifacients or could have that effect. Id. He explains
that because the Final Rule requires Medicare to cover those
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drugs, “it is impossible for [him] to enroll in Medicare or any other
health insurance as no religious exemption for the individual
exists.” Id. at 47. Dierlam also alleges that the Final Rule contains
a “definition of sex to incorporate gender affirming care, gender
identity, and pregnancy discrimination into all health insurance
including Medicare.” Id. at 62. He also explains that HHS prohibits
discrimination on the basis of sexual orientation, gender identity,
sex characteristics, pregnancy, and sex stereotypes. Id. at 62–63.
He takes the position that the “HHS Mandate is expanded to cover
gender mutilation and experimental off-label hormone therapies.”
Id. 	at 	63. 	Because 	of 	these 	alleged 	expansions 	of 	Medicare’s
coverage, enrolling in Medicare would be in violation of Dierlam’s
religious beliefs. As another example, Dierlam complains that
Medicare now covers “PrEP” drugs, which Dierlam describes as
being used “by homosexuals before sex to prevent the spread of
certain diseases.” Id. at 64. Dierlam points out that his Catholic
teachings require everyone to be celibate, except after marriage
between a genetic male and a genetic female. Id. He explains that
“LGBTQI+ 	are 	not 	immutable 	characteristics 	but 	activities
forbidden by [Catholic teachings].” Id. at 64–65. He takes the
position that “[p]ayment of premiums to support others in these
activities constitute indirect participation and support.” Id.
Dierlam has not enrolled in Medicare or other insurance
because he believes that all options available to him require that
he abandon his faith. FAC at 51, 83. Dierlam also argues that he
faces substantial lifetime penalties for signing up for Medicare
after the required time frame. Id. at 82. As Dierlam puts it,
I am required to sign a contract and/or pay premiums
to 	support 	a 	system 	which 	will 	harm 	individuals
including innocent children to obtain health care. Just
as during 2013 to 2020, it is impossible to find ANY
health insurance including Medicare, compliant with
my 	religion. 	The 	government 	is 	unconstitutionally
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making 	an 	important 	benefit 	“enjoyed 	by 	other
citizens” conditional upon the acceptance of its belief
system.
Id. at 83–84.
The court notes that Dierlam litigated an earlier case, that
he brought while employed, in which he alleged similar violations
related to the individual mandate and prior HHS regulations and
the impacts those regulations had on his private insurance options.
See, e.g., FAC at 46, 55, 102. In his previous case, it appears to the
court that 	Dierlam 	was 	found to have standing 	and 	that he
received a refund of the shared-responsibility payments he made
under the ACA from 2014–2017. Dierlam v. Biden, No. 23-20401,
2024 WL 863355 (5th Cir. Feb. 29, 2024), cert. denied, 145 S. Ct.
278 (2024). The remainder of the case was ultimately dismissed.
Id. The case currently pending before the court is related to the
effects 	that 	the 	Final 	Rule 	and 	related 	regulations 	had 	on
Medicare, not private insurance through an employer.
Dierlam has brought eighteen causes of action, including
claims under the Administrative Procedures Act, the Religious
Freedom Restoration Act, and various constitutional claims under
the First, Fourth, Fifth, and Ninth Amendments. FAC at 86–161.
Dierlam seeks a preliminary injunction “such that all Mandates
like 	[the 	Government’s] 	ultra 	vires 	‘contraceptive 	mandate,’
‘gender 	affirming 	care,’ 	‘pregnancy 	discrimination,’ 	‘gender
discrimination,’ IVF and any other regulation in the area of health
care and/or ‘minimum essential coverage’ which impacts faith and
morals is suspended and held unenforceable until this case is
decided.” ECF No. 15 at 16. Dierlam also asks the court for various
forms of relief, such as to “set aside and hold unlawful the HHS
Mandates[,]” and to “prevent the defendants from imposing any
regulation in the future which can impact faith and morals[, and]”
declare the ACA unconstitutional. FAC at 165–169.
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The court accepts as true that Dierlam is a devout Catholic
and that he believes in what he says in the FAC. The court also
does not at this stage of the proceeding take issue with Dierlam’s
reading of the Final Rule and the other regulations that he is
referring to. Assuming for the sake of discussion that Dierlam has
a firmly held religious objection to the Final Rule and the related
regulations, and that the Final Rule and regulations have the
impacts he alleges, Dierlam still lacks standing to bring the claims
he asserts.
2. Legal Standard and Analysis
The court liberally construes Dierlam’s pro se pleadings.
Erickson v. Pardus, 551 U.S. 89, 94 (2007). Even doing so, the
party invoking subject matter jurisdiction has the burden to prove
standing. Spokeo, Inc. v. Robins, 578 U.S. 330, 338 (2016), as
revised (May 24, 2016). “[A] plaintiff must demonstrate standing
separately for each form of relief sought.” Friends of the Earth, Inc.
v. Laidlaw Envtl. Services (TOC), Inc., 528 U.S. 167, 185 (2000).
The burden changes “with the manner and degree of evidence
required at the successive stages of the litigation.” Lujan v. Defs.
of Wildlife, 504 U.S. 555, 561 (1992). “At the pleading stage,
general factual allegations of injury resulting from the defendant’s
conduct may suffice, for on a motion to dismiss we presume that
general allegations embrace those specific facts that are necessary
to 	support 	the 	claim.” 	Id. 	(internal 	quotation 	omitted). 	The
elements of constitutional standing are that the plaintiff: “(1)
suffered 	an 	injury 	in 	fact, 	(2) 	that 	is 	fairly 	traceable 	to 	the
challenged conduct of the defendant, and (3) that is likely to be
redressed by a favorable judicial decision.” Spokeo, Inc., 578 U.S.
at 338.
The 	Government 	argues 	that 	Dierlam 	does 	not 	have
standing. ECF No. 30 at 7–10. According to the Government,
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because Dierlam has not enrolled in Medicare, his injury is not
actual 	or 	imminent. 	Id. 	The 	Government 	also 	argues 	that
Dierlam’s claims are not redressable because the relief he seeks
violates 	separation 	of 	powers 	and 	goes 	beyond 	the 	scope 	of
available relief. Id. at 9.
Throughout all of his many claims for relief, Dierlam argues
that he is effectively required to choose between violating his
religious beliefs and obtaining Medicare. Dierlam also argues that,
because he is older than 65, if he enrolls in Medicare now, he will
be charged an increased premium. ECF No. 33 at 8–9. Dierlam
alleges that he has suffered retrospective, current, and prospective
injuries. FAC at 80–86.1
The first question, and the question that is dispositive of this
case, is whether Dierlam has or will suffer an injury in fact. To
establish an injury in fact, the plaintiff must have suffered “‘an
invasion 	of 	a 	legally 	protected 	interest’ 	that 	is 	‘concrete 	and
particularized’ 	and 	‘actual 	or 	imminent, 	not 	conjectural 	or
hypothetical.’” Spokeo, Inc., 578 U.S. at 339 (quoting Lujan, 504
U.S. 	at 	560). 	For 	an 	injury 	to 	be 	“particularized,” 	it 	must
personally affect the plaintiff in an individual way. Id.; Arizona
Christian Sch. Tuition Org. v. Winn, 563 U.S. 125, 134 (2011).
“When 	. 	. 	. 	a 	plaintiff’s 	asserted 	injury 	arises 	from 	the
government’s allegedly unlawful regulation (or lack of regulation)
of someone else, . . . standing is not precluded, but it is ordinarily
1 To the extent that Dierlam relies on the individual mandate and the general
availability of insurance in the marketplace to allege his claims, Dierlam’s prior suit
already addressed those issues. As the court previously held, “Congress effectively
nullified the penalty by setting its amount at $0,” and Dierlam’s claims are moot.
Dierlam v. Biden, et al., 4:16-cv-0307, ECF No. 121 at 7; California v. Texas, 593 U.S.
659, 669–70 (2021) (“Because of this, there is no possible Government action that is
causally 	connected 	to 	the 	plaintiffs’ 	injury—the 	costs 	of 	purchasing 	health
insurance.”); Little Sisters of the Poor Saints Peter & Paul Home v. Pennsylvania, 591
U.S. 657, 687 (2020) (“the Federal Government has arrived at a solution that exempts
the [religious objectors] from the source of their complicity-based concerns”).
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‘substantially more difficult’ to establish.” Lujan, 504 U.S. at 561–
62.
The court recognizes that some courts have found individual
plaintiffs to have constitutional standing to complain about the
ACA’s effects on their private insurance options. A judge in the
Northern District of Texas found that the plaintiffs had standing
to challenge regulations related to the ACA as purchasers of
private 	health 	insurance 	through 	their 	employer. 	Braidwood
Mgmt. Inc. v. Becerra, 666 F. Supp. 3d 613, 622 (N.D. Tex. 2023),
aff’d in part, rev’d in part and remanded, 104 F.4th 930 (5th Cir.
2024), cert. granted in part, 145 S. Ct. 1038 (2025) and cert. denied,
145 S. Ct. 1053 (2025) and rev’d and remanded, 606 U.S. 748
(2025). The court held that the “choice between purchasing health
insurance 	that 	includes 	religiously 	objectionable 	services 	or
forgoing conventional health insurance altogether is an injury-in-
fact.” Id.
In Braidwood, the relevant plaintiffs were “six individuals
. . . who challenge the legality of the preventive care mandates as
violative of the Constitution and [] RFRA.” Braidwood Mgmt. Inc.,
666 	F. 	Supp. 	3d 	at 	618–19. 	The 	plaintiffs 	argued 	that 	the
preventative 	care 	mandate 	prevented 	them 	from 	obtaining
insurance that did not include coverage for certain types of care.
Id. There, the court found that “there is little doubt that Plaintiffs’
injuries . . . are fairly traceable to Defendants’ enforcement of the
preventive 	care 	mandates.” 	Id. 	at 	625. 	The 	court 	found 	that
individuals who objected to coverage required in the contraceptive
mandate had purchaser standing because they “show[ed that]
their opportunity to purchase their desired product, as defined by
its core features, has been reduced or eliminated.” Id. at 623. On
appeal, the Fifth Circuit acknowledged that “religious objector”
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plaintiffs had standing. Braidwood Mgmt., Inc., 104 F.4th at 957,
939 n.24.2
The parties have not cited cases addressing issues that are
analogous to those that Dierlam raises here. The only case that the
court has found that is analogous to this one is Soda v. U.S. Office
of Pers. Mgmt., No. CV 15-898, 2021 WL 533768 (D. Md. Feb. 12,
2021). In Soda, the plaintiff challenged the ACA’s impact on the
Federal Employee Health Benefits plan (FEHB). Id. at *1. The
plaintiff’s complaints in Soda are similar to Dierlam’s. The ACA
required the FEHB to cover certain contraceptive services that the
Plaintiffs objected to on religious grounds. Id. at *2. The plaintiff
in Soda identified as a devout Roman Catholic and his religious
beliefs forbade any participation in, providing access to, paying for,
or 	otherwise 	supporting 	abortion 	or 	most 	methods 	of
contraception. Id. The plaintiff sought to enjoin any insurance
provider that participated in the FEHB from being required to
offer 	contraceptives. 	Id. 	at 	*3. 	The 	court 	characterized 	the
plaintiff’s injury as an “injury to his religious practice, stemming
from his concern that his voluntary participation in FEHB plans
that cover contraception without cost-sharing [would cause] him
‘to pay for contraceptive services’ provided to others in violation of
his religion.” Id. at *4. The court noted that the Plaintiff’s theory
was founded on the notion that “in some concrete sense, Plaintiff’s
healthcare 	premiums 	directly 	fund 	other 	plan 	participants’
contraceptive care.” Id.
The court in Soda rejected the plaintiff’s argument, noting
that the plaintiff was participating in a complex system wherein
2 The court in Real Alts., Inc. v. Sec’y Dep’t of Health & Human Servs., 867 F.3d 338,
360 (3d Cir. 2017), did not address constitutional standing, but reached the merits of
the individual plaintiff’s claims and thus implicitly found they had standing. As with
Braidwood, the plaintiffs in Real Alts. lodged religious complaints related to the ACA’s
impact on their private, employer-provided insurance.
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his contributions to the program are routed through a pooled fund
from which the Office of Personnel Management pays the insurers.
Soda, 	2021 	WL 	533768, 	at 	*4. 	The 	court 	explained 	that 	the
plaintiff’s 	fear 	that 	a 	portion 	of 	his 	contributions 	could
hypothetically 	be 	used 	to 	pay 	for 	another 	participant’s
contraceptive care was “conjectural.” Id. The court distinguished
cases 	where 	an 	employer 	directly 	subsidizes 	the 	employee’s
healthcare. Id. (citing Real Alts. Inc., 867 F.3d at 359–60). The
court analogized the case to that of a religious taxpayer bringing
suit to object to the government’s use of income tax revenue. Id.
To see the analogy between the FEHB and Medicare, a very
brief discussion of Medicare is helpful.3 “In 2024, Medicare covered
over 67.6 million people. Total expenditures in 2024 were just over
$1.1 	trillion.” 	U.S. 	C ENTERS 	FOR 	M EDICARE 	AND 	M EDICAID
SERVICES, 	How 	is 	Medicare 	funded?, 	https://www.medicare.
gov/about-us/how-is-medicare-funded (last visited Feb. 17, 2026).
Medicare is paid for through two trust fund accounts that are held
by the U.S. Treasury. Id. In turn, those accounts are funded by
several sources including payroll taxes, income taxes paid on
Social Security benefits, funds authorized by Congress, premiums
from individuals enrolled in Medicare Parts A, B, and D, and
interest earned on the trust fund investments. Id.
Medicare Parts A, B, and D include hospital insurance,
medical 	insurance, 	and 	drug 	coverage. 	U.S. 	C ENTERS 	FOR
M EDICARE 	AND 	M EDICAID 	SERVICES, 	Parts 	of 	Medicare,
https://www.medicare.gov/basics/get-started-with-medicare/medic
are-basics/parts-of-medicare (last visited Feb. 17, 2026). Medicare
Part C, or Medicare Advantage, is a Medicare-approved insurance
plan provided by a private company. U.S. DEPARTMENT OF H EALTH
3 The court may take judicial notice of information on government websites. Swindol
v. Aurora Flight Scis. Corp., 805 F.3d 516, 519 (5th Cir. 2015); Fed. R. Evid. 201(b).
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AND 	H UMAN 	SERVICES, 	What 	is 	Medicare 	Part 	C?,
https://www.hhs.gov/answers/medicare-and-medicaid/what-is-me
dicare-part-c/index.html (last visited Feb. 17, 2026). Medicare pays
a 	fixed 	amount 	to 	the 	private 	companies 	offering 	Medicare
Advantage Plans to partially fund Medicare Part C. Id.
As in Soda, the key to Dierlam’s argument is that, in some
concrete sense, his Medicare premiums, if he were to enroll, would
directly fund other plan participants’ contraceptive care. Dierlam’s
alleged injury is no different than the injury a taxpayer suffers
when 	the 	government 	makes 	objectionable 	use 	of 	their 	tax
payments. Generally, the rule against taxpayer standing provides
that “the interests of a taxpayer in the moneys of the federal
treasury are too indeterminable, remote, uncertain and indirect to
furnish a basis for an appeal to the preventive powers of the Court
over their manner of expenditure.” Hein v. Freedom From Religion
Found., Inc., 551 U.S. 587, 600 (2007) (quoting Doremus v. Bd. of
Ed. of Hawthorne, 342 U.S. 429, 433 (1952)).
Dierlam’s interest in how Medicare funds are used is as
remote and uncertain as a taxpayer’s interest in the government’s
use of tax revenues. Again, Medicare covered more than 67 million
people in 2024 and is funded from a variety of sources, including
two trust fund accounts, which are themselves funded by various
taxes, 	congressionally 	authorized 	funds, 	and 	premiums 	from
individuals 	enrolled 	in 	Medicare. 	The 	idea 	that 	Dierlam’s
premiums, should he enroll in Medicare, would fund another’s
religiously objectionable care is far too attenuated and speculative
to be a concrete, particularized injury. He lacks standing. Every
claim and form of relief that Dierlam requests suffers from this
same defect.
Dierlam also lacks standing to argue that, because he is
unable to enroll in Medicare without violating his religious beliefs,
he now faces an increased premium for late enrollment. Because
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any injury related to enrolling in Medicare is too attenuated to
constitute 	an 	injury-in-fact, 	so 	too 	is 	any 	penalty 	based 	on
Dierlam’s personal decision not to enroll in Medicare.
The court also notes that any relief in this case would also
be 	completely 	unworkable. 	As 	the 	Third 	Circuit 	has 	stated,
“[m]edical treatments that some might view as objectionable are
as varied as they are numerous. Examples that are by no means
exhaustive 	include 	. 	. 	. 	vaccination; 	organ 	transplant 	from
deceased 	donors; 	blood 	transfusions; 	euthanasia 	or 	physician-
assisted suicide; and so on.” Real Alts., Inc., 867 F.3d at 364
(internal citation omitted). Medicare would simply stop operating
if it could not provide coverage for a medical treatment that was
objectionable under any citizen’s religious beliefs. See id.
Moreover, as the Supreme Court explained fifteen years ago,
Few exercises of the judicial power are more likely to
undermine public confidence in the neutrality and
integrity of the Judiciary than one which casts the
Court in the role of a Council of Revision, conferring
on itself the power to invalidate laws at the behest of
anyone who disagrees with them. In an era of frequent
litigation, 	class 	actions, 	sweeping 	injunctions 	with
prospective 	effect, 	and 	continuing 	jurisdiction 	to
enforce judicial remedies, courts must be more careful
to insist on the formal rules of standing, not less so.
Making the Article III standing inquiry all the more
necessary 	are 	the 	significant 	implications 	of
constitutional litigation, which can result in rules of
wide applicability that are beyond Congress’ power to
change.
Arizona Christian Sch. Tuition Org., 563 U.S. at 145–46.
Dierlam 	does 	not 	have 	Article 	III 	standing. 	The 	court
therefore 	does 	not 	have 	jurisdiction 	to 	hear 	Dierlam’s 	case.
Defendants’ 	Motion 	to 	Dismiss 	should 	be 	GRANTED 	and
Dierlam’s claims should be DISMISSED without prejudice for
lack of subject matter jurisdiction.
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3. Leave to Amend is Denied
“Dismissing an action after giving the plaintiff only one
opportunity to state his case is ordinarily unjustified.” Davoodi v.
Austin Indep. Sch. Dist., 755 F.3d 307, 310 (5th Cir. 2014) (quoting
Jacquez v. Procunier, 801 F.2d 789, 792 (5th Cir. 1986)). If the
plaintiff seeks leave to amend, he “must give the court at least
some notice of what . . . [his] amendments would be and how those
amendments would cure the initial complaint’s defects.” Scott v.
U.S. Bank Nat’l Ass’n, 16 F.4th 1204, 1209 (5th Cir. 2021) (citation
omitted). The court may deny leave “[i]f the plaintiff does not
provide a copy of the amended complaint [or] explain how the
defects could be cured[.]” Id. (citation omitted). The court may also
deny leave to amend when amendment would be futile or when the
plaintiff chooses to stand on his complaint and argues that it
satisfies 	the 	pleading 	requirements. 	See 	Khoury 	v. 	Thota,
No. 20-20578, 2021 WL 3919248, at *4 (5th Cir. Sep. 1, 2021)
(affirming the district court’s denial of leave to amend when the
plaintiff 	chose 	to 	stand 	on 	his 	complaint 	and 	argued 	that 	it
satisfied the pleading requirements); Wimm v. Jack Eckerd Corp.,
3 F.3d 137, 139 (5th Cir. 1993) (discussing futility of amendment
as justification for denying leave to amend).
Here, 	Dierlam 	has 	had 	an 	opportunity 	to 	amend 	his
Complaint. The court granted Dierlam leave to file an Amended
Complaint, and Dierlam filed his FAC thereafter. ECF No. 22. In
response to the pending Motion to Dismiss, Dierlam has neither
requested to amend nor proposed amendments to his FAC. The
court has no reason to believe that Dierlam could further amend
his 	FAC 	to 	remedy its 	defects. Amendment 	would 	be 	futile.
Therefore, any request for leave to amend is denied.
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4. Motion for Preliminary Injunction
Because the court recommends that Defendants’ Motion to
Dismiss be granted, Plaintiff’s Motion for Preliminary Injunction,
ECF No. 15, should be DENIED as MOOT.
5. Conclusion
The court recommends that Defendants’ Motion to Dismiss,
ECF No. 30, be GRANTED. Dierlam’s Motion for Preliminary
Injunction, ECF No. 15, should be DENIED as MOOT.
The 	parties 	have 	fourteen 	days 	from 	service 	of 	this
Memorandum and Recommendation to file written objections. 28
U.S.C. 	§ 636(b)(1); 	Fed. 	R. 	Civ. 	P. 	72. 	Failure 	to 	timely 	file
objections will preclude appellate review of factual findings or legal
conclusions, 	except 	for 	plain 	error. 	See 	Thomas 	v. 	Arn, 	474
U.S. 140, 147–49 (1985); Rodriguez v. Bowen, 857 F.2d 275, 276–
77 (5th Cir. 1988).
Signed at Houston, Texas, on February 17, 2026.
______________________________________
Peter Bray
United States Magistrate Judge
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