A Federal Appeals Court Has Delivered a Victory for Trans Healthcare

James Factora
·3 min read
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AP Photo/ Jonathan Drew, File

A federal appeals court has ruled that state insurance policies in West Virginia and North Carolina are discriminatory for refusing to cover gender-affirming care. This marks the first time that an appellate court has weighed in on whether state insurance exclusions of gender-affirming care are lawful, per ABC News. The case could be headed to the Supreme Court, NBC News reported.

On Monday, the 4th U.S. Circuit Court of Appeals ruled 8-6 in favor of the plaintiffs in the lawsuit Kadel v. Folwell, which challenged North Carolina’s coverage exclusion, and Fain v. Crouch, which challenged West Virginia’s exclusion. The former was initially filed in 2019, and the latter in 2020. North Carolina’s insurance plan categorically excluded coverage of gender-affirming care for trans government employees and their dependents, whereas West Virginia withheld coverage of gender-affirming surgery from Medicaid recipients.

The court’s opinion upheld the lower court rulings in both cases, finding that both were “obviously discriminatory” on the basis of gender identity and sex. “A policy that conditions access to gender-affirming surgery on whether the surgery will better align the patient’s gender presentation with their sex assigned at birth is a policy based on gender stereotypes,” Circuit Judge Roger Gregory wrote. He gave the example of mastectomies, which are a procedure that can be performed on anyone who has breast tissue regardless of their “biological sex.” If someone who was assigned male were to undergo a mastectomy for gender-affirming purposes (as cis men with gynecomastia sometimes do) that would be covered under these insurance policies; if someone were assigned female, however, that procedure would not be covered.

“This difference in coverage is rooted in a gender stereotype: the assumption that people who have been assigned female at birth are supposed to have breasts, and that people assigned male at birth are not,” Gregory wrote. “No doubt, the majority of those assigned female at birth have breasts, and the majority of those assigned male at birth do not. But we cannot mistake what is for what must be.”

The plaintiffs and legal counsel involved in both cases celebrated the ruling. Shauntae Anderson, a plaintiff who is a Black transgender woman and West Virginia Medicaid participant, said in a statement via Lambda Legal that her state’s “denial of medically necessary care just because of who I am was deeply dehumanizing.”

The Supreme Court Will Allow Idaho to Enforce Its Gender-Affirming Care Ban for Now

The ruling reverses an injunction that blocked the law from taking effect.

“I am so relieved that this court ruling puts us one step closer to the day when Medicaid can no longer deny transgender West Virginians access to the essential healthcare that our doctors say is necessary for us,” Anderson said.

Ezra Cukor, senior counsel for the Transgender Legal Defense & Education Fund, said in a statement that such exclusions are “degrading and humiliating.” “Trans people only want to get the same coverage for their health care needs as their co-workers. The court saw how blatantly discriminatory and wrong North Carolina’s policy was and found that the state employee health plan broke federal law, and we are delighted with this outcome,” Cukor said.

The decision has potentially far-reaching implications. Sruti Swaminathan, a staff attorney at Lambda Legal, told Them, “While technically the decision only binds those two systems, the Fourth Circuit governs all of the states in its jurisdictions, and they would do well to heed the clear instruction that this kind of discrimination is unlawful.”

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Originally Appeared on them.

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