Appeals Court Says State Health Policies Excluding Sex Change Surgeries Violate Constitution

The U.S. Court of Appeals for the Fourth Circuit ruled against two state-level health policies that exclude so-called “gender-affirming” treatments, teeing up potential review by the U.S. Supreme Court. Judge Roger Gregory, an appointee of Presidents Bill Clinton and George W. Bush, wrote in his majority opinion that the policies’ exclusion of surgeries such as vaginoplasties for certain diagnoses violated the Equal Protection Clause of the 14th Amendment. “The coverage exclusions facially discriminate on the basis of sex and gender identity, and are not substantially related to an important government interest,” he said. The 8–6 decision affirmed lower court decisions against West Virginia’s Medicaid policy and the North Carolina State Health Plan for Teachers and State Employees. Both aimed to preclude coverage of procedures or treatments pursuant to attempts at changing one’s gender....