KNOXVILLE, Tenn. — A lawsuit filed against the State of Tennessee, its insurance committee and several other government entities says transgender people are discriminated against in the state's public employee health benefits program.
Two people brought the lawsuit to court. One is an academic advisor at the University of Tennessee at Chattanooga, and the other is a former special education teacher in Knox County Schools. Both required treatment for gender dysphoria and had enrolled in the state's Comprehensive Medical and Hospitalization Program, which covers around 290,000 employees.
"The State Committee and LE Committee, through their members, each approve the plans to be offered under the Program, including the State Plan and the Local Education Plan, and are ultimately responsible for determining the plans’ “premiums, benefits package, funding method, administrative procedures, eligibility provisions, and rules,'" the lawsuit says.
Both UT and KCS participate in the program, and the lawsuit said it denies coverage for surgeries that treat or are related to "sex transformations." It says the exclusion has been included since at least 2016.
The lawsuit says that exclusion only applies to transgender people, because of the specific mention of "sex transformations." It also says that the program denies coverage for all health care related to a person being transgender, other than counseling.
"Program enrollees who are not transgender do not face similar hurdles and indeed can receive coverage for the same care that is denied to transgender enrollees because, for non-transgender employees, these treatments are not 'for . . . sex transformations,'" the lawsuit says.
It says that the exclusion violates the 14th Amendment of the U.S. Constitution, Title IX, and Title VII.
Around 21% of transgender people in Tennessee lost a job due to their gender, according to a study by the National Center for Transgender Equality. The Transgender Law Center also found 47% of transgender people and 58% of transgender women in the South saw high levels of violence from strangers.
The lawsuit says Story VanNess worked at KCS until July 2022 and had gender dysphoria. According to several medical boards and associations, gender dysphoria treatment is to help a person undergoing a gender transition in order to alleviate distress and allow the person to live in alignment with their gender identity.
Treatment can have three components: social, pharmacological and surgical.
The lawsuit says VanNess first told others she was transgender in her early 20s and was formally diagnosed with gender dysphoria. It said she was treated with hormone replacement therapy, but faced ridicule and lost several relationships as a result of her identity.
The lawsuit said she had to move back home and pause her transition, worsening her gender dysphoria.
"Although this was exceptionally difficult and worsened Ms. VanNess’ dysphoria, the alternative was homelessness," the lawsuit says.
She started working with KCS in July 2016. Around four years later, she started seeing a doctor who reconfirmed her diagnosis of gender dysphoria. A few months later, she told her friends that she was transgender and asked them to use her chosen name and pronouns. She also resumed hormone replacement therapy, under the supervision of her doctor.
Despite the therapy's benefits, she still faced severe distress as a result of gender dysphoria. The lawsuit also said that she feels unsafe in public.
"Every time she leaves the house, she braces herself for a violent attack. She experiences significant distress because, in addition to treating her gender dysphoria, facial gender-affirming surgery would make Ms. VanNess safer in public, but the Exclusion made this possibility inaccessible to her," the lawsuit says.
In 2021 her doctor, therapist and two surgeons recommended she undergo surgery to treat her gender dysphoria. However, she received a notice from her insurance company denying a pre-authorization request for coverage under KCS' insurance plan. It cited the state program's exclusion of surgeries for "sex transformations."
She appealed the denial in early 2022, and the insurance company continued to deny coverage. So, VanNess ended up paying out-of-pocket for part of the surgery.
"Because of the exclusion, she had to spend all of her savings, get financial assistance from friends, and delay paying other bills," the lawsuit says.
It says in July 2022, she felt she had no choice but to leave her job, "in part because of her inability to access necessary transgender-related care." It says she wants to continue working as an educator and got a master's degree in educational leadership in 2022.
The lawsuit also says Gerda Zinner works at the University of Tennessee at Chattanooga.
Zinner started hormone replacement therapy under the care of a doctor in Nov. 2019 and legally changed her name in Aug. 2020. However, she said the social and pharmacological treatment was not adequate to treat her gender dysphoria. So, she received several consultations and providers determined gender-affirming surgery was necessary to treat her gender dysphoria.
Her doctor and two therapists recommended she have surgery. However, in June 2020, she received a letter that said, "gender reassignment surgery isn't covered under your plan."
She later reached out to a state committee, asking them to include transgender healthcare in the insurance. But still, her surgery was canceled in November 2021 because of the exclusion.
She was not able to pay for the surgery out-of-pocket.
"Ms. Zinner feels that her life is on hold. Her unmet healthcare needs continue to weigh on her, leading her to feel stressed, anxious, depressed, and preoccupied," the lawsuit says.
The lawsuit asks for a trial by jury and asks for the court to declare that the state's exclusion of transgender healthcare in its insurance programs is unconstitutional.
