10-01-2025
A transgender woman worked as a deputy for Houston County, Georgia. Anna Lange began presenting as female in 2017. She underwent hormone therapy, met with an endocrinologist, and received psychological care with her employer’s insurance covering each of these treatments. However, when Lange wanted gender-affirming surgery, the County denied the claim. The County’s policy expressly excluded medications, services, and supplies related to gender affirming surgery. Lange filed a charge of discrimination with the EEOC and then a lawsuit.
A district court granted summary judgment in her favor, and an Eleventh Circuit panel affirmed that decision. However, the full court voted to rehear the case on a single issue: whether the County’s insurance policy facially violated Title VII for its exclusion of gender reassignment surgery. Lange’s attorney argued that the County would have provided similar coverage for individuals requiring this type of surgery for cancer or a car accident. They argued that, given the ‘undisputed’ fact that the challenged provision of the plan denied coverage solely to transgender members, it facially discriminated based on sex.
The en banc appellate court reversed its earlier decision, largely based on the U.S. Supreme Court’s opinion in United States v. Skrmetti (2025). In that decision, the Supreme Court upheld Tennessee’s ban on gender-affirming care for minors, holding that coverage was denied based on medical care, not on an individual’s sex. Because the County’s health insurance policy would deny Lange treatment for gender reassignment surgery, whether she was male or female, they claimed it was not discriminatory based on sex. The Eleventh Circuit said, “The County’s policy does not pay for a sex change operation for anyone regardless of their biological sex.”