A transgender state employee in Alaska is suing the state for denying her health care benefits, thereby forcing her to pay out-of-pocket expenses for medically necessary surgery.
Alaska’s current health insurance plan for state employees prohibits coverage for the same surgical procedures used in transition-related surgery that would otherwise be covered had the patient been cisgender instead of transgender.
Jennifer Fletcher, a 36-year old Juneau resident who works as a state legislative librarian, was diagnosed with gender dysphoria in 2014. Consulting with her doctors, Fletcher started hormone therapy and was advised to pursue gender confirmation surgery as well.
Because AlaskaCare has contained a blanket exclusion on transition-related surgery since 1979, Fletcher was denied coverage for the surgery and had to pay out of pocket. Beginning in 2018, AlaskaCare began covering hormone therapy for transgender employees, recognizing it as medically necessary, but continues to deny requests for surgical-related expenses.
Fletcher subsequently enlisted the help of Lambda Legal and sued the state.
“Jennifer Fletcher was denied coverage for medically necessary treatment specifically because she is transgender,” Lambda Legal Senior Attorney Peter Renn said in a statement. “This is unlawful and stigmatizing discrimination that jeopardizes the health of hardworking state employees. The state employee health care program — AlaskaCare — covers medically necessary treatment for all state employees except transgender employees. That’s textbook discrimination by any standard.”
In its lawsuit, Lambda Legal argues that the State of Alaska is violating Title VII of the Civil Rights Act, which prohibits sex discrimination. In March 2018, the U.S. Equal Employment Opportunity Commission found that there was reasonable cause to believe the State of Alaska violated Title VII when it refused to cover Fletcher’s medical expenses.
“All that I am asking is that the State of Alaska stop discriminating against people like myself,” Fletcher said in a statement. “My coworkers are able to receive coverage for their care, but coverage for transition-related care is denied. This sends a clear message that the State does not value me, and does not consider me equal to its other employees, by forcing me to pay out of pocket for my medically necessary care. How is this not discriminatory, when equivalent care is routinely provided to other state employees?”
Most mainstream medical associations, including the American Medical Association and the American Psychological Association, recognize that transition-related surgical treatments are often considered medically necessary for transgender people who have been diagnosed with gender dysphoria. As such, they have called for an end to discriminatory exclusions like those in AlaskaCare.
“Whether your insurance will cover medically necessary treatment should not depend on who you are,” Lambda Legal Counsel Tara Borelli said in a statement. “The State itself recognizes that transition-related care is medically necessary, which is why it covers hormone therapy. The only reason for this lingering blanket exclusion against surgical treatment is irrational discrimination.”