Health care for transgender people must be covered by state insurance: Court of Appeals declares:
Lawsuits about transgender people and their rights have been working their way through the court system for many years. Here, people protested in support of transgender rights in front of the Supreme Court in 2019.
Manuel Balce Ceneta/AP
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Manuel Balce Ceneta/AP
Lawsuits about transgender people and their rights have been working their way through the court system for many years. Here, people protested in support of transgender rights in front of the Supreme Court in 2019.
Manuel Balce Ceneta/AP
A federal appeals court ruled Monday that state health insurance plans must provide coverage for gender-affirming care in North Carolina and West Virginia. Transgender advocates say this is a huge victory, especially as bills restricting transgender rights increase in state legislatures.
The 4th District Court of Appeals in Richmond, Va., issued decisions in two cases. One was brought by North Carolina state employees and their dependents who are transgender and cannot receive insurance for gender-affirming care.
The other lawsuit comes from West Virginians who are transgender and on Medicaid. They may be covered for some treatments – like hormones – but not for surgery.
These cases were heard last fall by the 4th Circuit en banc – meaning all the judges on that appeals court heard the arguments.
During oral arguments, the justices asked about mastectomy as an example. These are covered for breast cancer patients, but they are not covered in health insurance plans for transgender patients.
In an 8-6 decision, the 4th Circuit majority ruled that these patients are entitled to health insurance coverage for their care. Justice Roger Gregory, who delivered the majority opinion, called the denial of coverage “clearly discriminatory.”
West Virginia Attorney General Patrick Morrisey defended his state’s decision not to cover gender-affirming surgeries in Medicaid. Morrisey responded to the loss in a statement, saying: “Decisions like this, from a court dominated by Obama and Biden appointees, cannot stand: we will took this matter to the Supreme Court and won.”
Supporters of Missouri’s ban on gender-affirming care for minors gather on the floor of the statehouse in Jefferson City in March 2023.
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Charlie Riedel/AP
Supporters of Missouri’s ban on gender-affirming care for minors gather on the floor of the statehouse in Jefferson City in March 2023.
Charlie Riedel/AP
In a statement, North Carolina State Treasurer Dale Folwell called the verdict “unflinching judicial activism.”
The 4th circuit has Seven judges are appointed by Republican presidents and eight judges are appointed by Democratic presidents.
“We are really pleased that the court ruled that discrimination has no place in the law,” said Tara Borellisenior counsel at Lambda Legal who argued the case for the plaintiffs.
Borelli noted that the policies in question have changed. Both state health plans have been required to cover transgender health care since lower federal district courts ruled in favor of patients in 2022, she said.
Now that the appeals court has issued its decision, Borelli says it sets an important precedent and that other states across the country should pay close attention.
Attorneys for North Carolina and West Virginia have argued that the denial of coverage is based on saving taxpayer money, not favoritism.
Borelli noted that appealing to the Supreme Court would cost taxpayers more money.
The Supreme Court’s recent actions on transgender issues have been mixed.
Earlier this month, the justices allowed Idaho’s juvenile care ban to take effect.
But they declined to hear other cases of transgender students accessing bathrooms and participating in school sports. Court watchers saw it as a reluctance to enter the fray.
Meanwhile, on Friday, the Biden administration promulgate regulations strengthen anti-discrimination protections for transgender patients nationwide. That rule applies to any health care — not just care related to their gender — so, for example, a transgender person with a broken arm cannot be mistreated in the emergency room. .
A group of Republican-led states has pledged to challenge the rule in court.
