A Georgia County Doesn’t Want to Pay the Bill for Trans Surgery
Georgia's Houston County is appealing a ruling finding its employee health plan exclusion on transition-related surgery is unconstitutional.
A Georgia county has asked a federal appeals court to overturn a ruling that it discriminated against a transgender sheriff’s deputy when it denied her insurance coverage.
In June 2022, U.S. District Court Judge Marc Treadwell of the Middle District of Georgia ruled that Houston County had discriminated against Anna Lange, a 16-year veteran of the sheriff’s office, when it failed to amend a decades-old exclusion in its employee health plan prohibiting county dollars from being used to pay for surgical treatments meant to assist someone in transitioning from one gender to another.
The county had previously been warned, in 2016, by its insurance provider that the exclusion was likely discriminatory and violated patient protections contained in the Affordable Care Act.
But county commissioners voted to keep the exclusion in place, reports ABC News.
In 2018, Lange informed her boss, Sheriff Cullen Talton, of her intent to transition and begin dressing according to department grooming standards for women.
Talton told Lange he “doesn’t believe in sex changes” and warned her of needing to develop “tough skin” to handle potential harassment by co-workers, but ultimately allowed her to present as a woman while on the job.
In 2019, Lange asked county commissioners to amend the employee insurance plan to cover the cost of gender confirmation surgery, but was rebuffed.
She subsequently sued in court, arguing that the insurance exclusion was unconstitutional. She was ultimately forced to pay out of pocket for surgery, even though her doctors confirmed the procedure to be medically necessary to treat her gender dysphoria.
Treadwell ruled that the county employee health plan’s insurance exclusion was a form of sex discrimination — using the same rationale used by the U.S. Supreme Court in a 2020 ruling relating to workplace discrimination — but he also found that there was not enough evidence to say if the county had intentionally discriminated against Lange.
Treadwell then ordered a civil trial to determine if Lange was entitled to damages to compensate her for the financial costs of moving forward with the surgery.
Following a two-day trial in September 2022, a jury ruled in favor of Lange, awarding her $60,000 in damages for discrimination suffered due to being denied medically necessary care.
Houston County has since appealed the decision, arguing that the Supreme Court case cited by Treadwell only prohibits firing people because of their gender identity and has nothing to do with health insurance coverage.
Lawyers for the county also maintain that the surgical exclusion isn’t discriminatory because the county’s employee health plan covers other transition-related treatments that Lange was able to benefit from, such as hormone therapy and visits to an endocrinologist.
“We have one plan that Sgt. Lange got, just like every other county employee and sheriff’s employee,” Patrick Lail, an attorney representing the county, argued before an 11th U.S. Circuit Court of Appeals panel earlier this month.
Lawyers for Lange argued that the U.S. Supreme Court ruling cited by Treadwell makes it clear that anti-transgender discrimination is a form of sex-based discrimination, thereby entitling Lange to damages.
They pointed to six other court rulings in other circuits that align with Treadwell’s decision.
The U.S. Department of Justice has intervened in the case on Lange’s behalf, saying the government has an interest in protecting the rights of transgender people and upholding prohibitions on sex-based discrimination contained in Title VII of the Civil Rights Act of 1964.
In a statement, David Brown, the legal director of the Transgender Legal Defense and Education Fund, which is representing Lange, said, “This is a simple case. The Supreme Court has established that an employer who offers unequal benefits because of sex violates Title VII.”
Lange, for her part, expressed confidence after the appeals court hearing that both Treadwell’s ruling and the jury’s verdict would stand. “The law is on our side, clearly,” she said.
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