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Navigating employer-sponsored health insurance, care

One in four trans patients denied coverage for gender-affirming care

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(Photo by maxxyustas/Bigstock)

Even though 86% of transgender Americans have health insurance, one in four reported being denied coverage for gender-affirming care in the 2015 and 2022 U.S. Transgender surveys. These denials can occur when an insurance plan contains a categorical exclusion of gender-affirming care. It is important to note that transgender employees who receive insurance coverage through their employers are entitled to legal protections. 

Employers are responsible for ensuring that the insurance plans they provide do not violate any laws, including anti-discrimination laws. In 1983, the Supreme Court ruled that under Title VII of the Civil Rights Act of 1964, employers are legally required to provide employees with equal pay and benefits, including health insurance. This protection now extends to transgender employees after the Supreme Court’s ruling in Bostock v. Clayton County (2020), which clarified that sex discrimination under Title VII includes gender identity discrimination.

Since Bostock, several transgender employees have successfully sued their employers for discrimination because they were denied coverage of gender-affirming care by their employers’ insurance. While employers can be held liable under Title VII, it remains unclear whether insurance companies will be held liable under Section 1557, the antidiscrimination provision of the Affordable Care Act (ACA), in the future.

Most—if not all—courts have ruled that employers can be held liable for choosing insurance plans with categorical exclusions of gender-affirming care. A categorical exclusion is when an insurance plan has a blanket ban of coverage for certain services. Although discrimination cases generally require proof of intent to discriminate, it is not required of transgender employees because categorical exclusions of gender-affirming care are facially discriminatory (i.e. the policy is explicitly and obviously discriminatory in nature).

In Kadel v. Folwell (2024), the Fourth Circuit court considered the Fourteenth Amendment, Title IX, and ACA claims in a consolidated case considering two state health plans: the State of North Carolina’s insurance plans for teachers and West Virginia’s Medicaid program. The Fourth Circuit court held that it is impossible to ban coverage of gender-affirming care without discriminating against transgender people because (1) gender dysphoria is a legitimate medical diagnosis which requires medically necessary treatment; and (2) the services provided under gender-affirming care are also provided to cisgender patients for other medical diagnoses. In short, there is sufficient evidence of discriminatory intent because categorical exclusions of gender-affirming care are facially discriminatory. Under Kadel, the Fourth Circuit also ruled that a policy does not have to explicitly exclude transgender patients. “Rewording the policies to use a proxy,” like sex changes or sex modification, is still facially discriminatory.

Along a similar vein, in Lange v. Houston County (2024), the Eleventh Circuit court found that the Sheriff’s Office’s categorical exclusion of gender-affirming care was a violation of Title VII. Agreeing with the reasoning in Kadel, the court cited a 1991 Supreme Court Case which ruled that proof of intent to discriminate is not needed for facially discriminatory policies. The court also held Anthem Blue Cross liable because third-party administrators in the Eleventh Circuit (i.e., Alabama, Florida, and Georgia) can be held liable as an employer if they make employment decisions as the authorized agent of an employer. However, this decision is unique to the said jurisdictions, and the liability of third-party administrators/insurance providers remains generally unclear. Moreover, the decision is not final because the court granted an en banc appeal, and a panel of all twelve judges re-heard the case in February 2025. The decision after re-hearing remains to be seen. 

Recently, Executive Order 14168 and the EEOC’s motion to dismiss its lawsuit against Harmony Hospitality on behalf of a transgender worker prompted concerns over transgender employees’ ability to bring federal discrimination claims. While such concerns are understandable, there has yet been any mandate prohibiting the EEOC from issuing right to sue to transgender individuals. In other words, even if the EEOC may not investigate and file lawsuits on behalf of transgender individuals, it does not bar private parties from doing so. Ultimately, the executive branch alone does not have the power to make changes to the Constitution or any federal statutes. It is up to the legislatures to amend laws and the Constitution, and courts to interpret and rule on constitutionality. 

Protections Against Discrimination by Insurers Under Section 1557 Remain Unclear

While employers can be held liable for categorical exclusions of gender-affirming care, employees may be less likely to find relief for legal claims against insurers regarding discrimination on the basis of gender identity. Since Bostock, courts have found insurers liable for denying coverage of gender affirming care under Section 1557 of the ACA, extending sex discrimination to include gender identity. Recent litigation surrounding Section 1557 and the new presidential administration may precede a change in this trend.

In May 2024, the Biden administration issued a final rule implementing Section 1557.It reversed the rule put forth by the Trump administration four years prior, which had revised the Obama administration’s interpretation of the statute. The Biden administration’s final rule defined sex discrimination to include discrimination on the basis of gender identity and sexual orientation. Additionally, under the new rule, a wider swath of insurers and third-party administrators that receive federal financial assistance would be subject to Section 1557. 

However, in July 2024, a Mississippi District judge granted a nationwide injunction preventing the Department of Health and Human Services from enforcing the final rule’s prohibition of sex discrimination with respect to gender identity. Additionally, executive orders during the early days of the Trump administration, and guidance from the Department of Health and Human Services that followed, rescinded wide swaths of Biden-era guidance extending sex discrimination protections to include discrimination based on gender identity. It is not yet clear how the new administration’s position on Section 1557 will impact courts’ decision-making regarding insurer liability and the extent of sex discrimination provisions in relation to gender identity going forward. 

As the recent history of Section 1557 demonstrates, executive actions may influence the implementation of statutory antidiscrimination provisions, but do not change the law itself. While employers continue to face liability for discrimination towards employees seeking insurance coverage of gender-affirming care under Title VII, some protections remain on less certain ground as the United States enters a new presidential administration. 


Ting Cheung, Luke Lamberti, and Neha Sharma are with Sanford Heisler Sharp McKnight.

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How do we honor Renee Good, Alex Pretti?

Lives more than last 10 seconds captured on video

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Protesters in Haymarket, Va. on Jan. 11 protest against U.S. Immigration and Customs Enforcement after an ICE agent shot Renee Good to death in Minneapolis. (Washington Blade photo by Michael Key)

Renee Good. Alex Pretti.

During this last year, I wondered who would be the first U.S. citizen to be shot by our government. It was not a matter of if, but when. Always.

And now we know.

I thought it would be soldiers. But the masked men got there first. Because when you mix guns and protests, guns inevitably go off. The powers that be always knew it, hoped for it, and wanted it to happen. 

Why? Because masked men and guns instill fear. And that’s the point. Ask yourself when’s the last time you saw masked men and guns in our cities, or anywhere for that matter. I always thought that men masked men with guns robbed banks. I was wrong.  

Masked men want to rob us of our dignity as human beings. Of our assurance in the calmness and contentment of our communities. They want to rob us of our trust in our institutions, and our faith in each other. And truly they want to rob us of the happiness and joy that we all constantly yearn to find in our lives.  

But our only collective ability as a nation to push back is our protests. Peaceful protests. As Renee and Alex did.

But peaceful protests? Because they are the perfect power to shame the cowardice of those that believe guns and force are the only true authority. Fortunately, our last hope and fiercest ally is our Constitution, which gives us the power — and the right — to protest. 

How much more peaceful can you get when you hear Renee Good’s last words, “I’m not mad at you, Dude.” I may be mad at the system, the government, the powers of unknown people pulling the strings but not you personally. “Dude.” Peaceful to the last word.

Yet, what becomes lost in the frantic pace of hair-trigger news cycles, of officials declaring impetuous damnations alongside johnny-on-the spot podcasters spouting their split-second opinions are the two human beings who have lost their lives.

How habituated we’ve become as we instantly devour their instant obituaries. The sum of their lives declared in less than 10 seconds of cellphone video. They haven’t just lost their lives.  They’ve lost all of their lives. And now we watch over and over again as their death is re-revealed, re-churned, re-evaluated, and re-consumed. In that endless repetition, we forget the meaning of life itself.

We must remember that Renee and Alex believed in their communities, in the purpose of their work, in the happiness of their loves and lives, and in the dignity and curiosity of life itself. They were singular individuals who did not deserve to die at the end of a gun barrel for any reason, ever.

How fitting that Renee was a poet. Sometimes in confronting the massiveness of loss in our lives, we look to our poetry and our psalms, our hymns and our lullabies, to find a moment of solace in our communal grief, and to remember Renee and Alex, for what they gave us in life.

Yet, at this moment, I cannot escape the reality of what was taken from them so soon, so violently and so forever. They were exceptionally courageous and normal people, and for that reason, I must remember them through a poem to explain to me, and others, the unexplainable. 

I dream of this not happening. 

I dream this day and night.

For none of this is real.

And none of this is right.

I dream of these sons and daughters

who now will not go home,

and dream of their mothers and fathers,

who now must stand alone.

I dream of all the flowers that they will never hold —

the kisses never shared again, the secrets to not be told.

I dream of all the sunsets that for them will never set,

I dream of all the love they gave and now they must forget.

I dream of all their dinners

with wine to never spill,

or books to read, or bread to break

or babies to be held.

I dream of each one still reaching 

in the middle of the night,

for a hand that needs another 

to stop a nightmare’s flight.

I dream of them not dreaming, 

which I could never do,

for how can you not dream a dream

that never will come true.

I dream of this not happening.

I dream this day and night.

For none of this is real

And none of this is right. 

Carew Papritz is the award-winning author of “The Legacy Letters,” who inspires kids to read through his “I Love to Read” and the “First-Ever Book Signing” YouTube series.

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Gay Treasury Secretary’s silence on LGBTQ issues shows he is scum

Scott Bessent is a betrayal to the community

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Treasury Secretary Scott Bessent (Washington Blade photo by Michael Key)

We all know the felon in the White House is basically a POS. He is an evil, deranged, excuse for a man, out only for himself. But what is just as sad for me is the members of the LGBTQ community serving in his administration who are willing to stand by silently, while he screws the community in so many ways. The leader, with his silence on these issues, is the highest ranking “out” gay ever appointed to the Cabinet; the current secretary of the treasury, the scum who goes by the name, Scott Bessent. 

Bessent has an interesting background based on his Wikipedia page. He is from South Carolina and is what I would call obscenely wealthy. According to his financial assets disclosure to the U.S. Office of Government Ethics, Bessent’s net worth was at least $521 million as of Dec. 28, 2024; his actual net worth is speculated to be around $600 million. He married John Freeman, a former New York City prosecutor, in 2011. They have two children, born through surrogacy. I often wonder why guys like Bessent conveniently forget how much they owe to the activists in the LGBTQ community who fought for the right for them to marry and have those children. Two additional interesting points in the Wikipedia post are Bessent reportedly has a close friendship with Donald Trump’s brother Robert, whose ex-wife, Blaine Trump, is the godmother of his daughter. The other is disgraced member of the U.S. House of Representatives, John Jenrette, is his uncle.  

Bessent has stood silent during all the administrations attacks on the LGBTQ community. What does he fear? This administration has kicked members of the trans community out of the military. Those who bravely risked their lives for our country. The administration’s policies attacking them has literally put their lives in danger. This administration supports removing books about the LGBTQ community from libraries, and at one point even removed information from the Pentagon website on the Enola Gay, the plane that dropped the first atomic bomb, thinking it might refer to a gay person. It was actually named after Enola Gay Tibbets, the mother of the pilot, Col. Paul Tibbets. That is how dumb they are. Bessent stood silent during WorldPride while countries around the world told their LGBTQ citizens to avoid coming to the United States, as it wouldn’t be safe for them, because of the felon’s policies. 

Now the administration has desecrated the one national monument saluting the LGBTQ community, Stonewall, in New York City, by ordering the removal of the rainbow flag. The monument honors the people who get credit for beginning the fight for equality that now allows Bessent, and his husband and children, to live their lives to the fullest. That was before this administration he serves came into office. I hope his children will grow up understanding how disgusting their father’s lack of action was. That they learn the history of the LGBTQ community and understand the guts it took for a college student Zach Wahls, now running for the U.S. Senate from Iowa, to speak out for his “two moms” in the Iowa State Legislature in 2011, defending their right to marry.  

Bessent is sadly representative of the slew of gays in the administration, all remaining silent on the attacks on the community. They are mostly members of the Log Cabin Republicans who have given up on their principles, if they ever had any, to be subservient to the felon, and the fascists around him, all for a job. 

There are so many like them who supported the felon in the last election. Some who believed in Project 2025, others who didn’t bother to read it. Many continue to stand with him, with the sycophants in the Congress, and the incompetents and fascists in the administration, as they work to destroy our country and end the democracy that has served us so well for 250 years. To keep out all immigrants from a nation of immigrants. They all seem to forget it was immigrants who built our country, who fought against a king, and won. These sycophants now support the man who wants to be king. Who openly says, “I am president I can do anything only based on my own morality,” which history clearly shows us he has none. 

I believe we will survive these horrendous times in American history. We have fought a king before and won. We have kept our country alive and thriving through a civil war. We the people will defeat the felon and his minions, along with the likes of those who stood by silently like Scott Bessent. They seem to forget “Silence = Death.” 

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

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Unconventional love: Or, fuck it, let’s choose each other again

On Valentine’s Day, the kind of connection worth celebrating

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(Image by kotoffei/Bigstock)

There’s a moment at the end of “Love Jones” — the greatest Black love movie of the 21st century — when Darius stands in the rain, stripped of bravado, stripped of pride, stripped of all the cleverness that once protected him.

“I want us to be together again,” he says. “For as long as we can be.”

Not forever. Not happily ever after. Just again. And for as long as we can. That line alone dismantles the fairy tale.

“Love Jones” earns its place in the canon not because it is flawless, but because it is honest. It gave us Black love without sanitizing it. Black intellect without pretension. Black romance without guarantees. It told the truth: that love between two whole people is often clumsy, ego-driven, tender, frustrating, intoxicating—and still worth choosing.

That same emotional truth lives at the end of “Eternal Sunshine of the Spotless Mind,” my favorite movie of all time. Joel and Clementine, having erased each other, accidentally fall back into love. When they finally listen to the tapes that reveal exactly how badly they hurt one another, Clementine does something radical: she tells the truth.

“I’m not perfect,” she says. “I’ll get bored. I’ll feel trapped. That’s what happens with me.”

She doesn’t ask Joel to deny reality. She invites him into it. Joel’s response isn’t poetic. It isn’t eloquent. It’s not even particularly brave. He shrugs.

“Ok.”

That “OK” is one of the most honest declarations of love ever written. Because it says: I hear you. I see the ending. I know the risk. And I’m choosing you anyway.

Both films are saying the same thing in different languages. Nina and Darius. Clementine and Joel. Artists and thinkers. Romantics who hurt each other not because they don’t care — but because they do. Deeply. Imperfectly. Humanly.

They argue. They retreat. They miscommunicate. They choose pride over vulnerability and distance over repair. Love doesn’t fail because they’re careless — it fails because love is not clean. 

What makes “Love Jones” the greatest Black love movie of the 21st century is that it refuses to lie about this. It doesn’t sell permanence. It sells presence. It doesn’t promise destiny. It offers choice.

And at the end — just like “Eternal Sunshine” — the choice is made again, this time with eyes wide open.

When Nina asks, “How do we do this?” Darius doesn’t pretend to know.

“I don’t know.”

That’s the point.

Love isn’t a blueprint. It’s an agreement to walk forward without one.

I recently asked my partner if he believed in soul mates. He said no—without hesitation. When he asked me, I told him I believe you can have more than one soul mate, romantic or platonic. That a soul mate isn’t someone who saves you — it’s someone whose soul recognizes yours at a particular moment in time.

He paused. Then said, “OK. With those caveats, I believe.”

That felt like a Joel shrug. A grown one.

We’ve been sold a version of love that collapses under scrutiny. Fairy tales promised permanence without effort. Celebrity marriages promised aspiration without truth. And then reality — messy, public, human—stepped in. Will and Jada didn’t kill love for me. They clarified it.

No relationship is perfect. No love is untouched by disappointment. No bond survives without negotiation, humility, and repair. What matters isn’t whether love lasts forever. What matters is whether, when confronted with truth, you still say yes.

“Love Jones” ends in the rain. “Eternal Sunshine” ends in a hallway. No swelling orchestras. No guarantees. Just two people standing at the edge of uncertainty saying: Fuck it. I love you. Let’s do it again. 

That’s not naïve love. That’s courageous love.

And on Valentine’s Day — of all days — that’s the kind worth celebrating.

Randal C. Smith is a Chicago-based attorney and writer focusing on labor and employment law, civil rights, and administrative governance.

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