A federal judge in Georgia has ruled a veteran Houston County sheriff’s deputy was wrongfully denied health insurance coverage for gender-affirming care.
Anna Lange informed longtime Sheriff Cullen Talton, her coworkers and the county director of personnel in 2018 that she intended to live openly as a woman and planned to have gender reassignment surgery.
She was initially told by the middle Georgia county’s third-party administrator, Anthem Blue Cross Blue Shield, her procedure would be covered if deemed medically necessary, but Houston County officials objected and pointed to its exclusion for sex change surgery and drugs related to the procedure.
Judge Marc T. Treadwell, chief judge of the U.S. District Court in Macon, ruled Thursday that the county’s policy is discriminatory because it only affects transgender employees, and it specifically discriminates against Lange because she is the county’s only openly transgender worker.
Treadwell noted, for example, the county’s health care plan would cover a mastectomy when deemed medically necessary for cancer treatment but not for gender dysphoria.
The Obama-nominated judge’s ruling relied partly on a landmark U.S. Supreme Court decision in 2020 that granted workplace protection from discrimination for LGBTQ employees, which was released the year after Lange sued the county.
“Ignoring Bostock doesn’t make it go away,” Treadwell wrote, referring to the Supreme Court ruling.
“In short, the defendants can’t find a Bostock workaround,” he also wrote in his order. “That is understandable. The Exclusion plainly discriminates because of transgender status.”
Treadwell did, however, throw out Lange’s claim that the county violated the Americans with Disabilities Act.
Houston County Administrator Barry Holland said county officials could not comment on the ruling Friday, citing “ongoing litigation.”
Lange and the Transgender Legal Defense & Education Fund (TLDEF), which filed the lawsuit on Lange’s behalf, celebrated the ruling as a major blow to trans-related health plan exclusions and called it a landmark decision for transgender rights.
“The Court’s decision makes clear that depriving transgender people of healthcare is not only immoral but also illegal,” the fund’s legal director, David Brown, 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.”
Treadwell has not yet specified what relief Lange would be awarded, but Lange’s focus Friday was on accessing the care she was first denied nearly five years ago.
“It’s a huge relief to know that I can finally receive the medically necessary care that I was repeatedly and unfairly denied,” Lange said in a statement. “I can confidently move forward with my life knowing that gender affirming care is protected under federal law. This decision is not only a personal victory, but a tremendous step forward for all transgender Southerners who are seeking insurance coverage for medically necessary care.”
Future proceedings will ferret out whether the county intentionally discriminated against its transgender workforce – or if its decision not to cover gender-affirming treatment was more related to cost and the financial impact on the county’s self-funded plan.
The specific procedure Lange originally sought is estimated to cost about $25,600, according to information Anthem provided to the county that was cited in Treadwell’s ruling. Anthem told the county the cost for gender reassignment surgery can run upwards of $186,000 but noted that utilization of gender-confirming care is low.
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