Transgender Worker Wins Health Care Fight – But Is Not Done Yet

The Eleventh Circuit affirmed a lower court’s ruling that an employer cannot exclude gender-affirming coverage for a transgender plan participant under its employee health insurance plan. But the full court then decided to rehear the matter.

Transgender employee comes out at work

Anna Lange is a transgender woman who has worked at a sheriff’s office in Georgia since 2006. During that time, she experienced symptoms of gender dysphoria, a condition that causes feelings of distress and discomfort because of the disconnect between the person’s gender identity and the sex assigned at birth.

In 2017, Lange sought treatment and was formally diagnosed with gender dysphoria. If left untreated, the condition can lead to other problems, including anxiety, depression and suicidal ideation.

The following year, Lange notified her employer of her transgender status and her intention to begin living as a woman.

Lange’s healthcare provider started her on a treatment plan to begin her transition. The plan included both hormone therapy and gender-affirming surgery, both of which have been shown to alleviate symptoms of gender dysphoria.

Health insurance denies coverage

Lange sought to have her treatment covered by her employer-provided health care plan. However, her request for coverage was denied based on the plan’s exclusion of “[d]rugs for sex change surgery” and “[s]ervices and supplies for a sex change and/or the reversal of a sex change.”

She filed an appeal, which was denied.

Was it sex discrimination? Jury thinks so

She then filed a federal lawsuit. Among other things, she asserted a sex discrimination claim in violation of Title VII of the Civil Rights Act of 1964.

The district court sided with Lange on the Title VII claim. After a trial, a jury awarded Lange $60,000 in emotional damages.

The employer appealed to the Eleventh Circuit, arguing the lower court made the wrong call.

Landmark SCOTUS ruling provides guidance

Among other things, Title VII prohibits discrimination in employment based on protected characteristics, including sex.

Importantly, the U.S. Supreme Court’s ruling in Bostock v. Clayton County established that Title VII’s ban on employment discrimination bars employers from firing someone based on their sexual orientation or sexual identity.

The landmark ruling extended Title VII protections to lesbian, gay, bisexual and transgender employees, as the majority determined that it “is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex.”

Applying Bostock to the current case, the Eleventh Circuit decided the lower court made the right call in finding the health care plan’s exclusion violated Title VII.

In the Eleventh Circuit’s view, the exclusion was a blanket denial of gender-affirming surgery.

The panel reasoned that because transgender individuals would be the only participants who would seek gender-affirming surgery, then “the plan denies health care coverage based on transgender status.”

The Eleventh Circuit affirmed the district court’s finding that the health care plan’s exclusion was facially discriminatory in violation of Title VII. The full Eleventh Circuit then vacated that ruling and decided to rehear the matter.

Lange v. Hous. Cnty., No. 22-13626, 2024 U.S. App. LEXIS 11591 (11th Cir. 5/13/24), vacated at 2024 U.S. App. LEXIS 20702 (11th Cir. 8/15/24).