A4TE Responds to Eleventh Circuit Decision Upholding Discriminatory Health Care Exclusion

[Atlanta, GA] – Last evening, the US Court of Appeals for the Eleventh Circuit issued its ruling in Lange vs. Houston County, a challenge brought by a transgender woman against her employer for banning access to medically necessary healthcare.  The appellate court reversed the trial court’s decision in Sgt. Lange’s favor, ruling she must go to trial to prove her employer discriminated against her, despite the clear language in the employer’s health plan excluding coverage for transition-related healthcare based on sex. 
 
“After everything I’ve been through, it’s crushing to know I will have to continue to fight to get what a jury already said I was entitled to,” said Sergeant Anna Lange. “This should never have happened to me, and it shouldn’t happen to anyone else.” 

Advocates for Trans Equality (A4TE), formerly TLDEF, brought the case on Lange’s behalf in 2019, after her employer refused to cover her healthcare needs. Despite clear medical needs and expert recommendations, the county maintained a categorical exclusion on transition-related care. 

“This is a loss not just for Anna, but for every trans person who relies on employer-provided health insurance,” said Gabriel Arkles, A4TE Co-Interim Legal Director. “The court had a chance to deliver a clear, decisive ruling that discrimination against trans workers in health benefits is illegal. Instead, it has muddied the waters and needlessly prolonged this case. Nonetheless, we are confident Anna can prove her case at trial.” 

"While we are deeply disappointed in the court’s decision, we remain focused on vigorously fighting for Anna’s right to medically necessary healthcare and will continue to do so as the case proceeds,” said Jill Grant of Willkie Farr & Gallagher LLP. 

Even though the U.S. District Court for the Middle District of Georgia ruled in 2022 that Houston County’s policy violated Title VII and a panel of the Eleventh Circuit upheld the trial court’s decision, the full Eleventh Circuit’s failure to affirm that holding undercuts the impact of that win. Sergeant Lange, a sheriff’s deputy, came out to her employer as a trans woman in 2017 and was diagnosed with gender dysphoria. Her care was denied solely because it was related to her transition. Houston County instead chose to pour around $2 million of taxpayer money into defending its exclusion - many times the cost of the care Lange actually needed. 

In 2019, A4TE filed suit, and over the years, the case drew support from the U.S. Department of Justice and leading medical experts across the country. Sgt. Lange prevailed before a panel of the Eleventh Circuit. Still, the en banc Eleventh Circuit declined to uphold the trial court’s and panel’s decisions and instead sent the case back for trial.  

“Federal law still protects trans workers,” said Arkles. “Employers that choose to exclude trans care from coverage will have to defend their actions in court, as Houston County must here. Discrimination against trans people remains illegal, expensive, and wrong.” 

Sergeant Lange is one of more than 500,000 trans people living in the South, according to research by the Williams Institute at UCLA School of Law. Nationally, one in four transgender people have been denied insurance coverage for gender-affirming care, and 55% have been denied coverage for surgical procedures, according to the most recent U.S. Transgender Survey. 

The case is litigated by A4TE attorneys Gabriel Arkles, Ezra Cukor, Shayna Medley, Seran Gee, and Kelly Parry-Johnson, with co-counsel from Willkie Farr & Gallagher LLP, Cooper, Barton & Cooper, and the Quinnipiac University School of Law Legal Clinic. Former TLDEF attorneys David Brown, Alejandra Caraballo, and Noah Lewis also contributed to the case. 

The case is Lange v. Houston County, Georgia. 
 
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