Wisconsin Health Insurance Gender-Reassignment Exclusion Struck Down

A federal judge ruled that a Wisconsin state rule excluding health insurance coverage for medically necessary gender reassignment surgery is considered sex discrimination under federal law, reported WiscNews.

U.S. District Judge William Conley said, in a lawsuit brought by two UW-Madison employees who are transitioning to female, Alina Boyden and Shannon Andrews, that the rule set by the state Group Insurance Board (GIB), which excludes coverage of gender transition-related care, violates a federal prohibition on discrimination on the basis of sex under the federal Civil Rights Act.

Conley added that it also violates an anti-discrimination provision of the Patient Protection and Affordable Care Act.

GIB voted in July 2016 to drop the exclusion and was to begin allowing coverage for transition-related care in January 2017.

However, in August of 2017, the state Department of Justice asked GIB to reinstate the exclusion, arguing that federal rules improperly interpreted sex discrimination as applying to gender identity.

According to Conley’s ruling, the state argued that the cost of providing coverage and the safety or efficacy of gender-confirming surgery and hormone therapy were the reasons for reinstating the exclusion. However, Conley said there appeared to be no dispute that the cost was “immaterial” at 0.1 to 0.2 percent of the total cost of providing healthcare to state workers.

“Not only is the record devoid of any evidence to show that GIB members voted as they did for cost or efficacy reasons,” Conley wrote in his ruling, “the evidence is overwhelming that the actual or genuine reason for the reinstatement had to do with the DOJ’s guidance,” specifically a belief by DOJ that an injunction issued by a court in Texas “absolved defendants of any legal obligation to provide coverage.”

DOJ disagreed with this claim, insisting that cost and efficacy were the reasons.

Conley made a similar ruling in July in a separate case involving a rule that bars the use of Medicaid funds for gender-confirming surgery for people diagnosed with gender dysphoria.

In this case, Conley issued a preliminary injunction barring enforcement of the rule. The state Department of Justice appealed this ruling.