Trans State Employees Sue Georgia Over Denial of Insurance Coverage
Lawsuit claims exclusion in state employee health plan prohibiting coverage for gender-affirming care is discriminatory.
Two Georgia state employees and a public school employee are suing the state of Georgia over an insurance exclusion in their employee health insurance plan that prohibits coverage for transition-related health care expenses.
The lawsuit, filed last Wednesday in federal court, argues that Georgia’s State Health Benefit Plan, which insures more than 660,000 state government and public school employees and retirees, discriminates against transgender employees, or the transgender dependents of employees, by refusing to cover what their doctors deem to be medically necessary care, reports The Associated Press.
The plaintiffs — Micha Rich, a transgender man and staff accountant at the Georgia Department of Audits and Accounts; Benjamin Johnson, a transgender man a media library clerk with the Bibb County School District; and a third state employee, Jane Doe, suing on behalf of her dependent college-age transgender son, John Doe — argue that the exclusion in the insurance plan should be overturned and that they should be repaid for out-of-pocket costs they incurred in obtaining the surgical treatments that were not covered by their insurance.
The plaintiffs have also requested additional monetary damages and asked that the state pay their attorney’s fees, if the courts ultimately decide in their favor.
All three plaintiffs initially appealed their denials and won findings from the U.S. Equal Employment Opportunity Commission that Georgia had discriminated against them by refusing to cover the treatments. They reached out to the state to try and settle the matter outside of court, but when the state refused, the plaintiffs decided to file the lawsuit.
“They did not accept our invitation to negotiate an end to their discrimination without litigation — and, plainly, they didn’t remove the exclusion,” David Brown, the legal director for Transgender Legal Defense & Education Fund, which is representing the plaintiffs, said in a statement.
Not content to wait for the issue to be resolved, the plaintiffs went ahead with surgical treatments. Rich paid $11,200 for his surgery in 2021 and later declared bankruptcy. John Doe’s family took out loans for the $8,769 cost of surgery, and is still repaying those. Both Rich and Doe say the state also owes them for testosterone prescriptions. Johnson dropped his state insurance and bought independent coverage, ultimately undergoing surgery in September.
“My employer should not be able to deny me health care because of who I am,” Rich said in a statement. For years, I had to put off living my life fully while I waited to have the medical treatments that my doctors and I knew I needed.”
In the lawsuit, the plaintiffs argue that the exclusion violates their right to equal protection under the 14th Amendment to the U.S. Constitution, and, in Johnson’s case, under Title IX’s prohibitions on sex-based discrimination in educational settings. The lawsuit also cites the Supreme Court’s decision in Bostock v. Clayton County, in which the high court found that discrimination based on gender identity is inherently a form of illegal sex discrimination under Title VII of the Civil Rights Act of 1964.
“The exclusion not only harms the health and finances of transgender people seeking gender dysphoria treatment, it also reinforces the stigma attached to being transgender, suffering from gender dysphoria and seeking a gender transition,” the lawsuit argues. “The exclusion communicates to transgender persons and to the public that their state government deems them unworthy of equal treatment.”
The lawsuit further notes that the insurance companies that provided the plan — Anthem Blue Cross Blue Shield and UnitedHealthcare — warned the state back in 2016 that the transgender exclusions were discriminatory, and a state lawyer told the administrators of the State Health Benefit Plan in 2020 that a court would likely find the exclusion to be illegal.
“Yet the defendants have knowingly and intentionally maintained the exclusion year after year, long after it became plain — and the SBHP itself concluded — that doing so is unlawful discrimination,” the lawsuit states.
The lawsuit, Rich et.al. v. State of Georgia et.al., is the fourth lawsuit to be brought against Georgia state agencies challenging insurance exclusions denying coverage of gender-affirming care. The University System of Georgia previously paid $100,000 in damages and was forced to change its insurance coverage rules in 2019 when it settled a case brought by a University of Georgia catering manager.
In April, the Department of Community Health — which also oversees the State Health Benefit Plan — agreed to change the rules of Georgia’s Medicaid program to settle a lawsuit brought by two Medicaid recipients. And in September, a jury ordered Houston County to pay $60,000 in damages to a sheriff’s deputy after a federal judge found she had been discriminated against when she was denied coverage for gender confirmation surgery.
Beyond Georgia, a federal court ruled earlier this year that similar exclusions in the North Carolina State Health Plan were discriminatory, violating the Equal Protection Clause of the Fourteenth Amendment to the United States Constitution, Title IX of the Education Amendments of 1972, and Section 1557 of the Patient Protection and Affordable Care Act, the latter of which prohibits sex-based discrimination in health care and insurance coverage. The state is appealing that ruling.
Wisconsin overturned a similar ban on gender-affirming care in its employee health care plan in 2018, after a jury awarded $780,000 in damages to two plaintiffs who were denied coverage for surgical expenses. West Virginia and Iowa have previously lost lawsuits regarding similar exclusions, according to TLDEF.
“Time and again, courts have ruled that denying health care to people because they are transgender is not only clearly wrong — it is also clearly illegal,” Brown, the legal director of TLDEF, said in a statement. “We had a landmark victory on this exact question just a few months ago, and we are confident that the courts will once again come to the right decision — that there is no room for discrimination in Georgia.”
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