Last week, a federal court found that the state of Alaska unlawfully discriminated against a transgender state worker when it denied her insurance coverage for transition-related surgery due to an exclusion in her employee health care plan.
Jennifer Fletcher, 37, a legislative librarian, sued the state after her employer-sponsored plan, known as AlaskaCare, denied her coverage in 2017 for gender confirmation surgery due to the exclusion.
As a result, Fletcher was required to pay more than $25,000 in out-of-pocket costs to pay for the surgery and related recuperative care, even though the state of Alaska’s consultant had estimated in 2016 that the cost of coverage for the surgery would be negligible in terms of the burden shouldered by the state.
In 2018, the AlaskaCare plan began covering transition-related hormone therapy, categorizing it as medically necessary, but has kept in place its policy — which dates back to 1979 — refusing to cover the cost of gender confirmation surgery.
Fletcher filed a complaint with the U.S. Equal Employment Opportunity Commission, which found in March 2018 that there was reasonable cause to believe the state had violated Title VII of the Civil Rights Act.
Enlisting the help of Lambda Legal, Fletcher sued the state in June 2018, alleging that she had been discriminated against her based on her sex. The state responded, arguing that the denial of care was not motivated by Fletcher’s sex.
In his opinion, District Judge H. Russel Holland of the U.S. District Court of Alaska found that the state had “adopted and relied upon a formal, facially discriminatory policy,” noting that the material facts of the case were not disputed by either party.
“[Fletcher] was treated differently because of her natal sex. Under the provisions of AlaskaCare, ‘a natal female born without a vagina qualifies for coverage of a vaginoplasty, but not the plaintiff[] here because [her] natal sex is male,'” Holland wrote. “If plaintiff’s natal sex were female and it was medically necessary for her to have a vaginoplasty to correct a congenital defect, coverage would have been available under AlaskaCare. But, because plaintiff’s natal sex is male and she was seeking to transition to a female, coverage was not available.
“Plainly, defendant treated plaintiff differently in terms of health coverage because of her sex, irrespective of whether ‘sex’ includes gender identity,” Holland added. “AlaskaCare covers vaginoplasty and mammoplasty surgery if it reaffirms an individual’s natal sex, but denies coverage for the same surgery if it diverges from an individual’s natal sex. That is discrimination because of sex and makes defendant’s formal policy, as expressed in the provisions of AlaskaCare, facially discriminatory.”
Tara Borelli, an attorney with Lambda Legal who is representing Fletcher, praised the court’s decision in a statement.
“”Transgender employees should never be forced to endure what Jennifer endured, to be denied potentially life-saving treatment simply because of who they are,” Borelli said. “Jennifer was denied coverage for medically necessary treatment while her co-workers received full coverage for all their health care needs, all because of a discriminatory policy. The court rightly saw that as wrong and found that Alaska broke federal law, which prohibits sex-based discrimination in employment.”
All mainstream medical associations, including the American Medical Association and the American Psychological Association, recognize transition-related surgical treatment is considered medically necessary for transgender people struggling with gender dysphoria.
For that reason, the AMA and other medical organizations have called for an end to exclusions on surgical care in private and public health insurance plans.
“It was stigmatizing and traumatic to have my colleagues receive coverage for their medical needs while I was denied,” Fletcher said in a statement. “I am grateful that the court saw that treatment for what it was — unlawful discrimination — and I hope that this ruling means that no one else will have to go through being targeted for discrimination by their employer. We should all be able to count on our employers to treat us equally, especially for something as important as our health care.”
Donald Trump's ads attacking Kamala Harris for her support of gender-affirming care for transgender prisoners are ringing a bit hollow following a New York Times exposé that showed his own Justice Department held a very similar position.
Trump is not being widely called out for his hypocrisy, however. Most Democrats, save Harris, sidestep any mention of transgender issues -- appearing concerned that their support of transgender rights will hurt them among moderate and swing voters. Republicans, meanwhile, simply ignore all historical facts.
In his ads, Trump has lambasted Harris for supporting gender-affirming care for transgender inmates, including undocumented immigrants who are in custody, in an attempt to paint her as too liberal in the eyes of moderate and independent voters.
The U.S. Supreme Court has granted a petition for divided argument in U.S. v. Skrmetti, the federal challenge to Tennessee's law prohibiting doctors from prescribing treatments for gender dysphoria to transgender youth.
The court previously agreed in June to take up the case, as well as its companion case, L.W. v. Skrmetti, during the 2024-2025 court session.
The outcome of the case will likely determine the fate of similar laws in 23 other states, where Republican lawmakers have sought to criminalize the provision of gender-affirming care, like puberty blockers or hormones, to transgender youth to help them transition and assuage their feelings of gender dysphoria.
Ad from anti-Trump Republican PAC seeks to defend Kamala Harris by pointing out Trump's hypocrisy and accusing the former president of "gaslighting" voters.
The Lincoln Project, a political action committee for anti-Trump Republicans, released an ad to counter former President Donald Trump's anti-transgender attacks on Vice President Kamala Harris.
In the past few weeks, the Trump campaign has leaned heavily into anti-transgender messaging in an attempt to cast Harris as out-of-step with Americans on social issues.
Many of the ads attack Harris over her support of gender-affirming care for incarcerated individuals, a stance she adopted in 2019 when she was running for the Democratic nomination for president.
"Kamala's for they/them," a narrator says in one of the ads. "President Trump is for you."
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