Opinions
Navigating employer-sponsored health insurance, care
One in four trans patients denied coverage for gender-affirming care

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.
Opinions
Returning to Alcatraz: Memory through a queer lens
Trump would like to ‘rebuilt and reopen’ notorious island prison

When I arrived at Alcatraz Island, what I felt wasn’t curiosity — it was discomfort. Standing before such a photogenic landscape, something felt off. As if the place was trying to erase what it truly was: a mechanism of punishment, a machine built to control and define who should be excluded. I couldn’t walk those corridors without thinking about what this place represents for so many of us: a symbol of how the state has decided, time and again, that some lives matter less.
As a queer person, what struck me wasn’t just the past Alcatraz holds — but how that past is still alive in today’s policies. As I looked into the empty cells, I thought about the many LGBTQIA+ people who have been punished simply for existing. People like Frank Lucas Bolt, the first prisoner of Alcatraz — not convicted for violence, but for “sodomy,” a label the legal system used to persecute gay men.
He was not the only one. For decades, being gay or trans was enough to end up in a federal prison or a psychiatric hospital. Not for a crime, but for defying the norm. The legal and medical systems worked hand in hand to suppress any deviation from prescribed gender and sexuality. In prisons, queer people were subjected to physical punishment, solitary confinement, and even conversion therapy. Alcatraz was not an exception — it was one of the system’s most brutal epicenters.
But the queer memory of this place isn’t found in tourist brochures. To uncover it, you have to read between the lines, search through archives that are never taught in schools, and listen to those who still carry the scars. Walking among those walls, I realized that remembering isn’t enough — we have to contest the meaning of memory itself. What isn’t told, is repeated.
That’s why, when a few weeks ago President Trump said he’d like to “rebuild and reopen Alcatraz,” I didn’t take it as just another symbolic gesture. I took it as a warning. In times of crisis, punishment becomes an easy offer: lock them up, expel them, make them disappear. And in that narrative, queer, migrant, and racialized bodies are always the first to be targeted.
The danger isn’t just in the idea of a reopened prison, but in what it represents: The longing to return to a social order that was already deeply unjust. The nostalgia for “tough-on-crime” prisons is the same one that criminalizes unhoused people, persecutes migrants, and stigmatizes queer and trans youth in public spaces. Anyone who dreams of locking up more people isn’t thinking about justice — they’re thinking about control.
In 1969, a group of Native American activists occupied Alcatraz for over a year. They did it to denounce land theft and the government’s betrayal of treaties. During their occupation, they painted a message on the island’s water tower: “Peace and Freedom. Home of the Free Indian Land.” That gesture was a radical reclamation of space, a way of saying: this island can also be a place of resistance.
Alcatraz holds many layers. It was a high-security prison, yes, but it also became the stage for one of the most powerful acts of civil disobedience in the 20th century. That tension still lingers. The question is not just what happened at Alcatraz, but what we want it to represent today. A renewed model of punishment — or a site of memory that helps us prevent more harm?
As I walked its halls, I couldn’t stop thinking about the migrant detention centers that are still full today. About trans people held in inhumane conditions. About arbitrary detentions. About those of us who, like me, crossed borders just to survive. The distance between that Alcatraz and our present is not as wide as we’d like to believe. The walls may change, but punishment still operates on the same bodies.
Standing before the empty cells, I felt what many must have felt there: the weight of abandonment, the state’s mark upon their body, the feeling that their existence was a problem. But I also felt something else: conviction. The certainty that we will no longer walk into those spaces in silence. That we will not let ourselves be labeled as “mistakes” or “deviants.” That if they try to lock us up again, they will find us organized, with memory, with dignity.
Alcatraz does not need to be rebuilt. It needs to be understood. And we — queer, racialized, migrant communities — need to transform that understanding into action: to push back against hateful rhetoric, to protect those still living under threat, and to tell our full stories. Let no one be punished again for being who they are. Let history not become a locked cell once more.
The views expressed in this article are solely my own and do not necessarily reflect those of my employer, colleagues, or any affiliated organization. They are shared from a personal perspective shaped by lived experience and advocacy work.

Lately I’ve sensed a deep seated antipathy in the queer population toward fixing systemic issues that sabotage the wellbeing of the queer population. Much of this antipathy is centered around race: wealthy cisgender (and mostly white) gay men feel that much of their needs are taken care of, with the exception of the Trump administration potentially taking away their right to marry. Then, all of a sudden, when reports come out that gay marriage is in jeopardy, these wealthy gay men rally around the flag and start to care. But for the most part, they are busy with their well-off lives renting penthouses in Logan Circle or Dupont, going to mostly all-white gay toga parties, finding casual hookups on Grindr. Their lives are not entirely full of discrimination. They work in offices that celebrate, or at least tolerate, their identity. Because to these office places, a capable, well-dressed, cisgender gay man who knows his business field and can present tidily well is no threat to their corporate good or corporate advance.
White cis gay men who come from lower socioeconomic backgrounds face a larger struggle: They might not be able to afford the wardrobe that fits an elite corporate culture; some middle or lower class folks can’t fit this mold. Moreover, they might not harbor the educational background to fit such job titles at Goldman Sachs, after all, Goldman is looking for Harvard MBAs. Indeed, they are looking for top-tier MBAs — a credential that very few queer people live up to. With poverty and lower socioeconomic class pervading the queer community, it’s hard to find gay or lesbian or — god forbid — trans folk who fit McKinsey’s mold and ethos of work.
Queer people who don’t acquiesce to corporate culture — people who don’t have Ivy League degrees or the best MBA grads from Wharton or Yale or Harvard tend to apply to other jobs. At the lower end of the ladder, queer people who don’t strive to be top tier consultants work barista jobs or retail. I mention “lower end of the ladder” not to deride queer people who choose to be baristas or work in retail — it is their choice, and amazing pro-BLM and pro-Palestine and pro-working class movements originate from these kinds of work places.
Yet other queer people settle for middle class jobs. Trans men who pass extraordinarily well as men become Realtors or insurance agents. Some even more become entertainers and singers and DJs; there are ample jobs available for trans people. Some drag queens or trans women like Laverne Cox shine bright on the national stage and become actresses that represent gender diverse women. And that is good for them.
What I’ve found though is much antipathy toward our job struggle. Not necessarily antipathy from the queer population itself, but antipathy from employers who are hesitant to hire a trans man or a trans man who doesn’t pass well. Trans men who don’t pass are an enormous issue to employers. Employers just don’t like non-passing trans people. They pose a liability to them. They make companies feel uncomfortable. It’s going to take years–if not decades–for companies to just “chill” about gender nonconformance. Trans people harbor many excellent minds, be it in mathematics, physics, English, computer science, or the arts.
It’s time that corporate America take a serious look at their queer workforce. Firing or denying someone employment because they don’t fit a certain gender mold is a cruel act. And this cruel act has gone on for far too long. There are some tales of getting it better. Most notably tech companies like Google or Amazon hiring gender nonconforming computer engineers to get the job done. They enforce an environment of respect and mutual aid. This trend needs to continue and grow.
If it doesn’t then the trans workforce is left feeling bereft, lost in translation. This can’t continue forever. It’s time for change.
Isaac Amend is a writer based in the D.C. area. He is a transgender man and was featured in National Geographic’s ‘Gender Revolution’ documentary. He serves on the board of the LGBT Democrats of Virginia. Contact him at [email protected] or on Instagram at @literatipapi
Opinions
Virginia 2025 GOP ticket gives DEI a bad name
John Reid’s views on trans issues are repugnant

The GOP ticket up for election in Virginia in 2025, is trying to prove DEI is bad. The ticket is Black, gay, and Latino and supports the racist, homophobic, misogynist, found liable for sexual assault, felon, in the White House.
There is all of this hullabaloo created by MAGA Virginia Gov. Glenn Youngkin about John Reid, the gay member of the DEI team, running for lieutenant governor, being on a porn site, or sending out pornographic material. There is no indication this is true, or if it is, that it was in any way illegal. There is most likely no young person today, straight or gay, who hasn’t visited a porn site — and not only young people. It is Reid’s own business. The issue for me is Youngkin and his aides, making this about Reid’s sexual orientation. That is despicable, but I would expect nothing less from this governor.
Clearly, I have no problem with Reid being gay. But it’s sad to see all the homophobic Republicans getting themselves in a twit over this. The reality is there are so many other things for decent people to be bothered about when it comes to John Reid’s candidacy. His stated views on so many areas are disturbing. His clear disdain for the trans community is offensive. His use of the term ‘wokism,’ which he, like so many other Republicans who use it, never explain what the hell it means to them.
Then I am always amazed when a member of a minority, thinks it’s OK to attack another minority. In Reid’s case it is surely a sign of a lack of self-worth. In any event, it is really disgusting. That is only the beginning of the issues I have with Reid. On his website Reid states “He believes we should prioritize first-class learning in education, free from leftist indoctrination.” What does that mean? Does it include banning gay-themed, and African American history books, among others, from school libraries? He says he is “dedicated to safeguarding and gaining knowledge from our heritage, rather than obliterating it. He appreciates the significance of our history and will always advocate for conserving our cultural landmarks and enlightening future generations about the foundation of our nation.”
Does that mean keeping up Confederate statues or using Confederate names for public institutions? Reid says “he is focused on stopping the divisive wokeness and bringing Virginians together on common values for a stronger future.” He claims to be “uniquely positioned to take the fight to the radical progressives head-on as he continues his fight against boys in girls’ sports, and the extreme trans-agenda being forced upon our children.” He calls that “common sense values.” I don’t think most of that would seem like common sense to any decent person.
He says, “You know best how to live your life and will fight to allow adults to make their own decisions without government intervention.” That is except for trans people, a woman who wants to control her own body, and healthcare, and anyone else he disagrees with.
He also says “we all must pay our own bills and personally own and be responsible for the consequences — good and bad, of our decisions.” Does that mean he opposes Medicaid, any government assistance for the poor, government sponsored pre-school, aid for childcare, or even assistance from a church or community group?
Then there is his full-throated support for Jason Miyares running on the ticket for attorney general, and Winsome Earle-Sears, the candidate for governor, both MAGA Republicans like himself, all giving their mutual strong, blind support, to the felon, racist, homophobic, misogynist, found liable for sexual assault, liar, in the White House. They continue to support him as he, and his Nazi sympathizing co-president, fire thousands of Virginians, including veterans, who fought, and were willing to risk their lives, for our country. They all support the felon as he slashes medical research programs for children. The felon who is cutting hot lines for the LGBTQ community to reach out if they have mental health issues. The felon who is cutting HIV/AIDS research, and hundreds of other grants, at NIH, dedicated to improving the health of the LGBTQ community, along with other programs the felon has cut, which will lead to more deaths around the world from polio and malaria. This is the GOP ticket in Virginia in 2025.
For the good of Virginians, and the nation, vote for Abigail Spanberger for governor, and the entire Democratic ticket, up and down the ballot.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.