Court rules Houston County, sheriff didn’t discriminate against transgender deputy

Appellate judges reversed their decision Tuesday, stating a transgender deputy for the Houston County Sheriff’s Office was not discriminated against when her healthcare plan denied her gender-affirming surgery.

Over a dozen appellate judges of the 11th District of the U.S. Court of Appeals reconsidered their previous ruling from last year, which ruled that Houston County and its sheriff, Cullen Talton, discriminated against Anna Lange, a transgender employee, for excluding gender-affirming surgery from being covered by the county’s insurance policy, which previously violated Title VII.

Judge Charles Wilson had ruled on May 13, 2024, that health insurance providers could “be held liable under Title VII of the Civil Rights Act of 1964 for denying coverage for gender-affirming care to a transgender employee because the employee is transgender,” according to court records. But Houston County and Talton argued that they did not discriminate against Lange by not covering her gender-affirming medication via the county’s insurance because the insurance plan covered her endocrinologist visits, hormones and other treatments for her transition, court records show.

The 13 appellate judges, including Wilson, reviewed whether the insurance policy violates Title VII after a Feb. 2 hearing in Atlanta, eventually ruling on Tuesday that it did not.

“Although the plan does not cover sex change surgeries,” court documents show. “It does not treat anyone differently based on a protected characteristic.”

The original judgment made by Judge Marc Treadwell in June 2022, when he ruled that Houston County and Talton sexually discriminated against the employee, was vacated as a result of the new ruling. Treadwell’s injunction from October 2022 that ordered Houston County and Talton to notify their insurance providers, Anthem Blue Cross Blue Shield, to stop excluding coverage for services and medication for gender-affirming surgery, would also be vacated, court records show.

What changed?

When Wilson made his initial ruling last year, he relied on a Supreme Court decision in Bostock v. Clayton County that established that it would be a violation of Title VII if a transgender person were discriminated against because they are transgender, according to court records. But a new Supreme Court decision in United States v. Skrmetti, where plaintiffs argued that Tennessee law discriminated against sex when denying gender dysmorphia treatments in children, changed the outlook of Lange’s case.

Skrmetti’s case ultimately ruled that children cannot have access to puberty blockers or hormones to treat gender dysphoria, gender identity disorder or gender incongruence, but could have access to them if they receive a qualifying diagnosis, court records show.

“The County’s policy does not pay for a sex change operation for anyone regardless of their biological sex,” according to court records. “ If Lange were instead a natal woman who wanted a female-to-male sex change, the insurance policy would not pay for it. Or if Lange were a natal woman who sought coverage for the same male-to-female sex change that Lange received (perhaps for a male dependent), the County’s policy would operate in the same way — it would deny coverage.“

Even though Lange argued that the exclusion in her insurance plan penalizes a person for wanting to transition, the appellate judges ruled that “this argument is simply a mischaracterization of the plan’s function,” according to court records.

“The fact that the plan excludes coverage for one treatment for gender dysphoria is not a penalty in any sense of the word,” court records show. “The plan does not, for example, impose a surcharge on employees who have undergone a sex change. Instead, the plan declines to extend a benefit —namely, coverage for a sex change operation. And that benefit is declined to everyone.”

Seven of the judges agreed that Houston County and Talton did not discriminate against Lange, while five of them disagreed.

Lange was previously told her surgery would be covered

Lange worked as a patrol officer for the Houston County Sheriff’s Office starting in 2006, when she wore men’s clothes, used her male birth name and responded to male pronouns until 2017 after she was diagnosed with gender dysphoria. She informed Talton that she wished to start wearing women’s clothes, using her female name and going by female pronouns and he was supportive, according to court records.

Even though she had gone through feminizing breast surgery and hormone replacement therapy to reduce her gender dysphoria, she later decided to move forward with bottom surgery. Lange had called Anthem Blue Cross Blue Shield to confirm if the surgery was covered and was told that it was, but after the surgeon applied her insurance to pre-authorize the surgery in 2018, it was denied.

Lange appealed the decision but was denied. Blue Cross Blue Shield never responded to her second appeal. When she approached the county to request that it remove the exclusions in the health plan, since they enforce the qualifications for health care coverage, she was told that the exclusions would stay, according to court records.

It resulted in a lawsuit she filed against Houston County and Talton on April 10, 2020. Treadwell ruled the case in Lange’s favor, and when a jury trial was conducted to establish how much damages Lange would receive in the case, she was awarded $60,000.