State treasurer will comply with court order on health coverage for transgender people

State Treasurer Dale Folwell says he will comply with a federal court’s order to stop an exclusion against treatment for transgender people covered by the state health plan.

“I strongly respect the rule of law,” Folwell said in a statement Wednesday. “So, until it is no longer in force, I must comply with the court’s order.”

Earlier this month, a federal judge in Winston-Salem a federal judge ruled in favor of plaintiffs in a lawsuit challenging North Carolina’s exclusion of gender-affirming health care for transgender state employee under the state health plan.

Policy Watch reported extensively on the suit and related issues when the suit was filed in 2019.

“We obviously disagree with the judge’s order that is, in essence, assuming responsibility for determining plan benefits for sex transition operations. We’re also disappointed the court decided to stop the case from being heard by a jury of North Carolinians,” Folwell said. “However, I’ve always said that if the legislature or the courts tell me we have to provide for sex transition operations and treatments, I would.”

Folwell, a conservative Republican and former state lawmaker, is chairman of the board by virtue of his office. Gov. Cooper’s state budget director, Charlie Perusse, is also an ex officio member. The other members are all appointed by Folwell or the General Assembly, whose GOP majority continues to contend that transgender identity does not exist, but is the result of improperly treated mental illness.

Treasurer Dale Folwell

That position is at odds with the view of the mainstream medical community, from the doctors who actually work with transgender patients to the American Medical Association and American Psychiatric Association. The APA recognizes gender dysphoria not as a mental illness but as “a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify.”

More than 40 years of research into and treatment of transgender people experiencing dysphoria has led psychiatric and medical professionals to conclude the most effective course of treatment is gender transition — aligning one’s life socially and sometimes physically to better match their gender identity. Not all transgender people choose to medically transition, but for those for whom it is judged necessary, medical experts agree it can be life-saving.

That’s why Blue Cross/Blue Shield of North Carolina, which administers the State Employee Health Plan has, since 2011, recognized dysphoria as a serious medical issue and covered treatments related to transition, including hormone therapy and gender confirmation surgery. That’s in line with many private health plans, Medicare and the federal employee health plan.

The trustees of the state health plan voted to begin covering treatments for gender dysphoria at the end of 2016 in order to comply with federal anti-discrimination laws.

Folwell and the plan’s trustees allowed that coverage to expire at the first opportunity — not renewing it for the 2018 plan year and making no move to reinstate it since.

For years Folwell has characterized the treatment recommended by doctors for transgender patients as “elective, non-emergency procedures” and referred to the treatment as “sex change operations.”

“Sex change operation” is not a term used by medical professionals treating transgender people, insurance companies or the LGBTQ community. It is widely considered offensive both because of its technical inaccuracy and because a wide array of various kinds of treatment — not just one operation — are utilized in gender transition.

In recent statements, Folwell has begun to refer to the procedures as “sex transition operations and procedures.”

One of plaintiffs in the lawsuit over the state health plan exclusion, Julie McKeown, is an assistant professor in the College of Education at N.C. State University.

In a statement on the victory, she said it sent “a powerful message of validation to the entire transgender community in North Carolina.”

“After years of fighting for fair treatment, finally having a court decide that these healthcare exclusions are wrong is vindicating,” she said. “As government employees, all we want is equal access to healthcare, but we were denied just because we are transgender.”

The federal court order was one of two significant victories for transgender North Carolinians last month.

The second was a to a consent judgment in a federal law suit  allowing people born in North Caorlina to change the gender marker on their birth certificates without undergoing medical transition.

The lawsuit, filed last year by Lambda Legal, Baker Botts LLP and Brooks Pierce McLendon Humphrey & Leonard, challenged state restrictions on how transgender North Carolinians can change their gender markers.

Many transgender people do not choose to have any surgery or to medically transition. They say requirements that they do so don’t reflect the reality of transgender peoples’ lives.

Last month’s judgment means the North Carolina Department of Health and Human Services and other state officials and agencies will have to provide birth certificates reflecting an applicant’s sex, consistent with their gender identity, without their having to undergo any surgery.
Under the judgment a transgender person born in North Carolina can change the sex designation on their birth certificate through submitting a sworn statement along with a passport or driver’s license or a certification from a licensed healthcare professional, social worker or case manager confirming their gender identity.

“This is a victory for all transgender people born in North Carolina that will help enable them to navigate life with safety and dignity,” said Omar Gonzalez-Pagan, counsel at Lambda Legal, in a statement Thursday. “We are gratified by North Carolina state officials’ agreement to reverse North Carolina’s policy prohibiting so many transgender people born in North Carolina from having accurate birth certificates. This lawsuit was just the latest step in our nationwide battle to break down barriers for transgender people to access accurate identity documents.”

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State treasurer will comply with court order on health coverage for transgender people