Georgia county fights paying for trans surgery

Attorneys representing Houston County and its sheriff told a panel of federal appellate judges that the government should not have to cover the gender transition surgery of a deputy.

Sgt. Anna Lange, a transgender woman who has worked for the Houston County Sheriff’s Department for 17 years, sued the county and its sheriff, Cullen Talton, in 2019 after she was denied health care coverage for a vaginoplasty, referred to as “bottom surgery” in the trans community. That surgery is estimated to cost about $25,000.

A federal district judge ruled last year that the denial discriminated against transgender people and ordered the county’s insurance plan to cover the treatment going forward.

During Tuesday’s hearing in the 11th U.S. Circuit Court of Appeals, attorneys for Houston County and Talton asked the appeals court to overturn the lower court’s ruling, arguing that the employee health care plan bans several procedures and medications.

For example, hormone therapy prescribed for gender dysphoria — the diagnosis often given to people who are transgender — is covered by the county plan, but surgeries are not, said Patrick Lail, an attorney representing Houston County.

“(That) shows that transition care is treated here like many other conditions, such as care for weight issues, is generally covered, but care for lap band surgery is excluded,” Lail said.

Appeals Court Judge Charles Wilson cited a 2020 U.S. Supreme Court ruling that said federal law prohibits discrimination against gay and transgender employees in the workplace.

“It’s clear that she is being denied medically necessary surgery solely based on the fact that she’s transgender,” Wilson said of Lange. “That’s clear here.”

David Brown, an attorney representing Lange, also based his argument on the 2020 Supreme Court ruling, which came in an unrelated Georgia case.

“The (Houston County) employee health plan covers medically necessary surgery,” Brown said. “Under it’s exclusion policy, it takes that coverage away from (Lange) because she is transgender. The exclusion here applies because of sex.”

Judge Andrew Brasher questioned whether the policy truly discriminated against transgender people.

Lange 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 the operation.

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.”