A Georgia County’s Decision to Exclude Gender-Affirming Care from Its Health Insurance Plan Was a Title VII Violation, According to a Federal Judge

Over the last decade-plus, much has been made about the way Americans obtain healthcare services and health insurance. Even after the passage of the Affordable Care Act (ACA), most Americans still get their health insurance coverage via their employer. Given the cost of healthcare in this country, employer-provided health insurance coverage often represents one of the more important terms and conditions of any job. That means that a denial of coverage on an improper basis can constitute illegal discrimination. If it’s happened to you, a knowledgeable Atlanta employment discrimination lawyer can help you learn more about protecting your rights.

One Georgia deputy’s discrimination case represents an important area where employer-provided health insurance coverage issues may constitute a Title VII violation: exclusions from coverage for gender-affirming care.

In 2018, A.L., a trans woman and a deputy in the Houston County Sheriff’s Office, notified her employer that she was trans and began transitioning. She underwent hormone therapy and “top surgery.” (Top surgery, according to the Mayo Clinic, seeks to “increase breast size and change the shape of the chest” to make it more feminine in appearance.)

Her doctors recommended that she also undergo “bottom surgery,” which included vaginoplasty. The county’s health insurance plan, however, contained exclusions for “sex change” surgery. The exclusions extended not only to surgery but also to drugs related to transitioning. Even though the treatments recommended by the deputy’s doctors met the insurance company’s definition of “medically necessary,” the exclusion meant they weren’t covered.

Based on the enactment of the ACA (and, more specifically, the non-discrimination mandate within Section 1557 of that law), the county’s insurer modified its plans to wipe out exclusions for “Gender Identity Disorders and Sex Change Surgery.” Despite that modification by the insurer, and contrary to the insurance company’s recommendations, the county elected to keep the exclusion in its plan.

The Impact of the U.S. Supreme Court’s Discrimination Ruling in the Bostock Case

According to a federal judge in Macon, that exclusion amounted to illegal discrimination in violation of Title VII. The U.S. Supreme Court’s ruling in Bostock v. Clayton County, which established that sexual orientation and gender identity were protected classes under the umbrella of Title VII’s prohibition of sex discrimination, established a requirement the employer couldn’t get around. The ruling said that, whenever an employer makes an employment decision adversely affecting the “compensation, terms, conditions, or privileges of employment” because of an employee’s gender identity or sexual orientation, then that employer violated Title VII.

In the deputy’s case, the exclusion was adverse and discriminatory on its face. The county’s health insurance plan, for example, covered medically necessary breast surgeries for patients with breast cancer, but not those for employees who were transitioning. The plan covered hormone drugs for women in menopause, but would not pay for hormone drugs administered as part of a patient’s gender transition. That was clear discrimination that required a judgment in the deputy’s favor on her Title VII claim.

A 2021 study by the UCLA School of Law found that nearly one-half (46%) of all LGBTQ+ workers reported encountering discrimination at work. If that’s happened to you, you have the right to take action. The Atlanta gender identity discrimination attorneys at the law firm of Parks, Chesin & Walbert are here to help. Our team is highly experienced in handling a wide array of discrimination matters and is ready to get to work for you. Contact us through this website or at 404-873-8048 to schedule a consultation.

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