New lawsuit could pave the way for better transgender health care

A lawsuit recently filed on on behalf of a transgender teenager could lead to significant legal progress for transgender people across the country who need gender-affirming care but have been unable to access it through their employer health plans.

LGBTQ advocacy group Lambda Legal filed the lawsuit last week on behalf of a 15 year-old transgender boy and his parents after he was denied gender-affirming care by his mother’s employer-provided insurance plan. The boy’s mother works at St. Michael Medical Center in Washington state, a medical clinic in the Catholic Health Initiatives Franciscan system.

Lambda Legal, which is working with the Seattle law firm Sirianni Youtz Spoonemore Hamburger PLLC, is suing Blue Cross Blue Shield of Illinois for refusing to cover gender-affirming care in that employer-provided plan, issuing a blanket exclusion of anything related to transgender health care needs.

In its complaint, the group said the decision by Blue Cross Blue Shield of Illinois to administer such a plan is discrimination on the basis of sex, which is banned under the Affordable Care Act.

The transgender boy, who is referred to in the lawsuit as C.P., is dependent on his mother’s insurance plan. Although he began receiving gender-affirming care three years ago, his family was recently informed that not all of his care could be covered because Catholic Health Initiatives Franciscan has an exclusion for health care “for or leading to gender reassignment surgery,” Lambda Legal explained.

C.P.’s family had to spend more than $10,000 on care that was not covered because of the exclusion, according to the suit.

Patricia Pritchard, C.P.’s mother, stated, “What is a family who cannot afford this very expensive care for their child supposed to do? This is a matter of life and death for many transgender people and children, and I hate to think of the difficult and scary decisions families are forced to make.”

She added, “It’s not fair, and it’s not right.”

According to a 2019 report from the Williams Institute, a research center out of the University of California Los Angeles, transgender people who wanted hormone therapy and surgical care and received that care “had a substantially lower prevalence of past-year suicide thoughts and attempts” compared to those who didn’t.

One of the lawyers working on C.P.’s case, Omar Gonzalez-Pagan, a senior attorney and health care strategist at Lambda Legal, said the lawsuit is key to improving health care access for transgender people everywhere.

He explained that it would create a standard that says third-party health plan administrators like Blue Cross Blue Shield Illinois “cannot apply or enforce discriminatory exclusions even if these are established by others.”

A win for C.P. and his family would also hold some significance in the face of a Trump administration rule that gutted a regulation in the Affordable Care Act over the summer.

In June, the administration eliminated a rule originally enacted in 2016 that clarified any ban on sex discrimination in health care also included discrimination against transgender people.

Although federal judges partially blocked the move, specifically provisions that excluded sex stereotyping from the definition of sex discrimination, the courts did not allow gender identity to be included in the 2016 regulation again, according to the Kaiser Family Foundation’s legal analysis.

Gonzalez-Pagan said that since the Trump administration reversal was not completely blocked, the lawsuit could serve to counteract later efforts to limit transgender people’s access to health care more broadly.

The Trump administration rule has also tried to narrow which entities have to follow the Affordable Care Act regulations, and Gonzalez-Pagan said C.P.’s lawsuit also seeks to counteract those efforts.

The suit is the latest in a long line of legal efforts by transgender people pushing for greater access to gender-affirming, medically necessary care.

Earlier this year, two transgender women who were denied gender-affirming health care under Florida’s state employee health plan sued state agencies, arguing that the Florida Department of Management Services “recognize[d] it is medically necessary but they choose not to cover it” regardless of that fact.

One of the women said she “had three suicide attempts” as a result of the state’s decision to block her care. “Life wasn’t worth living at that point,” she told Rewire News.

The women are being represented by the ACLU of Florida, Southern Legal Counsel, and pro bono attorney Eric Lindstrom, according to a press release from January.

Last year, the Iowa Supreme Court ruled in favor of two transgender women who argued that their sex reassignment surgeries were medically necessary. The court said Iowa’s ban on Medicaid coverage for gender-affirming care violated a state civil rights law.

“So many people still don’t understand that this is not something we need for trivial or cosmetic reasons,” EerieAnna Good said at the time. “It’s medical care a doctor is recommending for someone who has a medical need for it.”

Published with permission of The American Independent Foundation.