A transgender Houston County sheriff’s deputy fought Tuesday to preserve a landmark ruling by the conservative Atlanta-based federal appeals court as it reconsiders whether employers can be liable for denying insurance coverage for employees’ transgender-related health care.
Sgt. Anna Lange attended oral arguments at the 11th Circuit in Atlanta where her legal team worked to persuade a 13-judge panel that Houston County and its sheriff violated the Civil Rights Act by refusing coverage for Lange’s medical needs associated with her transgender status.
Lange’s case has implications for many transgender rights cases in Georgia, Florida and Alabama, where the 11th Circuit’s rulings are binding. It builds on the groundwork established in another landmark Georgia case, brought by Atlantan Gerald Bostock, that led to the U.S. Supreme Court protecting employees from discrimination because of sexuality or gender identity.
“I have hope that the right thing will be done,” Lange told The Atlanta Journal-Constitution after the 11th Circuit hearing Tuesday. “Transgender people are people and we deserve to be treated just like everybody else. The fight will continue until we’re treated equally.”
Credit: Rosie Manins
Credit: Rosie Manins
Houston County and its sheriff have been defending their policy for employee health coverage since Lange sued them in 2019. The county and sheriff urged the 11th Circuit to reconsider the case after a three-judge panel ruled in Lange’s favor in May 2024.
The May ruling was the first time a federal appellate court had concluded that it is unlawful for an employer to discriminate against transgender people in an employee health plan, according to Lange’s legal team.
In August, the 11th Circuit vacated its earlier decision in which a judge appointed by President Donald Trump dissented. On Tuesday, all 12 of the court’s core judges heard arguments in the case as well as Senior Judge Charles Wilson, a Bill Clinton appointee who wrote the May opinion in favor of Lange.
Georgia, Florida and Alabama filed a brief in the case supporting Houston County and its sheriff. The states asked the 11th Circuit to clarify that Congress did not require all employer health plans to cover sex-change surgeries.
The federal government had initially supported Lange in the case, filing a brief in October saying the Civil Rights Act prohibits sex discrimination, including discrimination on the basis of transgender status. Upon Trump’s return to the White House, the federal government withdrew its involvement in the case.
Houston County and its sheriff have maintained that their health plan lawfully provides and denies coverage based on the type of care or procedure, rather than an employee’s gender or sexual orientation.
“This health plan does not make distinctions based on people, it makes distinctions based on medical procedures,” Patrick Lail, an attorney representing Houston County and its sheriff, told the court Tuesday. “The plan covered Sgt. Lange’s nonsurgical care, including her endocrinologist visits, her hormones and her psychologist visits.”
Lange said Tuesday that she didn’t receive coverage under the plan for any treatment coded as transgender health care, including blood tests, health exams, some endocrinologist appointments and surgery. She said the county and sheriff allowed coverage for hormone replacement therapy because it wasn’t coded under transgender health care.
“The minute they started coding things under transgender health care is the minute I started getting denied for coverage,” she said. “When they say they covered things, it’s misleading.”
Lange said plan provider Anthem Blue Cross Blue Shield determined that every treatment she sought was medically necessary.
Lail said exclusions in the county’s health plan apply to all participants, transgender or not, and are based on the overall cost of the plan.
Gabriel Arkles, an attorney representing Lange, said treating her differently because she is transgender is unlawful and discriminatory. He said it is disappointing that Houston County and its sheriff’s office continue to defend the health plan, alleging they have spent more than $2 million on the case, far more than Lange’s health care would have cost.
Credit: Rosie Manins
Credit: Rosie Manins
The 11th Circuit is considered to be one of the most conservative federal appellate courts in the country, in large part because Trump was able to appoint six of its current judges. Chief Judge William Pryor Jr. was appointed by former President George W. Bush.
There is no deadline for the court’s decision.
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