Opinions
Insured on paper, excluded in practice
How fertility coverage definitions discriminate against LGBTQ+ workers
Pregnant workers in the LGBTQ+ community often encounter greater barriers than their cisgender or heterosexual counterparts, particularly when accessing company-sponsored health insurance. The challenges for pregnant workers are especially prevalent in obtaining fertility care, such as intrauterine insemination (IUI) and in vitro fertilization (IVF). Section 1557 of the Affordable Care Act prohibits sex discrimination in any federally funded health program, and a growing body of federal litigation now applies that prohibition to insurer-administered fertility benefits that exclude LGBTQ+ workers. Presently, 18 states and Washington, D.C. have infertility insurance laws, with requirements ranging from mandating private insurers to cover fertility treatments to merely offering coverage, which employers may choose not to select (MAP – Movement Advancement Project, “Fertility Healthcare Coverage”). Of these, six states and Washington, D.C. have language that is explicitly inclusive of LGBTQ+ people, while three states have language that may exclude LGBTQ+ people or couples. Where this coverage is not offered or is exclusionary, LGBTQ+ people must spend thousands of dollars for fertility care, while it may be guaranteed for other individuals. Today, 53% of LGBTQ+ adults live in states with no private-insurer fertility mandate, and a single IVF cycle can exceed $18,000 out-of-pocket.
Legal Framework: Section 1557 of the Affordable Care Act
Section 1557 of the Affordable Care Act protects individuals from sex discrimination in any health program or activity that receives any funding from the Department of Health and Human Services. It specifies that in terms of sex discrimination, an individual’s sex, including pregnancy, childbirth, and related medical conditions are protected. In turn, many claims challenging health insurance’s fertility policies invoke Section 1557 to argue that definitions of infertility or proof requirements that exclude same-sex couples constitute unlawful discrimination. Recently, the Ninth Circuit held that Section 1557 of the Affordable Care Act applies to an insurer if any part of the entity receives federal funds, even when the specific health plans at issue are not federally funded, though whether the insurer is ultimately liable under that section is a fact-specific inquiry. Pritchard v. Blue Cross Blue Shield of Illinois, No. 23-4331, slip op. (9th Cir. Nov. 17, 2025). Specifically, how insurers can be held liable in the context of fertility care to LGBTQ+ employees remains to be tested.
Case Study: Kulwicki v. Aetna Life Insurance Company
In 2022, a lesbian registered nurse, Tara Kulwicki, filed a complaint alleging that the medical plan offered by her employer, Wellstar Health System Inc. and Wellstar Cobb Hospital Inc., and administered by Aetna, Inc. and Aetna Life Insurance Company imposed discriminatory barriers on homosexual couples to seeking access fertility care. Under Kulwicki’s medical plan, fertility treatment such as intrauterine insemination (IUI) and in vitro fertilization (IVF) is covered only for couples who can meet the plan’s definition of “infertile.”
The medical plan’s definition for “infertile” is as follows: “For a woman who is under 35 years of age: 1 year or more of timed, unprotected coitus, or 12 cycles of artificial insemination; or [f]or a woman who is 35 years of age or older: 6 months or more of timed, unprotected coitus, or 6 cycles of artificial insemination. For heterosexual couples, infertility could be established by showing that six to twelve months of unprotected sex without contraception did not result in a pregnancy. The plan, however, defines “unprotected sex” as exclusively sexual intercourse between a man and woman. This definition effectively excludes homosexual couples as they do not have the capacity to become pregnant through unprotected sex with their partner. If couples are unable to prove they meet the definition, as in Kulwicki’s case, they are forced to pay high out-of-pocket costs, often totaling thousands of dollars, for IUI and IVF treatments before they qualify for coverage.
In Kulwicki’s case, Section 1557 is used as the basis for the claim. Kulwicki alleged Aetna administered Wellstar’s plan, denied her IUI precertification for not meeting “infertility,” and that the plan and Aetna’s policy tied infertility to unprotected heterosexual intercourse or multiple insemination cycles, resulting in out-of-pocket costs for non-heterosexual women.
The United States District Court for the District of Connecticut later denied Aetna’s renewed motion to dismiss for failure to join Wellstar, holding Aetna could face Section 1557 liability for its own role and that damages could provide complete relief without Wellstar. Most recently, on September 24, 2025, the court denied Aetna’s motion for partial summary judgment, finding factual disputes about Aetna’s collaborative role in shaping the plan language and its reserved contractual rights to align plan terms with Aetna systems, policies, and governing law. As a result, Tara Kulwicki’s class action will continue against Aetna. The court noted Aetna’s active role in shaping the plan’s infertility definition and retaining authority to ensure terms aligned with its systems, policies, and governing law.
Comparative Cases: Echoes of Kulwicki
Courts addressing similar infertility definitions have allowed claims to proceed where LGBTQ+ members face cost or proof burdens not imposed on heterosexual couples.
In Berton v. Aetna Inc. et al. (4:23-cv-01849, 2023), Mara Berton filed a suit against Aetna in violation of the Affordable Care Act after her insurance denied coverage for fertility treatment. This case raises question of first impression as to the “burden of proof” required to demonstrate infertility. In this case, the court denied Aetna’s motion to dismiss a Section 1557 claim where the plan formerly required “frequent, unprotected heterosexual sexual intercourse” or donor insemination cycles, and postJanuary 2023 language still required “eggsperm contact,” allowing heterosexual couples to attest through intercourse while same-sex couples had to incur costs for donor insemination cycles. The court found these allegations plausibly facially discriminatory. The court also rejected Rule 12(b)(7) arguments, concluding complete relief through damages could be afforded without joining the employer plan sponsor.
In Murphy v. Health Care Service Corporation (Blue Cross Blue Shield of Illinois) (No. 22-cv-2656, 2023), the court denied a motion to dismiss, holding that even under a 2020 policy listing multiple infertility pathways, the definition of “unprotected sexual intercourse” as malefemale intercourse left similarly situated samesex participants with no costfree route to establish infertility, plausibly alleging intentional discrimination under Section 1557 standards.
Two parallel actions against Aetna have already produced settlements that reshape the landscape. In Goidel v. Aetna Life Insurance Co., No. 1:21-cv-07619 (S.D.N.Y.), the court granted final approval on October 14, 2025 of a class settlement that aligned Aetna’s infertility definition with American Society for Reproductive Medicine guidelines and made intrauterine insemination a standard medical benefit. Weeks later, in Berton v. Aetna Inc., No. 4:23-cv-01849 (N.D. Cal.), the Northern District of California preliminarily approved a settlement under which most eligible class members who submit a qualifying claim will receive approximately $11,000 in compensation, with claims due by June 29, 2026.
Conclusion
Recent litigation underscores that insurers cannot avoid responsibility where they actively shape, interpret, or administer plan terms that disadvantage LGBTQ+ patients, including fertility coverage definitions and proof requirements. Section 1557 of the Affordable Care Act applies to health programs or activities receiving federal funding, and courts have allowed claims to proceed where infertility definitions or evidentiary burdens effectively exclude same-sex couples. The court in Kulwicki allowed a class action to proceed based on allegations that the insurer administered a plan tying “infertility” to unprotected heterosexual intercourse or multiple insemination cycles and played an active, collaborative role in shaping infertility language while reserving contractual rights to align plan terms with its policies. Other courts have similarly denied motions to dismiss Section 1557 claims where plans with definitions of “unprotected sexual intercourse” limited to male-female intercourse, leaving same-sex participants with no cost-free route to establish infertility. Taken together, courts are scrutinizing not only employers’ selection of plans but also insurers’ roles in designing and administering plan terms that may impose discriminatory barriers.
Employers should be proactive in counteracting harmful policies by incorporating specific protective language into their company policies and providing robust support systems for their transgender, nonbinary, and intersex employees. Employees who suspect their plan’s infertility definition imposes additional cost or proof burdens on same-sex couples should preserve all denial letters, plan booklets, and out-of-pocket receipts, and consult counsel promptly.
Isabelle Megosh, Lily Miller, and Ting Cheung are with Sanford Heisler Sharp McKnight, a national civil rights and employment law firm that represents employees in discrimination, harassment, and benefits-related litigation.
Opinions
Gun reform is an LGBTQ rights issue
‘I am sick of Congress refusing to lift a finger to protect our communities’
Earlier this month, 44-year-old Ousman Ceesay allegedly shot two people in the parking lot of Venture-N, a well-known gay bar in Tucson, Ariz. Both victims — Vincent Anthony Siquerioes and Cameron Davis Capara — died at the scene. Police discovered a list of several LGBTQ businesses on Ceesay’s person, and evidence points to how Ceesay confronted Siquerios and Capara in the bar’s parking lot before killing them. According to a news release, police are investigating the incident as a hate crime.
The event was reminiscent of the 2022 Club Q shooting and the Pulse nightclub shooting, where Omar Mateen shot and killed 49 people and wounded more than 50 more at the gay nightclub in Orlando. Survivors and the wider queer community recognized the 10th anniversary of the shooting this past June 12. As the queer community grieved another shooting targeting LGBTQ safe spaces this month, some members of the LGBTQ community are raising the call for gun reform as a key step to protect LGBTQ rights.
Gun violence is a major issue for the LGBTQ community. LGBTQ people are more than twice as likely to be the victims of violent crime than straight and cisgender people, with one in five hate crimes in the United States motivated by queer phobia. This means that LGBTQ folks are more likely to be violently attacked by a stranger compared to their cisgender, straight counterparts. In school settings, 29% of transgender youth and 16% of gay and lesbian youth have been threatened or injured with a weapon, compared to 7% of cisgender youth.
There is an ongoing epidemic of gun violence injuring and killing trans women of color in the United States today. One study by the nonprofit Everytown for Gun Safety identified that the number of trans people who were murdered in the U.S. doubled between 2017 and 2021, increasing 93% in that time period. Everytown for Gun Safety recognizes that these aren’t even the actual numbers as many trans people are misgendered or deadnamed by the police, media, or their families so their deaths are not incorporated into these numbers and tied to systemic gun violence against the wider LGBTQ community.
As a community with higher rates of self harm and suicide, easy access to firearms increases the risk that a suicide attempt will end in death. This does not mean that LGBTQ people are mentally ill, a popular far right talking point. LGBTQ people are not more likely to experience suicidal ideations and die by suicide not because they are LGBTQ but because of the stigma surrounding their identities. LGBTQ young people are more than four times likely than their non-LGBTQ peers to attempt suicide, and the Trevor Project estimates that 1.8 million LGBTQ people between the ages of 13 and 24 consider suicide in the United States.
As the Williams Institute shows, this makes gun violence a serious public health concern for the queer community. As Dr. David Hemenway, co-author of a 2016 study published in the American Journal of Medicine said, “differences in overall suicide rates across cities, states, and regions in the United States are best explained not by differences in mental health, suicide ideation, or even suicide attempts, but by availability of firearms.”
Gun violence is also a major queer issue given that trans and gender expansive individuals are at greater risk of experiencing intimate partner violence. Compared to the 35% of straight women who experience intimate partner violence, 44% of lesbian and 61% of bisexual women report experiencing rape, physical violence, or stalking by an intimate partner. This number is also higher for bisexual men (37% of whom experience intimate partner violence compared to 29% of straight men). This number is much higher for trans folks; more than half of people surveyed reported some form of intimate partner violence, according to a 2015 survey.
During the second Trump administration, ongoing legal attacks on LGBTQ rights, executive orders that deny the existence and protections of trans, nonbinary, and gender expansive individuals, and virulent opposition to and disbanding and defunding of DEI initiatives, LGBTQ employee resource groups, queer history collections, exhibitions, and education, LGBTQ representation in libraries and school settings, and the firing of federal workers allegedly because they are queer — realizing a new Lavender Scare — have emboldened violent homophobes.
After the Club Q shooting, Rodrigo Heng-Lehtinen, executive director of the National Center for Transgender Equality, explained that “the rhetoric and the legislative attempts to erase transgender people sends a signal that violence toward us is tolerated.” This has become even more dire after a 2025 White House memo prioritized identifying “radically pro-transgender” groups as national security threats, in line with the Heritage Foundation’s plan to designate trans people terrorists. In response, Congresswoman Suzanne Bonamici shared, “the Trump administration’s endorsement and proliferation of hateful and violent rhetoric against the trans community is putting lives at risk,” particularly the push to label trans people and their allies as terrorists.
As Congresswoman Adelita Grijalva said on the House Floor following this latest tragedy, “when that [anti-LGBTQ+] hate is combined with easy access to firearms, the consequences can be deadly. I am sick and tired of Congress refusing to lift a finger to protect our communities while, every day, dozens of people are shot and killed across the country.”
A 2018 survey shows that the wider LGBTQ community supports gun reform — with 93% of lesbian, gay, and bisexual adults supporting background checks and 72% opposing legislation and procedural changes that make it easier to obtain concealed weapon permits. This is not to say that the wider LGBTQ community opposes gun ownership. In fact, a growing cohort of LGBTQ individuals and other members of minority and marginalized groups are investigating gun training and ownership to protect themselves. Part of their motivation is not just protecting themselves against perpetrators of hate-motivated gun violence but also against state and federal agents that are increasingly attacking the LGBTQ community.
After the shooting, Tucson police increased their presence at other LGBTQ businesses in the city, but locals expressed concern that this would alienate some LGBTQ patrons, especially queer and trans patrons of color, and might also lead to further violence knowing that police continue to be instigators in and perpetrators of queer phobic violence. A Williams Institute study published this past year highlighted how LGBTQ people, especially queer people of color, LGBTQ youth, and trans and gender expansive individuals experience higher rates of profiling, discrimination, harassment, and entrapment from law enforcement.
This is one of the reasons that police presence at Pride events continue to be controversial, as community members remember how the police were the major antagonists at the Stonewall and Compton’s Cafeteria riots. The LGBTQ rights movement came to be largely because queer and trans people of color fought back against violent police harassment and abuse.
As someone who was traumatized by active shooter drills in elementary, middle, and high school, I am exhausted and heartbroken by continued gun violence and politicians’ refusal to consider and take action through gun reform legislation. Whether intentional or not, their hesitation to discuss and address this issue publicly and to use their political power to prevent future shootings communicates to LGBTQ+ people that they do not care about us. With gun violence disproportionately affecting our community, their silence and inaction is a form of queer phobic violence itself allowing tragedies like Tucson to continue happening.
(If you or someone you know is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline. You can also text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources. You are not alone.)
Emma Cieslik is a D.C.-based museum worker and public historian.
Opinions
Trump’s Cabinet: Dumb, dumber, dumbest, and evil
Corrupt officials working to undo 250 years of progress
Dumb, dumber, dumbest, and evil. Any of the felon’s Cabinet and close aides could fit these terms depending on the discussion.
You have Commerce Secretary Lutnick saying “no American military were killed in Iran war.” Then it was reported our venal Vice President JD Vance said, “The current hostilities shouldn’t even be called a war, since ‘active combat operations’ ended months ago. Right now, there is no active shooting, Vance insisted. This despite the U.S. and Iran still currently exchanging fire, including around the Strait of Hormuz.
Then the fool-in-chief, the felon in the White House, said about Vance’s comments, “U.S. strikes on Iran are now “intermittent” and a lot of people don’t call it a war. I can understand what he’s saying. I call it a military conflict because it’s small potatoes for us. It’s not a big thing.” All this even though this so called “conflict” has cost U.S. taxpayers more than $37.5 billion and left 18 U.S. service members dead, hundreds injured.
All this after Secretary of State Marco Rubio said, “the Trump administration’s objective in the conflict surrounding the Strait of Hormuz is to restore shipping conditions to what they were before the war with Iran began.” Then self-hating, gay, Secretary of the Treasury, Scott Bessent, chimed in, after two days of meetings with finance ministers from around the world, blaming Ukraine for high oil prices citing “Ukraine’s attacks on Russia’s oil infrastructure as part of the reason for the global energy shock.” These people all belong in an asylum, or jail.
When not talking about the war, as he is losing it badly, the felon-in-chief talks BS at a rally in Texas. Then he talks about redesigning Washington. Lutnick, speaking at a judicial hearing on whether Trump can put his name on the National Monument honoring JFK, said, “Donald Trump is the most credible person in the world” while arguing that the Kennedy Center should bear his name because he’s vowed to raise the funds to renovate it. That, even though the funds were approved by Congress and not raised by Trump. Then Trump’s tariff war on the world, now focused on Canada, which is screwing the American people, and his believing an Executive Order can get the world to call bodies of water like the Gulf of Mexico, and Lake Ontario, by different names. Or that he can change the name of the Department of Defense, to the Department of War, which only Congress can do. With the help of the fascist sycophants around him, he creates chaos in the world.
He has torn down part of the White House, and tries to build an arch. Spent millions and caused the destruction of the reflecting pool. Some of these things will be undone, others will remain, but his name will go down in history, not on buildings, as the worst president ever. People will laugh at him as they move to remove his name from everything they can, just as New Yorkers did when he was first elected, embarrassed to be associated with him.
Now for any sane person looking at, and listening to, this chaos, it is abundantly clear how embarrassing all this is for the country. It is clear he is moving the nation backwards when it comes to the equality and equity we have fought so hard to accomplish. Our country began with us killing, and taking land, from Native Americans. The founders of our nation 250 years ago only recognized white men. They left out women and Black men. We have spent the past 250 years trying to move forward from that beginning. Trying to live up to the statement in the Declaration of Independence that said, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”
We have come a long way, but still have not been able to add women’s equality to our Constitution. But Trump, along with his fascist aides and sycophants in Congress, is trying his best to undo all we have accomplished in those 250 years. Trying either to take away the right to vote, or make it harder to do. They took away the right of women to control their own healthcare, and are making it harder for Black people and the LGBTQ community, to live their lives fully, with dignity and safety. They will accomplish all this, and more, if not enough people come out on Nov. 3 and say, NO MORE. However, if enough decent people vote, we can take back our country, and our future.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
Opinions
Gloria Steinem’s life of substance and consequence
Iconic activist never stopped working to make life better for women
Gloria Steinem was an icon, a feminist, a woman of substance and consequence. A rare person who made a difference her entire life; sometimes quietly, sometimes by making noise. She was an incredibly beautiful woman, inside and out.
I heard of Gloria Steinem and admired her for all she was doing. But that was from a distance. I read about her, and saw her on TV. It was 1963 when Steinem wrote and published her undercover Playboy Bunny exposé, “A Bunny’s Tale,” about her going undercover at New York’s Playboy Club. Her account revealed the physical toll, exploitative conditions, and pervasive sexism faced by the women employed there, challenging the magazine’s image of empowerment.
It was 1972 when I first met her in person. That first meeting happened while I was campaigning for Bella Abzug (D-N.Y.) at a street rally. I said “Hello, Ms. Steinem,” and she said “It’s OK to call me Gloria.” I was honored to do so.
Gloria was there to support her friend. Bella had been through a grueling primary against Bill Ryan, after being redistricted out of her seat. She lost, but then Bill died of cancer before the election, and Bella was named the Democratic candidate in the general election for New York’s 20th congressional district. When Bella won that race, I went to work for her full time. It gave me the chance to meet Gloria again a number of times after that, once even with Bella at her apartment. While she was one of the many famous people I met while working for Bella, she was different. She wasn’t Hollywood. She began her career as a reporter, and worked hard for all she believed in. She was a true activist. That was what she saw herself as. She could say she came by the activism gene from her paternal grandmother, Pauline Perlmutter Steinem who Wikipedia reported, “chaired the educational committee of the National Woman Suffrage Association and was a delegate to the 1908 International Council of Women. Also, the first woman to be elected to the Toledo Board of Education and a leader in the movement for vocational education. She helped rescue many members of her family from the Holocaust.”
So yes, in many ways, activism was in Gloria’s genes. She was the one who told me it was OK to call myself a ‘feminist’. That it isn’t only women who can call themselves that, but also men who believed and fought for full social, economic, and political equality of the sexes. She helped me to understand I was brought up by a feminist. My mom, though she never called herself that, was one by dint of how she lived her life, and fought for others.
Gloria never stopped working to make life better for women, and to make sure other women joined her in her activism. In 1969, she co-founded Ms. Magazine. Then in 1971, with Bella Abzug, Betty Friedan and Shirley Chisholm, she founded the National Women’s Political Caucus, which provided training and support for women seeking elected and appointed office. Then in the same year she co-founded the Women’s Action Alliance, which until 1997 supported a network of feminist activists and worked to advance feminist causes and legislation.
Gloria would hold other women to task if they didn’t speak out, even at difficult times, but always with love. In 1986, Bella’s husband Martin died at the young age of 69. We were at the funeral home the night before the funeral, and Bella was sitting with some of us, and saying she didn’t know what she would do without Martin. It had been a true love affair. She was saying things like she didn’t even know where the checkbook was, what their rent was, etc., because Martin handled all that. Well Gloria overheard this and came over and said to Bella, “Don’t you dare say that in public, women look up to you as a feminist, as independent, you can’t say that.” And we all laughed, even Bella, as did Gloria, but she was serious.
Then in the 1990s Gloria helped to establish what she called ‘Take Our Daughters to Work Day.’ She did this to try to have young girls learn about future career opportunities. But her work wasn’t done and in 2005, along with Jane Fonda and Robin Morgan, she co-founded the Women’s Media Center. It is an organization that “works to make women visible and powerful in the media.”
The last time I saw Gloria was at the opening night of “Gloria: A Life,” at Theatre J in D.C. She was 88, as beautiful, and sharp as ever, having just come back from a speaking engagement in some far-off country.
Gloria, the world will miss you, RIP.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
