- Winning plaintiffs have asked the US Supreme Court not to take up cases from North Carolina and West Virginia challenging taxpayer-funded health plans' bans on coverage of medical treatments typically sought by transgender patients.
- The 4th US Circuit Court of Appeals issued an 8-6 ruling in April striking down the bans.
- State Treasurer Dale Folwell, who oversees North Carolina's plan, filed paperwork in July asking the nation's high court to consider the case.
Plaintiffs are asking the nation’s highest court not to consider a case challenging the North Carolina State Health Plan’s ban on funding medical treatments typically sought by transgender patients. The 4th US Circuit Court of Appeals ruled for the plaintiffs and against the State Health Plan in April.
State Treasurer Dale Folwell oversees the health plan. He filed paperwork in July seeking the US Supreme Court’s review of the case. The request covers a similar dispute in West Virginia.
“North Carolina and West Virginia administer health plans to cover medically necessary healthcare for their state employees and indigent citizens, respectively. Both plans, however, contain a targeted exception: they categorically exclude medically necessary gender-affirming care for transgender recipients,” according to the response brief filed Monday. “The same treatments are available to cisgender members, including for gender-affirming reasons.”
“These exclusions have serious consequences for the States’ transgender plan members: if untreated, gender dysphoria — the condition of marked incongruence between one’s gender and one’s sex assigned at birth — can have debilitating consequences, including depression, self-injury, and even suicide,” according to the court filing.
The plaintiffs’ lawyers argued that North Carolina and West Virginia would be blocked from enforcing their bans on the targeted treatments, even if the Supreme Court chooses to review claims related to the Constitution’s Equal Protection Clause.
Twenty-four states filed a brief in August supporting North Carolina and West Virginia in their appeals to the US Supreme Court.
“We appreciate the support nearly half of the states have shown by filing an amicus brief urging the US Supreme Court to review the Fourth Circuit Court of Appeals’ decision,” Folwell said in a prepared statement on Aug. 30.
“Our position remains unchanged,” Folwell added. “State governing bodies are best equipped to evaluate health care coverage that provides the greatest good to the highest number of people. They, and not the courts, are the proper place to make such decisions.”
In an 8-6 ruling delivered on April 29, the 4th US Circuit Court of Appeals tossed out the North Carolina State Health Plan’s ban on covering sex-change surgeries and other treatments. The ruling covered a similar ban in West Virginia.
“Do healthcare plans that cover medically necessary treatments for certain diagnoses but bar coverage of those same medically necessary treatments for a diagnosis unique to transgender patients violate either the Equal Protection Clause or other provisions of federal law? We hold that they do,” wrote Judge Roger Gregory for the court majority.
Missouri Attorney General Andrew Bailey led a coalition of 24 states filing a friend-of-the-court brief challenging that decision. Other states supporting the appeal are Alabama, Alaska, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Montana, Nebraska, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, Virginia, and Wyoming.
The states note “their strong interest in preserving the democratic prerogative of States to make decisions ‘in areas fraught with medical and scientific uncertainties,’” according to their brief.
“The Fourth Circuit’s decision threatens this democratic prerogative. Right in the very first sentence, the court errs — badly — in a way that taints the rest of its analysis. It concludes that gender transition interventions (such as puberty blockers, cross-sex hormones, and irreversible surgeries) are ‘medically necessary.’ To the contrary, just a few weeks before the Fourth Circuit’s decision, a four-year, four-hundred-page, comprehensive review conducted by the United Kingdom’s National Health Service concluded that the evidence for gender transition interventions is ‘remarkably weak,’ with ‘no good evidence on the long- term outcomes of interventions,’” the states’ brief argued.
“In light of this Court’s precedent recognizing that States have wide authority in areas of medical uncertainty, this Court should permit the States appropriate latitude to respond to these scientifically unsettled issues,” the state brief argued.
Folwell’s lawyers filed a petition with the US Supreme Court on July 26.
“For decades, the North Carolina State Health Plan for Teachers and State Employees has chosen to exclude coverage for treatments ‘leading to or in connection with sex changes or modifications.’ That exclusion is one of many in the Plan, which also excludes coverage for cosmetic services, experimental treatments, surgery for psychological or emotional reasons, and more,” Folwell’s lawyers wrote. “Each of those choices is designed to ensure that the Plan can provide the best possible coverage for all 740,000 of its members at a reasonable cost.”
“In the decision below, the en banc Fourth Circuit concluded that North Carolina’s coverage choices violate the Equal Protection Clause and permanently enjoined the State from excluding coverage for sex-change treatments,” the Supreme Court petition continued. “That decision is seriously flawed. North Carolina’s exclusion of coverage for sex-change treatments does not draw any classifications based on any protected trait. It distinguishes between medical treatments.”
The 4th Circuit decision “deviates” from tradition, Folwell’s lawyers wrote. “The decision deepens a conflict among the courts of appeals about whether laws targeting sex-change treatments trigger heightened scrutiny. The decision is egregiously wrong, and the question presented is profoundly important.”