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Denying gender-affirming care coverage violates federal law, says appeals court

Image of police car and another image of Anna Lange
Georgia County Pays $1.2 Million to Fight Gender-Affirming Care Suit
Georgia County Pays $1.2 Million to Fight Gender-Affirming Care Suit

The 11th Circuit made the ruling in the case of Houston County, Ga., sheriff's deputy Anna Lange.

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A federal appeals court has upheld a lower court’s ruling that the Houston County, Ga., Sheriff’s Office violated antidiscrimination law by denying transition-related health care to a deputy.

Anna Lange sued in 2019 because she had been repeatedly denied insurance coverage for gender-affirming care under the county’s employee health plan. A U.S. district court in Georgia ruled in 2022 that the denial violated federal civil rights law, and Monday a three-judge panel of the U.S. Court of Appeals for the 11 Circuit affirmed that ruling.

It is only the second decision by a federal appellate court affirming that it is unlawful for an employer to discriminate against transgender people in an employee health plan, the first being a recent decision on North Carolina's plan for state employees. It is immediately binding on employers in Georgia, Florida, and Alabama, the states covered by the 11th Circuit, notes a press release from the Transgender Legal Defense and Education Fund, which is representing Lange along with a private law firm.

In his ruling for the 2-1 majority, Judge Charles Wilson cited the Supreme Court’s 2020 decision in Bostock v. Clayton County, in which the high court ruled that job discrimination based on sexual orientation and gender identity constitutes sex discrimination, banned by Title VII of the Civil Rights Act of 1964.

“Applying Bostock’s reasoning to the facts in this case, we conclude that the district court was correct in finding that the Exclusion violated Title VII,” he wrote. “There is no genuine dispute of fact or law as to whether the Exclusion unlawfully discriminates against Lange and other transgender persons. The Exclusion is a blanket denial of coverage for gender-affirming surgery. Health Plan participants who are transgender are the only participants who would seek gender-affirming surgery. Because transgender persons are the only plan participants who qualify for gender-affirming surgery, the plan denies health care coverage based on transgender status.”

“Today’s victory is a win not just for me, but for all transgender Southerners who deserve equal access to life-saving transition-related care,” Lange said in the TLDEF press release. “I have proudly served my community for decades and it has been deeply painful to have the county fight tooth and nail, redirecting valuable resources toward denying me basic health care — health care that the courts and a jury of my peers have already agreed I deserve. I’m pleased to see that yet another court has deemed those efforts to be unfair and illegal.”

Lange has spent 26 years in law enforcement, 17 of them with Houston County. She came out as trans in 2017.

“Today, the 11th Circuit upheld the well-reasoned ruling of the U.S. District Court that treating Sgt. Anna Lange differently because she is transgender is discriminatory,” TLDEF Co-Interim Legal Director Gabriel Arkles said in the release “Houston County and Sheriff [Cullen] Talton have once again lost in court, after spending some $2 million on lawyers to try to deprive Sgt. Lange of medically necessary care that costs orders of magnitude less solely to discriminate against transgender people.”

“We are pleased that the 11th Circuit Court came to the same conclusion as the lower courts that denying health care coverage to transgender individuals is wrong and illegal, and affirmed the lower court ruling in Sgt. Lange’s favor,” added Wesley Powell, partner at Willkie Farr & Gallagher LLP, who serves as co-counsel.

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Trudy Ring

Trudy Ring is The Advocate’s senior politics editor and copy chief. She has been a reporter and editor for daily newspapers and LGBTQ+ weeklies/monthlies, trade magazines, and reference books. She is a political junkie who thinks even the wonkiest details are fascinating, and she always loves to see political candidates who are groundbreaking in some way. She enjoys writing about other topics as well, including religion (she’s interested in what people believe and why), literature, theater, and film. Trudy is a proud “old movie weirdo” and loves the Hollywood films of the 1930s and ’40s above all others. Other interests include classic rock music (Bruce Springsteen rules!) and history. Oh, and she was a Jeopardy! contestant back in 1998 and won two games. Not up there with Amy Schneider, but Trudy still takes pride in this achievement.
Trudy Ring is The Advocate’s senior politics editor and copy chief. She has been a reporter and editor for daily newspapers and LGBTQ+ weeklies/monthlies, trade magazines, and reference books. She is a political junkie who thinks even the wonkiest details are fascinating, and she always loves to see political candidates who are groundbreaking in some way. She enjoys writing about other topics as well, including religion (she’s interested in what people believe and why), literature, theater, and film. Trudy is a proud “old movie weirdo” and loves the Hollywood films of the 1930s and ’40s above all others. Other interests include classic rock music (Bruce Springsteen rules!) and history. Oh, and she was a Jeopardy! contestant back in 1998 and won two games. Not up there with Amy Schneider, but Trudy still takes pride in this achievement.