Employers across the country have fought against including gender-affirming care for their trans employees in company-wide health insurance plans, often citing high costs or pretending the surgeries are unnecessary (despite healthcare professionals repeatedly confirming that gender-affirming care is “medically necessary”). But in new a joint report, the 19th News and ProPublica found that a Georgia state department spent up to 40 times more money fighting discrimination lawsuits than it would have spent if it had just paid for their trans employees’ care in the first place.
Sheriff’s deputy Anna Lange came out as transgender to her employer, the Houston County Sheriff’s Office in Georgia, in 2017. She’d worked there for over a decade. At the time, her therapist had diagnosed Lange with gender dysphoria, noting that she was experiencing “significant distress” from not being able to live out her true gender. Her insurance through Houston County covered her hormones, but did not include her biannual lab work visits to monitor her body’s response to the hormones, which cost $400 per visit. Lange made just $58,000 per year.
In 2018, Lange took out several thousand dollars from her savings and retirement funds, according to ProPublica, to pay out-of-pocket for chest surgery. But she needed over $25,000 for her next transition surgery, which she couldn’t afford on her own. When she raised the concern with her employer, they reportedly refused to update the county’s health insurance plan to include coverage of gender-affirming care, including the surgery Lange was seeking. The county cited cost as the primary reason behind their decision. So Lange filed a federal discrimination lawsuit.
Propublica later discovered that Houston County paid a private law firm close to $1.2 million to fight Lange’s case in court—about 40 times the cost of the surgery itself. Experts consulted by Propublica also noted it would’ve cost the county less to offer trans-inclusive healthcare coverage not only to Lange but to all of its 1,500 health plan members. Further documents show that the legal fees spent on Lange’s case (which was public money, by the way) totaled almost three times the county’s entire physical and mental health budget. Despite winning the case in 2022, Houston County continues to appeal, claiming the cost of the surgery would be “exorbitant” (in its argument, the county referenced a New York Times article about the cost of phalloplasty...which is for trans men, not trans women). Lange is still waiting to have her surgery.
“It’s been a lonely process and it’s just a grind,” Lange told Propublica. “It just tears at you each day that you go by. You’re constantly reminded that you’re still not who you’re supposed to be.”
According to the report, in 2022, just 15 states offered health insurance plans that did not cover gender-affirming care for state employees, despite federal judges “consistently” ruling that employers cannot exclude gender-affirming care from their company-offered plans. And so far this year, 25 states are considering or have already passed legislation to ban gender-affirming care for minors.
This attack on trans Americans, of course, has nothing to do with medical opinions and everything to do with fear-mongering as part of the conservative moral panic around gender-diverse people, drag queens, and sex education. Given how much money Houston County was willing to spend on litigation, it’s clear that this was never about financial concerns, but about regulating state employees’ gender identities.