Federal Judge Rules State Must Cover Transgender Treatment For Workers

A federal judge ruled Tuesday that Wisconsin’s Group Insurance Board and the University of Wisconsin System must cover hormone therapy and sex reassignment surgery for transgender state workers.

Judge William Conley of the U.S. District Court for the Western District of Wisconsin found that refusing transition-related care for state workers is unconstitutional and sex discrimination.

His ruling stated that it violates Title VII of the Civil Rights Act of 1964, which prohibits sex discrimination in employment, the nondiscrimination provision of the Affordable Care Act, and the Equal Protection Clause of the 14th Amendment to the U.S. Constitution.

“The judge’s recognition that discrimination against trans women and other trans people is specifically a form of sex discrimination is an excellent recognition to have,” said Dr. Shannon Andrews, an assistant researcher in the University of Wisconsin Carbone Cancer Center and one of the plaintiffs. That’s because it affords more robust legal protections for trans people in healthcare, beyond insurance companies paying for surgery or hormones, Andrews said.

Larry Dupuis, legal director for the American Civil Liberties Union of Wisconsin, which brought the suit on behalf of Andrews and her co-plaintiff, highlighted this categorization of sex discrimination as the “big thing” to takeaway from this ruling.

Dupuis noted that this follows a recent decision by the same judge that held the state cannot prohibit the use of Medicaid funds for gender reassignment surgery. In that case, Conley specifically issued an injunction against such an exclusion for two low-income Wisconsin residents who had sought treatment for gender dysphoria.

“All of this is part of what we see as a trend toward providing coverage for medically necessary care for transgender people around the country,” said Dupuis.

Andrews paid out of pocket for her own sex reassignment surgery in October 2015 after her insurance denied her request for pre-approval and her claim.

She said this week’s ruling made her “cautiously optimistic.”

“I think for everybody else (this ruling is) cause for celebration because it’s a major step towards equality in healthcare for Wisconsin,” she said. “For me and Alina personally, the fight is not over.”

Andrews and her co-plaintiff, Alina Boyden, have a jury trial in the same court next month, which will determine the amount of damages to which they are entitled and sketch out changes to state policy. Both are transgender women and UW employees.

While plaintiffs and advocates hailed the ruling as a victory, it’s somewhat symbolic on a practical level because the state Group Insurance Board already repealed its exclusion for this type of care last month in a 5-4 decision and said it would begin coverage Jan. 1, 2019. However, the Board has gone back and forth on offering coverage.

Both Andrews, the plaintiff and Dupuis, the ACLU Wisconsin legal director, said this ruling is significant given this history.

“The fact that the Group Insurance Board went ahead and lifted (the exclusion) again doesn’t really mean very much to me because unfortunately they have a history of going back on this and snatching things that they’ve promised,” said Andrews.

“We have concern that they could reverse course yet again, and so we just want finality on this,” said Dupuis. “That’s part of what will happen going forward.”

The Group Insurance Board did not respond to comment by time of publication.