Can an employer-sponsored health plan legally deny coverage for gender-affirming care to a transgender employee simply because the employee is transgender?
Houston County’s employee group-health plan covers “medically necessary” services such as surgeries and anesthesia, but specifically excludes coverage for “drugs for sex change surgery” and “services and supplies for a sex change and/or the reversal of a sex change.”
Anna Lange, a county employee, is a transgender woman diagnosed with gender dysphoria. To treat her condition, Lange’s healthcare providers started her on a treatment plan of hormone therapy and gender-affirming surgery, both of which they deemed “medically necessary.” The County’s health plan, however, denied coverage for the surgery based on its sex-change-related exclusions.
Lange sued for sex discrimination under Title VII. The 11th Circuit — relying on the Supreme Court’s holding in Bostock that transgender discrimination is sex discrimination — held that the plan’s exclusions unlawfully discriminated on the basis of sex.
“Health Plan participants who are transgender are the only participants who would seek gender-affirming surgery,” the majority opinion wrote. “Because transgender persons are the only plan participants who qualify for gender-affirming surgery, the plan denies health care coverage based on transgender status.” The court continued, “By drawing a line between gender-affirming surgery and other operations, the plan intentionally carves out an exclusion based on one’s transgender status. Lange’s sex is inextricably tied to the denial of coverage for gender-affirming surgery.”
This is the legally correct decision; it’s also the morally correct decision. Under Bostock, you can’t debate the former, even if your personal, political, or religious views take issue with the latter.
