The legal fights come as Georgia Republicans seek to prohibit transgender women from participating in women’sschool and college sports and to ban the use of taxpayer dollars — including payments from state employees’ health insurance — from being used for gender-affirming care. Some of the legislation was inspired in part by recent settlements won by transgender people.

Credit: Arvin Temkar/AJC

Credit: Arvin Temkar/AJC

Supporters of the Republican proposals say they reflect the will of a majority of Georgians, who do not want transgender women competing in women’s sports and don’t want their tax dollars used for gender transitions. A poll from The Atlanta Journal-Constitution last month found more than 70% of Georgia voters surveyed said they support requiring student-athletes to play sports according to the sex on their birth certificate.

Senate Appropriations Chairman Blake Tillery, a Vidalia Republican, said the General Assembly has already said transgender care should not be allowed for minors. He said his proposal — Senate Bill 39 — will prohibit the use of public money for such treatments is a natural extension of the will of the Legislature.

“We’re making clear to all state employees that we’re not going to use state taxpayer dollars to pay for this gender-affirming care and transgender surgeries any longer,” Tillery said on during a recent debate on the bill.

Credit: Natrice Miller/AJC

Credit: Natrice Miller/AJC

Transgender Georgians and their advocates say the latest proposals deprive them of needed medical care. Carrie Scott, a staff attorney in the state court system, said “after a long process of self reflection” she realized about 2½ years ago that she needed to transition to align with her identity as a transgender woman. Her surgery was covered by her State Health Benefits Plan.

“It has been a wonderful thing that’s happened in my life,” she told a panel of senators earlier this month. “That surgery — it was incredible for my well-being. I was in a lot of pain (emotionally) and now I’m not in pain.”

Credit: Jeff Amy/AP

Credit: Jeff Amy/AP

Recent history suggests whatever transgender legislation passes the General Assembly will likely end up in court, even as transgender legal victories continue to inspire new legislation.

Transgender care expands

Transgender Georgians have repeatedly turned to the courts when denied public funding for hormone treatments, surgeries and other gender-affirming care.

In 2015, a transgender inmate said she was refused adequate care and sued the Department of Corrections. The department agreed to use qualified medical and mental health professionals to evaluate inmates with possible gender dysphoria — a diagnosis used to identify distress caused when a person’s gender identity differs from the sex listed on their birth certificate.

In 2021, two transgender women sued the state when they were denied gender-affirming surgeries under Georgia’s Medicaid health insurance program. The state Department of Community Health settled the case a year later, agreeing to amend its policy to pay for gender-affirming care through Medicaid.

Transgender state employees also have sued to have their care covered. In 2019, a University of Georgia employee won a settlement that requires the state’s university system to cover medically necessary expenses, including gender confirmation services.

And in 2023 three transgender men reached a settlement that requires the State Health Benefits Plan to pay for gender dysphoria treatment.

Seran Gee, a staff attorney with Advocates for Trans Equality who worked on the 2023 case, said court settlements are binding contracts that can’t be broken by changing state law. Elected leaders passing laws to break a contract violates the state constitution, she said.

In additon to changing state policy, the plaintiffs in those lawsuits won cash settlements. The state paid $250,000 to the transgender inmate, $350,000 to the Medicaid patients, $85,000 to the UGA employee and $365,000 to the other state employees, records show.

But the total settlements received by the plantiffs in some cases are much higher because the state claims data reviewed by the newspaper doesn’t include payments from private insurers or other parties who were part of the settlements. One example: The state paid $1 million to the family of a transgender inmate who died by suicide at Valdosta State Prison. But the family received a total of $2.2 million in the settlement.

Settlement costs are only part of what the state has spent on such claims. The state has paid more than $2 million to date in legal fees for the 19 transgender claims the newspaper identified. And legal costs can be steep even if the state ultimately does not pay a cash settlement, the newspaper found.

Benjamin Johnson, a special education teacher in Macon, was one of the employees who sued for state health insurance to pay for his gender-affirming surgeries. He said the settlement covered medical and other debt that lifted a huge weight off of his shoulders.

“I was glad (the settlement) happened so that they didn’t just limit it to taking care of what (plaintiffs) were asking for, but that they took out the exclusions,” he said of the changed policy. “No one should have to go as far as a lawsuit to get access to something that’s a human right.”

Tillery’s bill would reverse the policy agreed to by the settlement and prohibit state tax dollars from being used to pay for gender transitions. It’s the latest attempt to curtail gender-affirming care in Georgia.

Two years ago, the General Assembly approved a law that prohibits transgender minors from receiving certain treatments for gender-affirming care, such as hormone replacement therapy. The U.S. Supreme Court is now considering whether a similar Tennessee law is constitutional.

Tillery said he filed SB 39 after discovering that minors covered by state employee health insurance were receiving care in other states. But his bill would go further and prohibit state insurance from paying for gender-affirming care for adults as well as minors. It includes exceptions for certain conditions, such as treatments for people born with ambiguous genitalia.

Democrats blasted the bill when it passed the Senate earlier this month. Sen. Nikki Merritt, D-Grayson, likened the Republican majority to bullies.

“We’re using the power of the state to pick on a vulnerable group of kids because you’ve got the power to do it,” Merritt said.

Tillery said employees can seek private insurance that would pay for gender-affirming care.

“What this bill does is, in no uncertain terms, makes clear that you cannot use state taxpayer dollars in any form for transgender surgeries,” Tillery said. “That is the simplicity of it. That is the complexity of it. That is the entire bill.”

Left unsaid is that the bill would also ban nonsurgical treatments, such as hormone therapy or puberty blockers.

Athlete sparks backlash

At the 2022 women’s swimming championships in Atlanta, Leah Thomas became the first openly transgender woman to win a Division 1 title in any sport.

Some of the athletes Thomas competed against were not celebrating. They were shocked to learn they would share a locker room with Thomas at Georgia Tech, which hosted the championship. University of Kentucky swimmer Riley Gaines tied for fifth place with Thomas in the 200-yard final.

Last year Gaines and more than a dozen other women athletes sued the NCAA, Georgia Tech, the University System of Georgia and others. Among other things, they said the defendants had violated Title IX — a federal law that prohibits sex discrimination in education, including athletics.

Credit: Arvin Temkar/AJC

Credit: Arvin Temkar/AJC

The case has become a rallying cry for critics of allowing transgender women to compete in women’s sports. Allowing people who were born male to compete against women, they say, denies women the opportunity for achievement because men are generally stronger than women and have a competitive advantage.

The case also has helped inspire two bills in the General Assembly.

Senate Bill 1 would bar transgender women and girls from competing in female sporting events at public K-12 schools and colleges, as well as in private schools that compete against public institutions. It passed the Senate earlier this month.

House Bill 267 — dubbed the “Riley Gaines Act” — would do the same. A House subcommittee gave initial approval to the legislation this week.

Both bills have the backing of top Republicans, and some version of the measures is likely to pass the General Assembly.

“This issue is simple — men don’t belong in women’s sports,” House Speaker Jon Burns said in announcing HB 267. “The Riley Gaines Act ensures that from now on in our state, young women who have dedicated countless hours, days and years of their lives to become the best they can be in their sport will never be forced to face a biological male on the field, on the court or in the locker room.”

The Georgia High School Athletic Association already prohibits transgender from playing on teams that match their gender identity, and Democrats say the bills address a nonissue. They see the measures as thinly veiled attacks on an already marginalized group.

State Sen. RaShaun Kemp, a South Fulton Democrat, said having the legislation regulating sports be one of the first bills to pass the chamber shows the priorities of the Republican majority.

“(Instead of) discussing the fact that 70% of our children are not reading on grade level, we’re making sure that we take rights away from our most vulnerable students in this state that make up less than 1% of our population,” Kemp said.

Meanwhile, the Gaines lawsuit is pending in U.S. District Court in Atlanta. Attorneys for the state argue the plaintiff’s beef is with NCAA policies, and the state defendants should be dismissed.

Records show the state has already spent about $185,000 to defend itself in the litigation.

Politics and lawsuits

Meanwhile, lawsuits and legislation keep coming. Records show the state faces at least six open liability claims involving transgender rights.

One example: The state has spent $725,000 to date defending the Department of Corrections in a 2023 lawsuit brought by a transgender inmate at Phillips State Prison in Buford.

The inmate, known in court filings only as “Jane Doe,” says she was illegally denied gender-affirming surgery, though court records indicate she has received hormones and other treatment for gender dysphoria.

A federal judge rejected the inmate’s request for a preliminary injunction to force the state to pay for some treatments. But the judge ordered the state to pay for some social-transitioning cosmetics and clothing. The state has appealed the decision to the 11th Circuit Court of Appeals.

This week, Sen. Randy Robertson, R-Cataula, introduced Senate Bill 185, which would prohibit state funds from being used to pay for sex reassignment surgery, hormone replacement therapy and cosmetic procedures intended to alter the appearance of sexual characteristics of those being held in Georgia prisons.

Robertson declined to comment for this article.

While politicians and courts decide their fates, transgender Georgians are pleading for understanding and fighting to preserve their access to care they say has saved their lives. Johnson, the teacher who successfully sued the state for care, said he can’t understand why Georgia politicians are so focused on transgender people, a tiny fraction of the population.

“Why is this the hill you decided to die on?” Johnson said. “I want them to tell me, what is it about my existence that threatens them so?”