Two transgender employees are suing the state of Florida, alleging sex discrimination in their health insurance coverage.
According to the complaint, Jami Claire and Kathryn Lane are going without necessary treatment for gender dysphoria because state health care plans specifically exclude coverage for gender-affirming care.
Claire, a senior biological scientist at the University of Florida, and Lane, a lawyer in the public defender’s office in Tallahassee, are both transgender women. They’re suing their employers as well as the state’s Division of Management Services, which manages health insurance benefits. The ACLU of Florida and Southern Legal Counsel are representing them.
Health maintenance organizations offered to state employees (including Aetna and UnitedHealthcare) exclude coverage of “gender reassignment or modification services and supplies,” according to published summaries of their plans. Florida Blue excludes “sexual reassignment, or modification services or supplies.” Exceptions can be made in certain cases, the plans note.
“Transgender state employees are singled out and explicitly denied coverage for one reason: they are transgender," said Southern Legal Counsel attorney Simone Chriss, lead counsel for the case. "That is discrimination, and it cannot stand.”
The lawsuit argues excluding gender-affirming care is sex discrimination and violates Title VII of the Civil Rights Act and the Equal Protection Clause of the Fourteenth Amendment.
“I think there’s this misconception that it’s special, unnecessary, different treatment,” Chriss said. “What we are asking for is simply equal treatment, equal access to a health insurance plan, equal access to coverage for these benefits.”
Claire, 62, has worked for the University of Florida for 32 years. She said she began transitioning in 1997, paying out of pocket, but had to stop five years later. The cost was too high.
When she found out then about the state’s insurance policy, she spiraled into a deep depression that led to three suicide attempts, she said.
The University of Florida does offer gender-affirming care to certain employees through “GatorCare," but that didn’t include Claire, according to the complaint.
In 2016, she resumed her transition but found the state’s insurance still wouldn’t cover her care. She hopes other transgender people won’t have to go without treatment.
“Having these surgeries is life-affirming,” she said. “Many trans people, and I’m one of them, attempt self-harm or attempt to remove those body parts. It can be bloody, it can be messy and it can kill you.”
Gender dysphoria is discomfort or distress that people can feel when their gender identity is different from the sex they were assigned at birth. It can cause anxiety and depression and lead to risks of self-harm and suicide, according to the Mayo Clinic.
A 2019 issue brief from the American Medical Association said when surveyed, 25 percent of transgender people had an issue with their insurance for transition care. The brief mentions that suicide rates plummet when transgender people receive medical treatment.
For Billy Huff, former director of LGBTQ Affairs at the University of Florida, the lack of health care coverage drove him to leave the state.
Huff, 44, is transgender and thought he’d be able to get top surgery, a double mastectomy. He said he paid the $500 deposit and was counting down the days on a calendar. But then Aetna notified him they wouldn’t cover it because of the state’s exception.
Now working at the University of Illinois Urbana-Champaign, Huff said he has the same health insurance provider as before. Only this time around, his surgery will be covered.
“It’s ridiculous to me that, depending on what state you’re in, you’re allowed to exist or not,” he said.
In recent years, residents of other states, like Wisconsin, have gone to court to fight exclusionary practices and won.
Another witness in the Florida case, who declined to be named out of respect for her daughter’s privacy, works for the state and has a 12-year-old transgender child. At the onset of puberty, transgender children can use hormone blockers to delay development.
When she called Florida Blue, part of her state-approved PPO plan, she was told her daughter couldn’t get the treatment, pointing to a part of their handbook that excludes health care services for “sexual deviations and disorders, psychosexual dysfunction.”
It was like a gut punch.
“No one should be called a psychosexual deviant,” she said. “It is 2020."
Her daughter was able to get the blockers covered, in a rare approval that required a fight. The mother said she was privileged to be able to contact a lawyer to help her out. But she doesn’t know if it’ll be taken away or if later medical procedures will be turned down.
To her, the lawsuit could change the things her daughter, and other trans people in the state, struggle with.
“A few people who have resources and courage and were willing to take really enormous personal risk are going to stand up and do the right thing,” she said. “And if they’re successful they'll be the change for all these other people who haven't been so privileged.”
Claire said she’s scared of retaliation or backlash from being a plaintiff, but she feels it’s vital. She said she’s essentially lost relationships with her family, both the one to which she was born and the one she raised. She warned that losing loved ones is often a risk for transgender people, and acknowledged that risks can be worse for transgender people of color.
But, she talked of the joy she feels in being able to live “as your authentic self,” and now has greater support from friends.
“I would not trade my life now for anything,” she said. “I am happier now than I have ever been, in spite of all the issues I have now.”
A University of Florida spokesman said the university does not comment on pending legislation. The Department of Management Services did not respond to requests by phone and email to comment.