On Friday, the American Civil Liberties Union and the ACLU of Iowa filed a lawsuit against the state of Iowa to block implementation of a recently passed law that exempts local governments and state agencies from having to use taxpayer dollars, including Medicaid funds, to pay for transition-related health care.
The law being challenged was passed in response to a unanimous March decision by the Iowa Supreme Court finding that a long-standing state regulation prohibiting Medicaid funds from being used to cover transition-related care was unconstitutional.
In its ruling, the court found that the provision in the Iowa Civil Rights Act prohibiting discrimination on the basis of gender identity extends to Medicaid, which is considered a “public accommodation.”
In response to that decision, Iowa lawmakers carved out a special exemption within the state’s public accommodations law that allowed government officials to refuse to allow taxpayer dollars to cover gender confirmation surgery, hormones, and other transition-related care, under the assumption that such procedures are not medically necessary.
Friday’s lawsuit, filed on behalf of the LGBTQ rights organization One Iowa and two transgender plaintiffs: Aiden Vasquez, of southeast Iowa, and Mika Covington, of central Iowa, alleges that the exemption violates transgender people’s right to equal protection under the U.S. Constitution, and their inalienable right to liberty, safety, and happiness under the Iowa Constitution.
The lawsuit also argues that the law violates Iowa’s “single subject rule” requiring that all legislation passed by the Iowa General Assembly only deal with one subject “and matters properly connected therewith.”
Under the “single subject rule,” if a bill includes a separate subject that is not listed in its title, any provision dealing with the unlisted topics is considered void.
Both Vasquez and Covington are transgender, qualify for Medicaid, and have doctors who agree that receiving gender confirmation surgery is necessary to treat their gender dysphoria.
Every mainstream medical association, including the American Medical Association, the American Psychological Association, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the National Association of Social Workers, and the World Professional Association of Transgender Health, have deemed gender confirmation surgery as medically necessary for treating some people’s gender dysphoria.
“This law reverts the State of Iowa back to its longstanding discriminatory policy and practice of denying transgender Iowans on Medicaid coverage for gender-affirming surgery, Rita Bettis Austen, the legal director of the ACLU of Iowa, said in a statement. “The law brings significant harm to our clients and others who rely on Medicaid and who desperately need this surgery. This is a matter of life and death.”
Bettis Austen also said the law has no basis in medicine or science, and violates the right to equal protection under the Iowa Constitution because it discriminates against people due to their gender identity.
The lawsuit comes one week after the Trump administration released a new regulation that would roll back LGBTQ protections within the Affordable Care Act by explicitly defining its prohibitions on sex-based discrimination in health care and insurance coverage as pertaining only to instances where someone is discriminated against based on their assigned sex at birth.
“No one should be denied the medical care they need, and that includes transgender individuals,” Daniel Hoffman-Zinnel, the executive director of One Iowa, said in a statement. “A patient’s health should always come first. Denying transgender people the medically necessary health care they need, as directed by their doctor, can contribute to depression, anxiety and increased risk of suicidal thoughts. Make no mistake, this law threatens lives.”
Vasquez said he was bringing the lawsuit in order to ensure that he and other transgender people are able to access medically necessary care.
“Now it’s time to join the front lines to stand up for my equality and wholeness, as well as for the rights of other transgender Iowans,” he said in a statement. “Tragically, society shames transgender people just for being who they are. But I’m not hiding anymore. I’m determined to help myself, and in that way, help others.”
“Gender-affirming surgery is not cosmetic surgery,” Covington said in a statement. “Getting the gender-affirming surgery that my doctors have determined is medically necessary for me will do nothing less than give me my life back. It will help me build a life in which my body is in harmony with my gender, so I can overcome the depression, lack of confidence, isolation, and other problems my gender dysphoria causes.
“It was very painful for me when the Iowa legislature passed this law,” Covington added. “All Iowans, regardless of income level, have the right to have medically necessary health care without discrimination because of who they are. It’s wrong to deny Iowans on Medicaid like me their medically necessary care just because we are transgender. This surgery is literally life-saving.”
The Trump administration has proposed two federal rules that would restrict access to gender-affirming care for transgender minors nationwide.
The proposed regulations, issued by the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS), would bar federal Medicaid funds from covering transition-related care for transgender youth under 19 and threaten to strip federal funding from hospitals that provide gender-affirming treatments to minors.
HHS officials told NBC News that CMS will begin the federal rule-making process with a 60-day public comment period, after which the rules could be finalized.
The U.S. Department of Health and Human Services has launched an investigation into Seattle Children's Hospital over its alleged provision of gender-affirming care to transgender minors, a practice the Trump administration has aggressively sought to end.
In a post on X, the HHS official account said the hospital had been referred to the Office of the Inspector General for "failure to meet professional recognized standards of health care" under a declaration issued on December 18 by HHS Secretary Robert F. Kennedy, Jr., according to The Hill.
Congressional lawmakers have approved a measure that would bar Medicaid -- the federal health insurance program for low-income Americans -- from covering gender-affirming care, including hormonal and surgical interventions, for minors.
The "Do No Harm in Medicaid Act," sponsored by U.S. Rep. Dan Crenshaw (R-Texas), is the third in a series of Republican-backed efforts to block people under 18 from accessing medical treatments that assist in a gender transition.
The measure passed by a 215-201 vote, with four Democrats -- Reps. Henry Cuellar (Texas), Vicente Gonzalez (Texas), Don Davis (N.C.) and Marie Gluesenkamp Perez (Wash.) -- joining Republicans in support of the ban.
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