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I understand our limited information about this appeal, but I am wondering whether at the trial level there was any evidence of WHY transgender surgery was excluded. Was it the decision of the insurer, reflected in policies elsewhere, that such surgery is "cosmetic" as presumably breast enhancement surgery or face life surgery is? Or was the county presented with a choice whether to include or exclude transgender surgery and chose to exclude it in their particular package? If the latter, what was the cost savings of choosing such a plan? It is hard to imagine that county employees would deluge the insurer with such requests, such that there would be significant cost savings of a group plan to exclude it.

I don't AGREE that sex change surgery is "cosmetic" but I can see an insurance company deciding it is. In general, do insurers routinely exclude it for that reason, or is this unusual? Does an insurer who deems such surgery in general cosmetic have an appeals process by the doctor as to why in a particular instance it is more than that?

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The panel majority and dissent actually do discuss elements of these issues, so, we do have much of this information on appeal in the links I provided.

In short, and as Wilson concluded for the panel majority:

"The dissent describes Houston County’s health insurance plan as “just a cheap plan.” Brasher Dissent at 8. But costs savings do not excuse discrimination, nor may they be used to circumvent liability under Title VII. See Newport News Shipbuilding, 462 U.S. at 685 n.26. Regardless, the district court found that Houston County had not considered “any cost information prior to deciding not to consider Lange’s request to remove the Exclusion.” Lange v. Hous. Cnty., 608 F. Supp. 3d 1340, 1348, 1355 (M.D. Ga. 2022)."

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Ah, that suggests it wasn’t the insurer’s own general decision. Of course, excluding say diabetes would create a HUGE cost savings, but wouldn’t be nearly as “safe” as depriving a few trans folks of help.

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Trans-gender people are NOT the only class. People born with 2 sex organs,once called hermaphodites, are also a class that would play into this decision.

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The County’s insurance plan covers transgender people and provides treatments for gender dysphoria. Lange’s sex is not relevant to the County’s insurer at all. All that matters is whether Lange is asking the insurer to pay for the constellation of medical procedures known as a “sex change.”

He doesn’t even know what he wrote there.

What was SCOTUS logic about discrimination? “The way to stop discrimination basis of race is to stop discrimination on the basis of race.”

These judges are wordsmiths and definitely have a good grasp of discrimination when they don’t see it. /s

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And, I said slowly....

And....

Yay, that medical insurance should cover gender affirming care.

I read the article twice and don't get it.

Will they let it happen?

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The question is not whether it can. The question is whether an exclusion is illegal.

The district court said it was, the panel said it was. Now, though, the more conservative full court is going to reconsider it. We don’t know what they will do, but, as I wrote, there are reasons — 2022 and 2023 decisions — to be concerned.

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I think this is about as succinct as I could get:

“The panel upheld a lower court’s decision that the county could be sued for the discriminatory exclusion.

“Thursday’s order, however, means that a majority of the full court voted to revisit the May decision.”

I then go on to describe why them wanting to reconsider it is concerning.

That’s what we know right now.

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