On April 29, the 4th Circuit Court of Appeals ruled that both North Carolina and West Virginia state health plans must provide coverage for gender affirming care. In an 8-6 decision, a majority of the court agreed that the denial of gender affirming care is discriminatory.
North Carolina’s previous policy indicated denial of coverage if it was “leading to or in connection with sex changes or modifications and related care.” Unlike N.C, West Virginia has been covering hormone therapy for transgender people since 2017. However, surgeries like mastectomies would only be covered if it was for cancer treatment, not to treat gender dysphoria.
Both states argued that coverage for gender affirming care would use more taxpayer money making it costly, and that it was medically ineffective. The court majority dismissed these arguments due to lack of support and evidence, noting that without safe access it would harm the mental and physical health of transgender people. According to Judge Roger Gregory, “the coverage exclusions facially discriminate on the basis of sex and gender identity, and are not substantially related to an important government interest.”
After hearing the ruling, North Carolina State Treasure Dale Folwell, hopes that the decision “will be corrected by the U.S. Supreme Court.” West Virginia Attorney General Patrick Morrisey states in his closing statement, “decisions like this one, from a court dominated by Obama- and Biden-appointees, cannot stand: we’ll take this up to the Supreme Court and win.”A dissenting judge from the 4th circuit further adds, “the authority to tell States how to draft insurance policies covering state employees on state health care plans…is a breach of our federal system. It is an intrusion upon the residual powers that the Constitution guarantees to the States.”
Miles Estep, an IB Junior at Millbrook, believes that this new ruling is a good precedent that provides hope.
Although this ruling is a stepping stone into inclusion, Estep expresses, “being queer is a big part of my identity and [who] I am, but being from the south…it feels weird to be living in a place that has so many systems set up that make it hard to exist as you are.” These systems include legislations like: SB49 which prevents teachers from creating safe, inclusive classrooms; HB57 that prohibits transgender students from participating in school sports consistent with their gender identity and HB808 that prohibits gender-affirming care for transgender minors.
This ruling protects access to gender-affirming care for transgender adults on both N.C and W.V state health plans. Megan Fritz, a teacher at Millbrook, believes that “health care policies need to be more equitable for people to access and receive the care they need.”
This decision will now apply to other federal court cases brought in other states in the 4th Circuit: South Carolina, Virginia and Maryland. The 11th Circuit is currently considering two other similar cases in Georgia and Florida.
