A Georgia county spent over $1.2 million in legal fees to deny a sheriff’s deputy’s gender-affirming care. Sergeant Anna Lange, who was diagnosed with gender dysphoria, sought surgery as part of her gender transition. Despite being recommended by the county’s insurance administrator to change the policy, the Houston County leaders refused to cover the surgeries or medications related to gender transition in their health plan citing cost as the primary reason. Lange filed a federal discrimination lawsuit against the county and argued that the denial of medical care subjected her to inferior treatment. In response, the county’s lawyers said health insurance premiums had already soared and that the county wanted to prevent a flurry of requests to remove other exclusions in the plan.
Access to transition-related care, also known as gender-affirming care, is medically necessary for transgender people according to major medical associations. Denial of gender-affirming care can harm their mental and physical health. Federal judges have consistently ruled that employers cannot categorically exclude gender-affirming care from health care plans. However, banning gender-affirming care has become a touchstone of conservative politics, and at least 25 states are considering or have passed bills that would ban gender-affirming care for minors. Bills in Oklahoma and Texas aim to ban insurance companies from covering transition-related health care for adults as well.
State and local government employers are waging long legal battles against covering gender-affirming care for their employees. ProPublica obtained records showing that two states, North Carolina and Arizona, have spent more than $1 million in attorney fees on legal fights similar to the one in Houston County. In these cases, both states claimed in court filings that the decisions they made not to cover the care for employees are purely financial and not discriminatory. However, budget estimates and real-world examples show that the cost of offering coverage of gender-affirming care is negligible.
Without necessary treatment, transgender people are at higher risk for depression, anxiety and thoughts of suicide. Discrimination against transgender individuals has become a growing concern in the US. At a time when transgender rights are under attack, transgender individuals face significant barriers to accessing healthcare. The legal battles against covering gender-affirming care for employees are especially concerning, as employers are spending large sums to fight coverage for a small number of people.
The cases in Georgia, North Carolina, and Arizona highlight the continued struggle for transgender individuals to access healthcare in the US. Denying gender-affirming care to employees or individuals is discriminatory and can harm their mental and physical health. While many states are attempting to ban gender-affirming care for minors, medical associations and federal judges have recognized the medical necessity of gender-affirming care for transgender individuals. As legal battles continue to unfold, it remains to be seen whether employers will choose to support their transgender employees or continue to deny them necessary medical care.