On Tuesday, the Eleventh Circuit Court of Appeals overturned a lower court ruling that had found Houston County, Georgia’s health insurance policy— which denied coverage for gender-affirming surgeries—constituted sex discrimination in violation of Title VII of the Civil Rights Act.

“After everything I’ve been through, it’s crushing to know I will have to continue to fight to get what a jury already said I was entitled to,” Sergeant Anna Lange, the plaintiff in the lawsuit, said in a statement. “This should never have happened to me, and it shouldn’t happen to anyone else.”

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Lange sued Houston County in 2019 after her health plan denied coverage for a gender-affirming surgery. In June 2022, the federal district court, citing Bostock v. Clayton County (2020), ruled that employers cannot exclude gender-affirming care from employee health insurance and awarded Lange damages. Houston County appealed, and in May 2024, a three-judge panel of the Eleventh Circuit upheld the ruling.

However, the full court reversed the district court’s ruling on Tuesday, partly relying on United States v. Skrmetti, a recent Supreme Court decision that upheld a Tennessee law prohibiting transgender minors from accessing hormone therapy.

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“This decision to withhold that care is steeped in animus and distorts the holding in Skrmetti to fit and further a discriminatory agenda, unlawfully expanding Skrmetti to apply to care for adults,” Khadijah Silver, Supervising Attorney of Civil Rights at Lawyers For Good Government, told LGBTQ Nation.

According to Lange’s lawyers, Houston County has spent around $2 million contesting coverage for a procedure that would cost around $20,000.

“Discrimination against trans people remains illegal, expensive, and wrong,” said Gabriel Arkles, co-interim legal director of A4TE, the organization representing Lange in this lawsuit.

The Eleventh Circuit has now sent the case back to the U.S. District Court for the Middle District of Georgia to be reconsidered in light of its decision. The outcome of Lange’s case could affect transgender people in Georgia, Alabama, and Florida—and potentially across the nation if it reaches the Supreme Court.

“This is a loss not just for Anna, but for every trans person who relies on employer-provided health insurance,” said Arkles.

Across the United States, roughly one in four transgender people report being denied insurance for gender-affirming care, and 55% have been refused coverage for surgical procedures.

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