State employee health plan sued over transgender procedures

Connor Thonen-Fleck addresses reporters while his parents stand by his side on Monday March 11, 2019, in Durham, North Carolina at the announcement of a lawsuit against North Carolina officials over how the state health plan is run. The lawsuit argues that North Carolina's state health plan for state employees discriminates by not covering hormone treatment and surgery for transgender people. (AP Photo/ Jonathan Drew)

DURHAM — North Carolina is being sued again over its treatment of transgender people, as state employees argue that their health plan violated federal law by dropping coverage of hormone treatments and certain surgeries.

The new lawsuit comes amid unresolved litigation over North Carolina’s so-called bathroom bill and the law that replaced it.


The lawsuit filed Monday argues the health plan for state employees violates federal health and education laws, as well as constitutional rights, by refusing to pay for some treatments that it once covered. The treatments prescribed by doctors to treat gender dysphoria are described as life-saving by five current or former state employees, along with two transgender dependents, who are suing.

“We have to think of it like any medical condition that is treated by a doctor and is diagnosed,” said Taylor Brown, the Lambda Legal lawyer leading the case, who is a transgender woman. “To have to live in a world that perceives you, and that assigns you, as something that you’re not … It can make life unlivable for many people. And that’s why we see such high suicide rates in the transgender community.”

The state employee health plan, which provides benefits for approximately 720,000 people, had covered the transition procedures for transgender people for the year 2017. The one-year policy went into effect just before former treasurer Janet Cowell left office. In December 2016, the health plan’s board considered a proposal to add the benefits. There was a procedural vote to consider the plan at a later meeting after the new treasurer took office. But Cowell, who did not seek re-election, broke a tie vote to have the plan voted on in Dec. 2016.

The lawsuit said coverage was excluded from the plan after that under Republican State Treasurer Dale Folwell, who took office in 2017.

A spokesman for Folwell, Frank Lester, said in an email that a previous treasurer had voted with the health plan’s board to cover the procedures for a year, but that no action was taken to extend the coverage under Folwell. Lester declined to comment further on the lawsuit, saying the office generally doesn’t discuss pending litigation.

The plaintiffs say the exclusion of coverage for transition-related treatments violates the federal Title IX education law, the constitution’s equal-protection clause and the federal Affordable Care Act.

“Transgender people are treated differently,” Brown said in an interview. “They’re not getting equal pay, in effect, for equal work.”

The Associated Press reviewed the lawsuit and was granted exclusive interviews with the plaintiffs before the litigation was announced at a news conference in Durham.

In similar cases, Lambda Legal sued Alaska on behalf of a legislative librarian and separately won a legal settlement for a New York county employee, both of whom were denied coverage for hormone therapy or surgery.

The North Carolina lawsuit comes amid a separate three-year legal fight over North Carolina’s 2016 “bathroom bill,” which in many public buildings required transgender people to use restrooms matching their birth certificates. While that requirement was later rescinded, a replacement law halts new local antidiscrimination ordinances until 2020. Last year, a federal judge allowed a lawsuit to move forward challenging the replacement law’s moratorium on new local measures.