RALEIGH, N.C. (CN) – State employees claim in court that North Carolina’s government health plan discriminates against transgender people by not providing them with coverage for vital medical care.
“Non-transgender enrollees receive coverage for medically necessary mental health, prescription drug and surgical needs that, because of their sex, transgender enrollees do not,” according to a lawsuit filed Monday in Raleigh federal court by attorneys with Lambda Legal, Transgender Legal Defense and Education Fund and local firm Harris, Wiltshire & Grannis.
Maxwell Kadel and six co-plaintiffs say the health plan for government employees and their dependents violates the equal protection clause of the Fourteenth Amendment, Title IX and the Affordable Care Act.
The health plan for teachers and other state employees covered sex reassignment procedures and other health benefits for transgender people in 2017, after exclusions of transgender-related health care were protested as discriminatory under the ACA. But that coverage only lasted a year, according to the complaint.
When Republican State Treasurer Dale Folwell took office, the more inclusive 2017 benefit resolutions expired and Folwell refused to remove the exclusions, the lawsuit states.
The current health plan, which mirrors the pre-2017 plans for state employees, does not cover hormone replacement therapy, counseling that is specifically appropriate for transgender people, or surgical procedures related to sex transitions.
“Because the only people who require treatments related to gender-confirming health care are transgender people, denying coverage for that type of health care discriminates against transgender people,” the 40-page complaint states.
Noah Lewis, senior staff attorney for Transgender Legal Defense and Education Fund, sought last October to remove the exclusions for transgender health care but Folwell, whose office oversees the state plan, allegedly said he will not do so unless a court orders him to.
Folwell, who did not immediately respond to a request for comment Monday, is listed as a defendant in the complaint alongside Dee Jones, executive administrator of the health plan, and several state universities.
Lewis, who is also the founder and executive director of Transcend Legal, told Courthouse News he began working toward bettering health coverage for state employees in 2015, when one of them was denied coverage for their 18-year-old son’s transition and approached him for help.
Courts in states across the country, including Alaska and Iowa, are finding similar health care exclusions to be unconstitutional, Lewis noted.
Taylor Brown, an attorney with the southern regional office of Lambda Legal, is working on a similar case in Alaska.
Brown said after she graduated from UNC Chapel Hill, she made the choice to leave her home in western North Carolina and travel to New York, where she could receive proper health care as a transgender woman.
Brown said through legal action, she hopes to set a precedent that shows state governments they should be inclusive of transgender people through their health care plans.
“People should not have to make that choice, to leave their families and their jobs, to move to a state where health care is accessible,” she said in an interview.
She said she is concerned for North Carolinians who don’t have the financial option to uproot to seek health care.
“The medical community has adopted standard practices for transgender patients,” Brown said. “I am tired of the headlines asking, ‘Why should taxpayers fund transition surgery?’ The employees are paying into this plan and it is not just surgery, but additional medical ways to help transgender patients and to treat gender dysphoria.”
Lewis said gender dysphoria is a recognized diagnosis by the American Medical Association.
Connor Thonen-Fleck, now 16, was an unhappy child, and it broke his father’s heart to witness his son’s suffering on a daily basis.
“He felt like an alien in his own body,” Connor’s father Jason Fleck, who works at UNC Greensboro, told Courthouse News on Monday.
When Connor visited a therapist and learned there are valid, medical reasons behind the distress he had always endured, his father said, the young man smiled and laughed for the first time in years.
Connor was assigned a sex and gender at birth that did not match his identity, and spent much of his childhood battling symptoms of gender dysphoria.
Not every transgender person experiences gender dysphoria, Brown said, but people who do have a higher risk of suicide and can experience depression and anxiety.
Lewis backed up Brown’s list of symptoms in a separate interview, adding that those with gender dysphoria can succumb to substance abuse as a result of lifelong distress.
Connor began hormone replacement therapy last January, which his parents paid for out-of-pocket.
Any counseling or medical visits related to his transition are not covered under his parents’ state employee medical plan since the 2017 backtrack by Folwell’s office.
On Monday, he confidently stood before news cameras to explain why he and his father joined in the lawsuit.
“Gender dysphoria is one of those things that is difficult to understand if you have never experienced it or have never been close to someone who is struggling with it,” Jason Fleck told Courthouse News.
He said, as detailed in Monday’s lawsuit, that he is paying into his state employee health plan and wants the same level of treatment and benefits given to those who are not transgender or do not have transgender dependents.
“Experience has shown that when employers get rid of exclusions in their health plans, the cost does not increase,” Lewis said. This is partially due to the small number of transgender employees in the U.S., he and Brown said.
The cost of covering transgender people under health plans is not an issue, according to Brown, Lewis and Fleck.
“It is hard to imagine how it feels for someone like Connor to hear somebody say that transgender health care is not really needed, that it is elective,” Fleck said.