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Georgia County Spent $1.2 Million to Deny One Employee Gender-Affirming Care

Officials said covering gender-affirming care would be too expensive yet spent more on legal fees to oppose it.

Sgt. Anna Lange in a video for Houston County's Sheriff's Department.

When a transgender sheriff’s deputy in Houston County, Georgia, requested that the department’s health insurance plan cover gender-affirming surgeries, local officials refused to cover them, claiming it was too expensive.

In the years since, however, officials have spent more than a million dollars of taxpayer money fighting a federal lawsuit brought by the deputy — far more than it would have cost to cover gender-affirming care for everyone on the county’s health plan, according to a report published by ProPublica this week.

Houston County paid a law firm around $1.2 million in legal expenses relating to the lawsuit, which was brought forward by Anna Lange, a deputy within the county’s sheriff’s department. Lange, who came out as transgender to her co-workers in 2017, had sought to use her county-provided health care plan to pay for surgeries related to her transition, but was told she could not do so because of the cost.

Per calculations made by Lange’s legal team, simply amending the health care plan to include gender-affirming care for all employees — which the county’s insurance administrator had recommended doing in 2016 — would have meant a mere 0.1 increase to the county’s health care budget, or around $10,000 annually. Put another way, for the amount the county spent trying to avoid covering Lange’s gender-affirming care, officials could have covered such care for every person employed by the county for the next 120 years.

Lange paid for one of her gender-affirming surgeries out of pocket using retirement funds and other savings, but could not pay for all of the care she requested. After seeking a number of remedies to her request, she eventually decided to sue the county in federal court, saying that she was being subjected to “inferior treatment” in their denial of her care.

Lange won the case in 2022, in part due to a 2020 Supreme Court decision against employment discrimination toward trans workers. The county is appealing the decision, however — a process that will likely result in the spending of even more taxpayer dollars.

“It was a slap in the face, really, to find out how much they had spent,” Lange told ProPublica. “They’re treating it like a political issue, obviously, when it’s a medical issue.”

While on appeal, the county has been ordered to provide care to Lange and any other employee who wants to receive gender-affirming care.

ProPublica noted in its reporting that two other jurisdictions — the states of North Carolina and Arizona — have spent more than $1 million in legal fees trying to deny state workers access to gender-affirming-related surgical care. Both states have dubiously cited high costs as their rationale for attempting to block such coverage. As the publication has noted, adding gender-affirming care to state workers’ plans would cost an amount that is practically insignificant — in North Carolina, for instance, where such care was paid for briefly in 2017, the health plan’s costs went up by just 0.01 percent.

Gender-affirming care can be lifesaving and results in overwhelmingly positive mental health outcomes for trans and nonbinary people.

However, right-wing lawmakers across the country are trying to ban gender-affirming care, with Republican-controlled legislatures and governors passing legislation or proposing bills to block access to such treatment — including nonsurgical options — through both private and state-sponsored health plans. While most of the bills focus on trans children, some GOP lawmakers are also pushing for bills to ban gender-affirming care for adults.

“We haven’t seen these types of bills in previous years. This is a startling new evolution of what these bills can be,” Vivian Topping, director of advocacy and civic engagement of the Equality Federation, told The 19th earlier this year.

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