A transgender state employee in Alaska is suing the state for denying her health care benefits, thereby forcing her to pay out-of-pocket expenses for medically necessary surgery.
Alaska’s current health insurance plan for state employees prohibits coverage for the same surgical procedures used in transition-related surgery that would otherwise be covered had the patient been cisgender instead of transgender.
Jennifer Fletcher, a 36-year old Juneau resident who works as a state legislative librarian, was diagnosed with gender dysphoria in 2014. Consulting with her doctors, Fletcher started hormone therapy and was advised to pursue gender confirmation surgery as well.
Because AlaskaCare has contained a blanket exclusion on transition-related surgery since 1979, Fletcher was denied coverage for the surgery and had to pay out of pocket. Beginning in 2018, AlaskaCare began covering hormone therapy for transgender employees, recognizing it as medically necessary, but continues to deny requests for surgical-related expenses.
Fletcher subsequently enlisted the help of Lambda Legal and sued the state.
“Jennifer Fletcher was denied coverage for medically necessary treatment specifically because she is transgender,” Lambda Legal Senior Attorney Peter Renn said in a statement. “This is unlawful and stigmatizing discrimination that jeopardizes the health of hardworking state employees. The state employee health care program — AlaskaCare — covers medically necessary treatment for all state employees except transgender employees. That’s textbook discrimination by any standard.”
In its lawsuit, Lambda Legal argues that the State of Alaska is violating Title VII of the Civil Rights Act, which prohibits sex discrimination. In March 2018, the U.S. Equal Employment Opportunity Commission found that there was reasonable cause to believe the State of Alaska violated Title VII when it refused to cover Fletcher’s medical expenses.
“All that I am asking is that the State of Alaska stop discriminating against people like myself,” Fletcher said in a statement. “My coworkers are able to receive coverage for their care, but coverage for transition-related care is denied. This sends a clear message that the State does not value me, and does not consider me equal to its other employees, by forcing me to pay out of pocket for my medically necessary care. How is this not discriminatory, when equivalent care is routinely provided to other state employees?”
Most mainstream medical associations, including the American Medical Association and the American Psychological Association, recognize that transition-related surgical treatments are often considered medically necessary for transgender people who have been diagnosed with gender dysphoria. As such, they have called for an end to discriminatory exclusions like those in AlaskaCare.
“Whether your insurance will cover medically necessary treatment should not depend on who you are,” Lambda Legal Counsel Tara Borelli said in a statement. “The State itself recognizes that transition-related care is medically necessary, which is why it covers hormone therapy. The only reason for this lingering blanket exclusion against surgical treatment is irrational discrimination.”
U.S. Rep. Becca Balint has introduced a bill to protect and expand access to gender-affirming care for transgender individuals at a time when the Trump administration is seeking to restrict the practice.
The Vermont Democrat's bill -- the Transgender Health Care Access Act -- establishes grants to support medical education programs and professional training in transition-related care, and to expand access to such services in rural communities.
She introduced the bill on March 31, coinciding with Transgender Day of Visibility.
The congresswoman noted in a news release that in a survey of students at 10 medical schools, nearly 4 in 5 students did not feel competent at treating transgender patients suffering from gender dysphoria.
U.S. District Judge Ana Reyes, of the District of Columbia, issued a preliminary injunction blocking President Donald Trump's executive order banning transgender people from enlisting in the military, which also includes expelling transgender service members from the Armed Forces.
The federal judge found the Trump administration's ban violates the Equal Protection Clause of the 14th Amendment to the U.S. Constitution because it discriminates against trans service members on the basis of their transgender status and sex.
Reyes said Trump's executive order was "soaked in animus."
West Virginia Republican Gov. Patrick Morrisey signed a bill that effectively erases the existence of transgender people from state law.
Surrounded by anti-trans advocates, Morrisey signed the "Riley Gaines Act" -- named after the former collegiate swimmer-turned-anti-LGBTQ activist -- into law.
The law defines the terms "man" and "woman" based on a person's biological anatomy at the time of birth in the state code.
For all legal purposes, the state will not recognize the gender of any person who identifies outside of the gender binary or identifies as a gender that does not align with their assigned sex at birth.
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