A judge ruled in favor of two transgender women challenged an insurance ban in Wisconsin for gender-affirming care and won.

In his order, US District Court Judge William Conley said the exclusion of gender-affirming care for state employee insurance plans violates federal anti-discrimination laws.

Gender dysphoria is the diagnostic term for the distress one feels when the sex they were assigned at birth does not match the gender they identify. University of Wisconsin-Madison graduate student Alina Boyden, and University of Wisconsin Medical School researcher Shannon Andrews both suffer from gender dysphoria.

They sued the Wisconsin insurance board and employee trust when they were denied coverage for treatment. According to their physicians, treatment is medically necessary for their gender dysphoria.

According to court documents, the state said in its defense it relied on benefits exclusions for “procedures, services, and supplies related to surgery and sex hormones associated with gender reassignment.”

In 2016, employee plans were amended to include gender affirming care in 2017. However, within days before the coverage went into effect, the state withdrew its amendment and reinstated the exclusion.

Wisconsin cited a federal court ruling in Texas that prevented federal enforcement of anti-discrimination protections for transgender and gender-nonconforming patients under the Affordable Care Act.

The state was concerned treatment would “insert the State directly into the business of encouraging surgeries meant to conform peoples’ appearances to their own perceived sex stereotypes.”

The state indicated the reason for restoring the original exclusion was the cost of providing coverage. The breakdown amounted to $300,000 in annual costs, around $.04 to $.10 per month per member.

Conley argued that not all transgender people need surgery in order to treat gender dysphoria. And that limiting the availability of resources for those who may seek gender-affirming treatment encourages sex stereotyping.

“The Exclusion entrenches the belief that transgender individuals must preserve the genitalia and other physical attributes of their natal birth over not just personal preference, but specific medical and psychological recommendations to the contrary,” Conley said.

He further said that by not allowing transgender people from living out their gender identity is “entirely disingenuous.”

Andrews ended up paying out of pocket for her surgery. “I’m pleased the court recognized that denying coverage for my medical care was sex discrimination,” she said.

“I, personally, was lucky to be in a position to have retirement funds and savings I could take out to fund my medical care, but had I been less fortunate I would not be alive today.”

“I hope that this will be a powerful signal that trans people are not fair game for discrimination and that our lives and health are not a political football.”

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