This post is co-authored by Simone Chriss, Staff Attorney, Southern Legal Counsel.

Jami Claire is a Navy veteran and a senior biological scientist at the University of Florida’s College of Veterinary Medicine, which has employed her for 32 years. She receives health insurance through the university, which is a component of the State of Florida.

Unlike the overwhelming majority of the state’s employees, Ms. Claire’s insurance fails to cover medical care that is necessary for her health and well-being. Ms. Claire is a transgender woman, and the state’s insurance plans explicitly exclude coverage for the gender-affirming care transgender people, like Ms. Claire, need. The state’s mandated policy targets Ms. Claire and other transgender state employees, essentially placing their lives at risk by denying them insurance for medically necessary – and often life-saving – gender-affirming care. 

This discriminatory treatment has no place in Florida or anywhere across the United States. That’s why the ACLU of Florida, Southern Legal Counsel, and pro bono attorney Eric Lindstrom are suing the Florida Department of Management Services, the University of Florida, and the Public Defender of the Second Judicial Circuit of Florida on behalf of two transgender state employees. 

The state’s mandated policy targets Ms. Claire and other transgender state employees, essentially placing their lives at risk by denying them insurance for medically necessary – and often life-saving – gender-affirming care. 

 

Too many people misunderstand gender-affirming health care to be optional. But, the reality is, it’s not optional. Gender-affirming care constitutes medically necessary and life-saving care for many transgender people. By denying this medically necessary care, the State violates the Equal Protection Clause of the Fourteenth Amendment to the U.S. Constitution. It also violates Title VII of the 1964 Civil Rights Act, which prohibits employers from treating an employee differently regarding that employee’s compensation, terms, conditions, or privileges of employment on the basis of sex.

Ms. Claire has paid significant out-of-pocket expenses for treatment that should have been covered by her state health plan. She would have paid even more were she not a United States veteran with access to limited gender-affirming care through the Department of Veterans Affairs. But because of the state’s exclusion, transgender employees like Ms. Claire are forced to forego gender-affirming care unless they can afford to pay for it themselves, an obstacle many people cannot overcome. In Ms. Claire’s case, she has already spent thousands of dollars for treatment that her doctors agree is absolutely necessary for her health. 

Many transgender people experience gender dysphoria, the medical term for incongruence between a person’s gender identity and their sex assigned at birth where such incongruence results in clinically significant distress. Left untreated, gender dysphoria places transgender people experiencing it at great risk for anxiety, depression, self-injury, and suicide. Sadly, the percentage of transgender people attempting suicide is nine times the national average. Although 4.6 percent of cisgender attempt suicide at some point in their lives, a staggering 41 percent of transgender people attempt suicide.   

As our client, Ms. Claire, stated, “People should understand that for some individuals, because of anti-trans bias, being transgender can come with a lifetime of challenges, and Florida’s exclusion for gender-affirming care has only made it worse. I have served my country and the State of Florida for decades, and I pay my taxes like everyone else. That’s part of what makes it so painful to know that despite everything I have done in public service, the State of Florida still treats me like a second-class citizen. I cannot live without access to healthcare, and no person should be forced to be without access simply because they are transgender. That's why I'm taking this to court.”Previously, public and private insurance companies excluded coverage for gender-affirming care, claiming incorrectly that such care was cosmetic or experimental. These claims are false. Today, private insurance programs and the majority of Fortune 500 companies routinely cover gender-affirming care. Moreover, more than 20 states explicitly cover gender-affirming care in their Medicaid plans. And 19 states and the District of Columbia prohibit excluding gender-affirming care in private insurance policies.

Opponents of transgender equality have argued supposedly excessive costs for gender-affirming care merit denying insurance coverage for transgender people.  But federal courts have rightly concluded this excuse lacks any merit. For example, a federal court recently ordered Wisconsin to fund gender-affirming care through Medicaid. The court found the cost for gender-affirming care amounted to less than one tenth of one percent of Wisconsin’s $3.9 billion share of the state Medicaid bill.  

Everyone wants to feel valued, empowered, and safe in their workplace. But a categorical exclusion that denies transgender employees coverage for medically necessary gender-affirming care devalues transgender employees’ contributions to the workplace. It also places the transgender employee at greater risk for harassment, and it undermines employers’ abilities to hire or retain talented transgender applicants. For transgender people like Dr. Billy Huff, Florida’s categorical exclusion caused him to leave Florida and move to Illinois. Unlike Florida, Illinois supports and covers his medically necessary, life-saving healthcare.  

“For some of us, having access to surgeries and medical technologies can quite literally save our lives,” Dr. Huff says.  

Florida’s unconstitutional exclusion harms more than its transgender employees. Florida’s arbitrary exclusion also injures state employees’ transgender family members, including the employees’ spouses, children, and other dependents. Parents and guardians have a duty to care for their children, yet Florida has created a harmful barrier that precludes the type of health-care coverage state employees need to provide for their transgender loved ones. 

This lawsuit does not ask for special treatment. It asks Florida to provide equal treatment to all its employees. 

Too many roadblocks exist across the United States that preclude transgender people from living authentically without significant risks of discrimination and violence. Our clients are fighting to ensure medical care is not one of those roadblocks, and to make Florida a safer and more welcoming place for transgender Floridians and their families. Our clients are fighting to save lives. We join them in their fight and ask Florida to provide equal and fair treatment to all of its employees.

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