Employers must include gender-affirming medical care in their health insurance coverage or face federal charges.
That's the decision handed down June 2 by Chief Judge Marc Treadwell of the U.S. District Court for the Middle District of Georgia in the case of Anna Lange – a transgender woman and sheriff's deputy in Houston County, Georgia, who was denied coverage for gender confirmation surgery under her employee health insurance plan. As the Washington, D.C.-based LGBTQ MetroWeekly.com reports, an exclusion in the sheriff's department's policy prohibited coverage for transition-related medical care, including counseling, hormones, and surgical procedures.
According to MetroWeekly.com:
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As a result of the exclusion, Lange was forced to pay out of pocket for some treatments, and forego more costly procedures, even though her doctors agree that such treatments are medically necessary to treat her gender dysphoria. She repeatedly petitioned her employer, the county, to remove the exclusion, but her requests were denied.
Lange then sued in court, arguing that the insurance exclusion in the county's employee health plan is discriminatory and unconstitutional. Specifically, she argued that the policy discriminates against her (and other transgender individuals) on the basis of sex, violates the Americans with Disabilities Act, and violates her right to equal protection under the law, as guaranteed by both the Fourteenth Amendment to the U.S. Constitution and the Georgia Constitution.
For the most part, Treadwell agreed, determining that the insurance exclusion "plainly discriminates because of transgender status" — a violation of prohibitions against sex-based discrimination in Title VII of the Civil Rights Act of 1964. He noted in his opinion that "the exclusion denies coverage for procedures and treatments that would otherwise be covered if provided in connection with a different diagnosis," such as hormone replacement therapy to treat menopause.
That said, Treadwell did rule against Lange's claim of an ADA violation, "because she has not established her gender dysphoria is the result of a physical impairment. Lange's equal protection claim will proceed to trial."
Lange is a 16-year veteran of the Houston County Sheriff's Office, which uses a health plan provided through Anthem Blue Cross and Blue Shield. Treadwell wrote in his opinion that "during the renewal process in late 2016, the County's insurance broker, who acts as a liaison between the County and Anthem, informed [the Director of Personnel for Houston County] of Anthem's 'Nondiscrimination in Health Programs and Activities Rule,' which states that '… the exclusion for Gender Identity Disorders and Sex Change Surgery will be removed from our plans.' Despite Anthem's recommendation to so, the County chose not to accept the nondiscrimination mandate."
LGBTQ advocates are celebrating the decision. "The Court's decision makes clear that depriving transgender people of health care is not only immoral but also illegal," David Brown, legal director for the Transgender Legal Defense and Education Fund, said in a statement. "An employer cannot refuse health coverage to a transgender employee who needs access to medically necessary, life-saving care. This ruling will have transformative impact on the quality of life for countless transgender people who live in the South."
According to MetroWeekly.com, 24 states and Washington, D.C., prohibit exclusions on gender-affirming care in private insurance plans, while 24 states, Puerto Rico, and Washington, D.C., have policies prohibiting exclusions for gender-affirming care for Medicaid recipients.
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