Apr 29, 2024 - Politics & Policy

State health care plans can't exclude gender-affirming surgeries, court rules

Trans pride flags flutter in the wind

Trans pride flags flutter in the wind. Photo: Robyn Beck/AFP via Getty Images

State health care plans must cover gender-affirming surgeries, a federal appeals court in Virginia ruled Monday.

Why it matters: The ruling marks a major victory for transgender rights at a time when many states have cracked down on gender-affirming care for children and adults.

State of play: The U.S. Court of Appeals for the 4th Circuit ruled Monday that North Carolina's and West Virginia's denial of some health care services via government insurance for trans people was discriminatory.

  • In both cases, the states argued that their policies were not discriminatory but rather rooted in "legitimate government interests," including costs.
  • West Virginia's Medicaid program has excluded "transexual surgery" since 2004. North Carolina in 2018 excluded treatment for gender dysphoria in the state's health care plan.

The big picture: Both health care plans had been deemed discriminatory by lower court rulings and appealed by the states, before being combined and presented to the 4th U.S. Circuit Court of Appeals, per AP.

  • Judge Roger Gregory described the policies as "obviously discriminatory" in the ruling.
  • "Because we hold that the coverage exclusions facially discriminate on the basis of sex and gender identity, and are not substantially related to an important government interest, we affirm the district courts," Gregory wrote.

What they're saying: Tara Borelli, senior attorney at Lambda Legal and the lead lawyer in both lawsuits, said in a statement Monday that the ruling would "save lives."

  • "It confirms that discriminating against transgender people by denying critical medical care is not only wrong but unconstitutional," Borelli added.

Zoom out: Half of U.S. states don't have laws ensuring inclusive insurance protection for LGBTQ people, while two states — Mississippi and Arkansas — explicitly allow insurers to deny coverage for gender-affirming care, according to the Movement Advancement Project.

  • State legislatures have introduced over 100 anti-trans health care bills in 2024 so far, according to data from the American Civil Liberties Union.

Go deeper: Axios Explains: Gender-affirming care in the U.S.

Go deeper