Transgender employees sue Florida over state's trans health care ban

State employees are unable to access gender-affirming health care due to a ban on those services in their health insurance plan.
By Tim Fitzsimons

Two transgender women filed a lawsuit against the state of Florida on Monday over its ban on transgender-related health care for state workers, arguing it violates the U.S. Constitution and Title VII of the Civil Rights Act.

“We brought this lawsuit because all people need access to medical care. This is not about special treatment; this is about equal treatment,” said lead counsel Simone Chriss. “Transgender state employees are singled out and explicitly denied coverage for one reason: They are transgender. That is discrimination, and it cannot stand.”

Jami Claire.ACLU Foundation of Florida

The suit, which was brought by Southern Legal Counsel, the ACLU of Florida and Eric Lindstrom, an attorney, seeks to end Florida’s State Plan Exclusion, a rule that prohibits state employer-provided health plans from covering “gender reassignment or modification services or supplies.”

The plaintiffs, Jami Claire and Kathryn Lane, both state employees, have had to delay their transition-related care, which their suit argues worsened their gender dysphoria.

In part because many of the same private insurance plans provided by Florida to its employees would cover transition-related care if the plans were provided by nonstate employers, the suit argues that the State Plan Exclusion “constitutes unlawful sex discrimination in violation of Title VII and the Equal Protection Clause.”

“As a result of the State Plan Exclusion, nontransgender employees receive coverage for all medically necessary health care, but transgender employees do not,” the suit states.

For example, if a cisgender Florida state employee required an orchiectomy as treatment for testicular cancer, it would be covered by his state-provided plan. However, if a transgender woman sought the same surgery to eliminate testosterone production and alleviate gender dysphoria, it would not.

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The plaintiffs are both employees of the state of Florida — Claire is a researcher at the University of Florida’s College of Veterinary Medicine, and Lane works in a Tallahassee public defender’s office. Both are covered by employer-sponsored health plans, but since the plans are provided by the state, they are banned from any coverage for transition-related health care.

The suit claims the plaintiffs have also faced additional financial burdens due to the state’s trans health care ban.

Claire began her transition in 1997, but was forced to pause in 2002 after her divorce affected her finances. Claire said she then attempted suicide three times.

“I literally couldn’t see a way financially forward,” she explained. “I went through 10, 14 years of hell.”

She resumed her transition 16 years later, and in 2016 fully transitioned socially. Although she has paid for her private insurance premiums through her employer, the University of Florida, Claire has been barred from any coverage of her transition-related care, and has therefore been forced to pay out of pocket for all of transition-related expenses.

Claire's experience with her employer has been positive — Claire said the university has been understanding as she has worked through her mental health challenges. However, she said her health plan’s ban on trans-related care has made her feel like “a second-class employee.”

“I pay for my health insurance for 30 years now, but I can’t use all of it,” she said. “Everybody else pays for their insurance and they get to use it like they want, but I don’t get to use mine.”

Billy Huff.ACLU Foundation of Florida

One of the original plaintiffs in the case, a transgender man, Billy Huff, will be called as a witness instead. Huff said he left Florida for a job in Illinois, since staying in the state while subject to the State Plan Exclusion was having too great an impact on his gender dysphoria.

“Part of the impact was having to leave,” Huff told NBC News. “I left my home and my friends.”

Huff was the director of the University of Florida’s LGBTQ center, where he said he promised students that he “would be their best advocate.”

“Knowing that a lot of students that I worked for would go on to work for state offices in Florida, I thought I should try to change it if I could do something,” Huff said of his efforts to start the lawsuit.

“When I was looking to leave, I only applied at universities that were in states that covered transition-related health care,” Huff said. “That was one of my main qualifications.”

Similar suits have had mixed success in other states. Last March, Iowa’s Supreme Court struck down a 1995 ban on Medicaid coverage of transition-related health care. The following month, Republican lawmakers passed a new bill reiterating and clarifying the state ban on transition-related Medicaid coverage, according to The Des Moines Register. That rule stands.

In addition, the U.S. Supreme Court is currently reviewing the question of whether Title VII of the Civil Rights Act — which “prohibits employment discrimination based on race, color, religion, sex and national origin” — affords protections to LGBTQ people through its ban on “sex” discrimination.

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