A complaint filed by multiple law firms wants the North Carolina State Employees Health Plan to cover transgender sex-reassignment surgeries and hormone treatments.
The complaint was filed by Lambda Legal, the Transgender Legal Defense and Education Fund (LLTDEF) and local attornies affiliated with Harris, Wiltshire & Grannis.
“The only reason our plaintiffs are being denied coverage for medically necessary health care is because they are transgender or they have children who are transgender,” said Lambda Legal’s Taylor Brown in a press release.
The filing accuses the State Health Plan of discriminating against transgender employees and their dependents by depriving “transgender enrollees of coverage for the treatment of gender dysphoria – the clinically significant distress that can result from the dissonance between an individual’s gender identity and sex assigned at birth.”
The suit claims ‘targeted discrimination’ due to the lack of “coverage for the treatment of gender dysphoria – the clinically significant distress that can result from the dissonance between an individual’s gender identity and sex assigned at birth.”
The suit says that the State Health Plan is not providing “counseling, hormone therapy, surgical care, and any other health care provided in relation to a person’s transgender status and/or gender transition.
The complaint claims that there is a “well-established medical consensus” that these procedures are all “medically necessary” and “life-saving.”
“In 2017, NCSHP covered medically necessary gender-confirming health care, but then State Treasurer Dale Folwell took office and revoked the coverage,” said Brown. “This is clearly unlawful discrimination that jeopardizes the health of hardworking state employees and their families.
Brown went on to claim lack of coverage under the state health plan “stigmatizes” the plaintiffs and “brands them as second-class.”
Treasurer Dale Folwell’s office responded citing that the State Health Plan’s policy of not covering sex-change operations as a benefit is “the same now as it was during the entire eight years of Treasurer Janet Cowell’s administration.”
Folwell’s statement is accurate regarding the plan’s history under Cowell. In 2017, North Carolina’s health plan allowed for gender dysphoria treatment costs like hormone therapy and sex-change procedures that were deemed “medically necessary.” This coverage was a trial period of only one year and the Board of Treasury Trustees allowed this provision to sunset in 2018.
Until the court system, a legislative body or voters tell us that we “have to,” “when to,” and “how to” spend taxpayers money on gender reassignment surgery, I will not make a decision that has the potential to discriminate against those who desire other currently uncovered, elective procedures, “said Treasurer Folwell in the statement.
Taylor Brown, Tara Borelli, and Omar Gonzalez-Pagan are the attorneys of record for Lambda Legal. Noah Lewis represents the Transgender Legal Defense and Education Fund (TLDEF), and Amy E. Richardson, Lauren Snyder, and Deepika Ravi are attornies with Harris Wiltshire & Grannis LLP.
The seven plaintiffs include three adults, two teenagers and one of each of their parents.
- Max Kadel, age 36, a transgender man employed at the University of North Carolina at Chapel Hill.
- Julia McKeown, age 43, a transgender woman who teaches at North Carolina State University.
- Sam Silvaine, age 30, a former North Carolina State University employee with “a male affirmed sex.”
- Connor Thonen-Fleck, age 16, and his father, Jason Fleck, an employee of the University of North Carolina at Greensboro.
- C.B. Bunting, age 13, and his father, Michael D. Bunting, Jr., an employee of the University of North Carolina at Chapel Hill.
The filing of the complaint was arguably telegraphed by a protest last October at State Treasury Board of Trustees meeting. The same families are involved in the complaint were at that meeting.
“For me, the biggest impact of the health coverage exclusion is the message that it sends me, as a transgender employee of UNC and the state of North Carolina: that I am not wanted as part of the Carolina community,” Kadel said according to a report by IndyWeek. “That I, and my health and well-being, are less valuable than the health and well-being of my cisgender colleagues.”
The IndyWeek report also included claims by Connor Thonen-Fleck’s parents that they cannot afford $9,000 chest-reassignment surgery necessary for their 16-year-old child’s ‘transition’. The family also claimed Thonen-Fleck was suicidal and self-harmed prior to hormone treatments.
“North Carolina Taxpayers should not be forced to pay for transgender surgeries and hormone treatments through the State Health Plan,” Tami Fitzgerald, NC Values Coalition Executive Director, said in a statement. “These are elective procedures which are not medically necessary. Transgender surgeries and hormone treatments should be paid for by the individuals who desire them, not the taxpayers.”
So what are the costs associated with transgender ‘transitioning’?
There are usually multiple surgeries involved in sex reassignment and female to male transitions can cost anywhere between $12,500 up to $50,000.
Full female to male reassignment often involves a full hysterectomy, which alone can cost anywhere from $9,400 to $12,700. Female to male surgeries also usually include double mastectomies, which range from $15,000 to $55,000 and involve the removal of breast tissue, underlying muscle, nipples, and lymph nodes.
Various sources put the average male to female reassignment cost between $7,000 and $24,000.
The surgeries are irreversible and complications from surgery are common.
Hormone treatments are very expensive. One year of hormone therapy can cost upwards of $22,400 for just four treatments. Maintenance dosages of hormones between treatments and after surgery average between $30-40 a month.
According to a 2016 report by Segal Consulting prepared for North Carolina officials, the annual cost for gender dysphoric participants in North Carolina is estimated to be anywhere from $350,000 to as high as $850,000.
The report broke out surgery and hormone cost estimates based on information and pricing from Blue Cross Blue Shield of North Carolina:
• For male to female surgery, they assumed roughly $28K, with $3,600 in hormonal therapy
• For female to male surgery, they assumed about $56K, with $7,200 in hormonal therapy
The Segal report also states that person having surgery “would have at least $10,000 in psychological counseling associated with this on an annual basis for an undetermined number of years.”
An inherent problem with the Segal Consulting report is that it in part relies on a Williams Institute paper from June of 2016. The Williams Institute has several papers or reports that are widely used but most reporting fails to note that they are unscientific.
Such is the case of a June 2016 report by the Williams Institute that estimated that .6% or 1.4 million of the adult population (18 and up) in the United States suffer from gender dysphoria. The report estimated there are 44,750 gender dysphoric adults in North Carolina, however, this number is based on 151,456 people’s answers to one of nineteen questions in a random phone survey administered in only nineteen states.
A 2014 report by the Williams Institute is much the same. The 2014 survey used for the report contains no validity or sample controls and openly states the only recipients were groups that were “known venues for contact with the transgender community throughout the United States.”
The Williams Institute also estimated in 2011 there were 700,000 transgender adults in the United States and is based on estimates from eleven “international surveys” and studies conducted between 2002 and 2011.
One study that has a firm scientific methodology and covers a significant time period was done in Sweden.
The 30-year long study spanning 1973-2003 documents gender dysphoria patients before, during and 10 to 15 years after surgical reassignment.
The study found that patients who had the sex-reassignment surgery skyrocketed to near 19 times higher than the rest of their peer-aged population.
Jumping forward to 2016, officials at the Centers for Medicare and Medicaid Services (CMS) in the Obama administration issued a mandate blocking such sex reassignment treatments from Medicare.
The CMS six-member team that included a Ph.D. and three medical doctors found that unlike the Swedish study, nearly all of the 33 studies they examined were either unscientific or fatally flawed, and contained no evidence of “clinically significant changes” to mental state after surgery.
The data suggests that those engaging in sex-change surgeries have a much higher than normal rate of mental relapse and requiring psychiatric care.
“There is not enough high-quality evidence to determine whether gender reassignment surgery improves health outcomes,” the CMS final report states.
In short, the use of various hormone therapies and surgeries to change one’s appearance from one sex to another did not change the underlying mental and emotional pathology of a gender dysphoric individual and therefore not “medically necessary.”
“Medically Necessary: Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”
Source: Heathcare.Gov
Most private insurance companies deem sex reassignment surgeries as “elective” and “cosmetic” because the procedures do not change the function of the body, just the appearance.
Sometimes surgery and hormones do not fix the feelings the gender dysphoric person has.
For individuals who elect for surgery, remorse and regret follow within years after the change, along with a realization that the surgery and hormones only masked the gender dysphoria disorder.
“After de-transitioning, I know the truth: Hormones and surgery may alter appearances, but nothing changes the immutable fact of your sex.” wrote Walt Heyer, a former transgender woman in a 2019 USA Today article.
There is alarming evidence that “transition affirming protocols” for young children and teens are doing serious harm to them.
Dr. Michelle Cretella, M.D., executive director of the American College of Pediatricians, has called it “institutional child abuse.”
“Professionals are using the myth that people are born transgender to justify engaging in massive, uncontrolled, and unconsented experimentation on children who have a psychological condition that would otherwise resolve after puberty in the vast majority of cases,” wrote Cretella in a 2017 Daily Signal article.
“Today’s institutions that promote transition affirmation are pushing children to impersonate the opposite sex,” Cretella wrote. “Sending many of them down the path of puberty blockers, sterilization, the removal of healthy body parts, and untold psychological damage.
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A.P. Dillon is the North Carolina Bureau Chief for The Tennesee Star and a reporter at Battleground State News. Follow A.P. Dillon on Twitter. Email Tips to [email protected].
Photo “TLDEF Press Conference” by TLDEF.
