After a federal appeals court ruled this week that transgender people have the same legal right to medically necessary care as everyone else, the immediate reaction in North Carolina and West Virginia was to He vowed to appeal the decision to the U.S. Supreme Court. court.
Han Henson, a North Carolina school district employee who has struggled for years to receive gender-affirming care, immediately broke down in tears. Last year, ProPublica wrote about his tumultuous journey seeking medical help in transitioning while living in a state with a long history of discrimination against transgender people.
“Having something makes you feel good and makes you feel healthy. Having it hanging over your head all the time is dehumanizing,” he says.
The Virginia-based 4th Circuit Court of Appeals found that both states violate federal law by banning certain treatments for transgender people while allowing them for others. It was decided that there was. These cases are the first of their kind to reach a federal appeals court, and the decisions could have implications for states and courts in other parts of the country.
Transgender people have long argued in court that the North Carolina Employees' Health Insurance Plan and West Virginia's Medicaid program discriminate against them by denying coverage to certain treatments prescribed to them. I've been insisting. A majority of the court agreed with this argument, echoing previous district court decisions, stating that West Virginia's Medicaid program “covers mastectomies for the treatment of cancer, but does not cover mastectomies for the treatment of gender dysphoria.” “It is not,” he emphasized.
Henson learned of the lawsuit in 2022, shortly after she started working as a communications specialist for a North Carolina school district. While the legal battle was ongoing, the state was under a court order to cover gender-affirming care, and he found himself in a race against time. He had hoped to have his last major surgery in November 2023, two months after the appeals court heard oral arguments in the case.
However, as the surgery date approached, he realized that he had to postpone the surgery due to a stomach ulcer. For months, he said, all he could think about was the impending court ruling. He even considered going ahead with the surgery despite his poor health. He finally underwent surgery in late March.
Dale Falwell, the state treasurer and named defendant, used the lawsuit in his gubernatorial campaign. (He lost the Republican primary in March.) He has argued in interviews and court documents that state health plans should have the power to decide which employee benefits are covered. He reiterated those comments in a statement this week, saying, “Regardless of the reality of the plan's financial situation, the majority opinion provides a path for disgruntled individuals to override the plan's rational and responsible decisions and lead it to collapse.” It opens,” he said.
credit:
Annie Flanagan, ProPublica Special Correspondent
Henson will need another surgery within five months, which is part of the general process. He said he was now relieved to know that the Court of Appeal's decision ensured he was less likely to miss out on treatment at a critical time. But he worries about other transgender people seeking services and imagines them compulsively updating court websites just like he does.
For now, the ruling protects transgender people's access to gender-affirming care in both states' health plans. The ruling also applies to federal lawsuits filed in the Fourth Circuit in other states: South Carolina, Virginia, and Maryland. The Eleventh Circuit is currently considering two similar cases in Georgia and Florida.
All active judges on the court heard oral arguments in the case in September. In Monday's ruling, eight of the 14 judges, nearly all of whom were appointed by Democratic presidents, ruled in favor of the transgender plaintiffs. “In addition to discriminating on the basis of gender identity, exclusion also discriminates on the basis of sex,” wrote Judge Roger Gregory, who was first appointed by President Bill Clinton and confirmed under the George W. Bush administration.
States argued that they were justified in not targeting gender-affirming care because it was too expensive and medically ineffective. The court's majority opinion rejected both arguments as unsupported. Evidence shows that it is likely to cost states little to cover this care, and major medical associations say bans on gender-affirming care can harm the mental and physical health of transgender people. Citing evidence that gender exists, it supports widespread access to gender-affirming care.
The judges who signed the three dissents were all appointed by Republican presidents. “In its haste to vindicate the plaintiffs' cause, today's results fall outside the scope of the law,” said Judge Julius Richardson, an appointee of President Donald Trump. I stated this in my dissenting opinion. “The majority asserts that the challenged exclusion uses a medical diagnosis as a proxy for transgender people, despite the complete lack of evidence for this claim.”
North Carolina and West Virginia plan to appeal the ruling to the U.S. Supreme Court, according to press releases from each state. “We remain confident in the merits of the lawsuit,” West Virginia Attorney General Patrick Morrissey said in a statement. “We have wide discretion to decide what the program can cover.”
It remains to be seen how and whether other states and insurance companies with restrictive policies to cover gender-affirming care will act in response to this opinion.
“This is a warning to private insurance companies, as well as states with state health plans and Medicaid programs,” said Omar Gonzalez Pagan of Lambda Legal, who represents transgender plaintiffs in North Carolina and West Virginia. It should be,” he said. “We hope this will serve as a deciding factor in adopting bad policies, as an inspiration to repeal the policies that currently exist.”
