A ruling that Houston County and its sheriff violated federal law by refusing to provide health care coverage for a deputy’s gender transition surgery has been upheld by the Atlanta-based federal appeals court.
Sgt. Anna Lange, a transgender woman who has worked for the Houston County Sheriff’s Office since 2006, said her court win is a victory “for all transgender Southerners who deserve equal access to life-saving transition-related care.”
“I have proudly served my community for decades and it has been deeply painful to have the county fight tooth and nail, redirecting valuable resources toward denying me basic health care – health care that the courts and a jury of my peers have already agreed I deserve,” she said in a news release. “I’m pleased to see that yet another court has deemed those efforts to be unfair and illegal.”
The county and its sheriff sought a ruling in their favor from the U.S. Court of Appeals for the 11th Circuit after a federal judge in Macon determined that the denial of coverage unlawfully discriminated against Lange and ordered the county’s insurance plan to cover her treatment. The judge had relied on a landmark U.S. Supreme Court opinion in a separate Georgia case, which held that federal law prohibits discrimination against gay and transgender employees in the workplace.
In a 2-1 ruling issued Monday, the appeals court affirmed the Macon judge’s “well-reasoned opinion” finding the county and its sheriff liable under the Civil Rights Act.
“Because transgender persons are the only (insurance) plan participants who qualify for gender-affirming surgery, the (county’s) plan denies health care coverage based on transgender status,” the court said. “Houston County deprived Lange of a benefit or privilege of her employment by reason of her nonconforming traits, thereby unlawfully punishing her for her gender nonconformity.”
Circuit Judge Andrew L. Brasher dissented, saying the county’s health insurance plan didn’t explicitly deny coverage to transgender people, but simply excluded coverage for “sex change surgeries.”
“On the face of this policy, it doesn’t treat anyone differently based on sex, gender nonconformity, or transgender status,” he said. “Assuming Lange is factually correct that only transgender people would want sex change surgery, that doesn’t mean the plan discriminates because of sex.”
Attorneys for the county and its sheriff did not immediately respond to questions about the ruling, which is binding on employers in Georgia, Florida and Alabama.
It is the first time a federal appellate court has concluded that it is unlawful for an employer to discriminate against transgender people in an employee health plan, according to the Transgender Legal Defense and Education Fund, which helped Lange in the case.
“Houston County and Sheriff (Cullen) Talton have once again lost in court, after spending some $2 million on lawyers to try to deprive Sergeant Lange of medically necessary care that costs orders of magnitude less solely to discriminate against transgender people,” TLDEF Co-Interim Legal Director Gabriel Arkles said in a news release.
Lange, who has worked in law enforcement for 26 years, came out as a transgender woman in 2017 and was diagnosed with gender dysphoria. After recommendations from her doctor, two psychologists and a surgeon, Lange determined she needed a procedure estimated to cost about $25,000.
In 2018, she began to seek coverage for the operation but was denied due to an exclusion in the county’s health plan that banned “services and supplies for a sex change.” Lange, who sued her employers in 2019, underwent surgery following the Macon judge’s ruling in 2022.
A jury awarded Lange $60,000 in damages on her discrimination claim under the Civil Rights Act. A trial on a separate claim against the county under the Equal Protection Clause of the U.S. Constitution has been on hold pending the appellate court’s ruling.
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