Gender transition surgeries must be covered in state health plans, federal court says

A federal appeals court on Monday said that state-funded health plans in West Virginia and North Carolina must cover gender transition surgeries for members of the transgender community.

The first-of-its-kind ruling said that excluding such surgeries from the plans amounts to sex- and gender-based discrimination.

State leaders had pointed to cost concerns to justify their coverage limits, arguing that transgender patients were treated the same as others.

“There is no service that is covered for a cisgendered person that is not covered for a transgender person meeting the same criteria,” Caleb David, an attorney for West Virginia, said during oral arguments, according to The Washington Post.

But the majority of the 4th U.S. Circuit Court of Appeals rejected those cost-based arguments and issued its second major ruling in favor of transgender individuals in as many weeks.

“Earlier this month, the court said a federally funded middle school could not ban a trans 13-year-old from playing on the girls’ track and field team,” The Washington Post reported.

Transgender health care

The consolidated cases out of West Virginia and North Carolina were brought by a group of transgender patients, who challenged both state-run Medicaid programs and the health plans offered to state employees, including professors at public universities.

One of the key questions in the cases was whether the lack of coverage for gender transition surgeries violated the 14th Amendment’s equal protection clause.

Attorneys from Lambda Legal, the law firm that represents the transgender patients, argued that it did, while state officials said that decisions made due to budgetary concerns don’t violate the Constitution.

“West Virginia is entitled to deference where they’re going to take their limited resources,” David, the West Virginia attorney, said during oral arguments, according to The Associated Press. “They believe that they need to provide more resources towards heart disease, diabetes, drug addiction, cancer, which are all rampant in the West Virginia population.”

Lower courts in the two states sided with the transgender patients, ruling that state-funded plans must cover gender transition surgeries.

Now, the 4th Circuit has said the same in a ruling that applies to minor patients as well as adults.

“The coverage exclusions facially discriminate on the basis of sex and gender identity, and are not substantially related to an important government interest,” the majority opinion said.

Debates over minors

Monday’s ruling comes as leaders across the country — and around the world — debate transgender health care and related issues, like whether transgender women should compete in women’s sports.

In recent years, multiple states have banned hormone therapy and gender transition surgeries for young people, and some have put restrictions on gender-related health care for adults, The Washington Post reported.

Then, earlier this month, the National Health Service in the United Kingdom released what’s called the Cass Review, which investigated the current state of gender identity-related health services.

It urges caution when treating young people experiencing gender dysphoria and has led health officials in the U.K. to stop prescribing puberty blockers, as the Deseret News previously reported.

In the U.S., the debate over transgender health care remains highly politicized.

Twenty-one Republican-led states filed a brief with the 4th Circuit calling for a ruling for state leaders, while 17 Democratic-led states filed a brief calling for the opposite ruling, per The Washington Post.

In his dissenting opinion that was also released Monday, Judge Jay Richardson argued that the majority was pulling health care policy into the culture war.

“In the majority’s haste to champion plaintiffs’ cause, today’s result oversteps the bounds of the law,” he wrote.