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Insured on paper, excluded in practice

How fertility coverage definitions discriminate against LGBTQ+ workers

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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.

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Solidarity beyond the parade: the actual cost of Pride

Chandreyi Guharay spoke with activists at World Pride in Amsterdam

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The World Pride Human Rights March took place in Amsterdam on Aug. 8, 2026. A loss of global funding has had a significant impact on the LGBTQ rights movement around the world. (Washington Blade photo by Michael Key)

Editor’s note: Chandreyi Guharay is the global advocacy officer for Walking the Talk. She spoke with queer activists from around the world at World Pride 2026 in Amsterdam about the impact of shrinking aid.

Queer activists and Dutch NGOs gathered at Amsterdam City Hall as part of “Building Bridges,” a World Pride 2026 visitor program for LGBTIQ+ community leaders run by the Dutch Ministry of Foreign Affairs and COC Nederland.

Pride is every day, everywhere

Although we were in Amsterdam, the work back home never stops for activists. Enkhmaa Enkhbold, executive director of the LGBT Center in Mongolia, excused themself a couple of times to check their phone.

“We’re organizing Pride in Mongolia, and it’s happening in two weeks,” they explained.

Among many other things, their organization drives policy advocacy and movement building for LGBTIQ+ rights, and helps queer people facing persecution find a safe way out.

John Mathenge Mukaburu is also doing the daily work of resistance. His organization HOYMAS in Kenya runs clinics across three counties, serving almost 20,000 patients from key populations, including gay and bisexual men and sex workers. In Nigeria, Cosmas Osinachi Ihenacho-Herbert, program director at Obodo, shared how they are changing the narrative by elevating the leading role queer people play in shaping art and culture across the country and the African continent.

And in Vietnam, Nguyễn Diệu Anh co-founded Yêu-nữ (Women Living Wicked), a sapphic collective that hosts regular gatherings where women have a place to find joy and each other. Whether it’s healthcare, protection, culture or belonging, these efforts keep communities alive. Still, they have never been properly funded.

Less funding, more backlash 

As an advocate for gender equality and a queer activist myself, I know how much LGBTIQ+ movements do with so little. Even before the dismantling of the U.S. Agency for International Development and the funding cuts across other major donor countries, just $.04 cents of every $100 in Official Development Assistance (ODA) went to queer communities. Now even that is rapidly disappearing. And what little there is doesn’t land evenly. As trans activist Marcela Morales from Asociación Lambda in Guatemala emphasized: “Most of the funding goes to gay men’s and trans women’s organizations. Very little reaches organizations of trans men and LBQ women.”

But this isn’t just about money. The same politics driving these cuts are shrinking civic space everywhere. Anti-rights actors are growing richer and bolder, finding new ways to target LGBTIQ+ people, as my colleague Jordan Dittmar has written. Queer and feminist activists defend the right to protest, to speak and love freely, to put care for people and the planet at the center and to decide over our own bodies and lives. And yet our rights are always the easiest target, and our funding the first to be cut. We are the canary in the coal mine, and everyone else’s freedoms are never far behind. That should worry all of us.

A lifeline built on solidarity

Bessy Ferrera was a trans activist from Honduras who fought for the rights of trans people, sex workers and people living with HIV, and whose life was violently cut short in 2019. A year later, Hivos established the Bessy Ferrera Emergency Fund in her name. It offers fast, practical help to LGBTIQ+ activists facing threats because of their work, from medical and legal costs to security and relocation. Since 2022, it has helped nearly 100 people and organizations around the world.

When I mentioned the fund to Ribal Maatouk, national chairperson of the LGBTIQ+ Task Force in Lebanon, he told me he already knew it well. Through Israel’s devastating invasion and war, the Task Force, alongside its member organizations, notably specialized local LGBTIQ+ CSOs, have continued to provide humanitarian support to queer people.

“From all the funding initiatives, the Bessy Ferrera Fund was the most easily accessible for our community, allowing for a faster deployment of emergency support than other organizations,” he said. “I need to give credit where it’s due.”

Hope for the long haul

Emergency funds provide a vital lifeline during a crisis, but activists and their movements also need lasting support. For Cosmas, the lesson is hopeful: governments change with elections, and funding changes with them, but movements can outlast both. For activists in the Global South, that has often been the reality.

“Maybe the question is not how we survive this crisis,” he said, “But how we build a movement infrastructure that’s strong enough for us to thrive through whatever comes next.”

He also sees an opening: with the U.S. stepping back, the Netherlands could once again be the champion of gender equality and LGBTIQ+ rights it used to be. With a new Dutch government in place, there are signs of greater political will, and now is the moment to turn it into funding.

What comes after the parade

The activists I met have been holding their communities together, standing alongside feminist and queer movements everywhere to defend rights and freedoms for all. As we often say in the gender equality movement, imagine what they could do with the right support. Solidarity beyond the parade means that governments, funders and allies invest in queer aspirations.

Chandreyi Guharay is a Nicaraguan-Indian gender justice specialist by training, and — in Sara Ahmed’s words — a feminist killjoy by political choice. She’s the Global Advocacy Officer at Walking the Talk/Hivos, weaving together strategic advocacy, policy analysis and coalition-building for gender equality financing. She’s previously worked with Oxfam, Plan International, She Decides, CIVICUS, and Share-Net on research, organizational development and political education. Outside of work, you’ll find her co-conspiring with Feministas en Holanda, a decolonial grassroots collective of Latin American people in the Netherlands, where she is a community organizer around anti-racist and migrant justice struggles.

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Trump, Netanyahu, and Putin are all war criminals

We are living in a world of chaos as a result

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From left, Donald Trump, Benjamin Netanyahu and Vladimir Putin. (Photo of Trump by andykatz; photo of Netanyahu by palinchak; photo of Putin by vverve / Bigstock)

Today there are war criminals leading three major governments. President Trump here in the United States, Benjamin Netanyahu in Israel, and Vladimir Putin in Russia. The world would be a better place if they were thrown into a jail cell together, and the key tossed away. 

We are living in a world of chaos. Although these three are not responsible for all of it, they have a major role. All three are carrying out wars that they can’t win. Wars that should have never been started. In the process they are not only killing their stated enemies, but they’re also causing the deaths of their own people. 

Here in the United States, we have a felon in the White House, who has done nothing but create chaos in the world since he took office. He has broken every promise he made to get elected, and while many of us knew they were all lies, he won anyway. He promised lower rents, lower mortgage rates, lower inflation, lower gas prices, lower grocery prices, and importantly, no new wars. He has accomplished the exact opposite in each of those areas. He began a war with Iran and started by bombing a school, mistake or not, killing innocent children. This after declaring war on immigrants here at home using his ICE Gestapo. He apparently thinks if he creates chaos, and then gets things back to close to where they were before he acted, he can claim victory.  But even that seems out of his reach. 

Then there is Prime Minister Netanyahu in Israel. His actions have made things worse not only for his enemies, but for Israelis at home, and Jews around the world. He began a war against Iran that he can’t win. He has committed war crimes against the Palestinian people in Gaza, and the West Bank, and by his actions brought out more anti-Semitism around the world. For me personally, he has made it more difficult to explain to people when I say I am a Zionist, it means I support the existence of the State of Israel, not its war criminal leader, and his government. He should have heeded what President Biden said to him after the Oct. 7 attack on Israel by Hamas. While retribution and getting back the hostages Hamas took was crucial, Biden counseled not to go overboard in response, like the United States did after 9/11. Instead, Netanyahu has killed thousands of Palestinian women and children, and has not made Israel much safer. He then began the war with Iran, and sent troops to fight in Lebanon. Yes, the Iranian government funds Hezbollah and Hamas, but one must ask if anything is better after Netanyahu’s actions. Israelis continue living in a state of active war. 

Then there is Putin in Russia. He believed he could attack Ukraine and walk away with pieces of their country, maybe even all of it. Instead, he has Russia embroiled in a four-year war, killing thousands of Ukrainians, including many women and children, destroying parts of their country, and losing thousands of his own troops in a war he can’t win. His own people are suffering, and now, four years later, Ukraine has shown it still has the ability to attack Moscow. All three of these men have managed to show the weaknesses of their own countries.

In his effort to bluster through his many failures, Trump has destroyed relationships with our allies. It will take years, if ever, for them to trust the United States again. He invaded Venezuela and stole their oil, is starving Cuba, and created unease with Canada and Mexico on our own borders. He thinks this makes him look like a strongman, when it really shows all of his weaknesses. People should remember the treaty he abrogated with Canada and Mexico, was one he negotiated in his first term. Now he invites Chinese President, Xi, to the United States, and gives him the same red-carpet welcome he previously gave to Putin in Alaska, and in both cases, received nothing in return. He tries to keep the press he doesn’t like from having access to him. 

All three are facing crucial elections that could severely impact their futures. Only Putin, a true dictator, is assured of winning because he controls the process. Trump is trying to emulate him, to keep from losing the Nov. 3, mid-term elections. Thankfully the courts are trying to stop him. Netanyahu could face being thrown out on Oct. 27, if Israelis do the right thing. 

Again, I truly believe putting the three of them in a jail cell together would make our troubled world a little safer, and a much better place. 


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

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Center Arts Gallery celebrates 10 years with reception, auction

Oct. 17 fundraiser to feature jazz combo, artwork created on site

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(Photo by Gilmanshin/Bigstock)

Ten years ago, I had a vision: to create a dedicated space within The DC LGBTQ+ Community Center for local LGBTQ+ artists to share their creativity in a community space conceived specifically for them. That vision became the Center Arts Gallery. Over the past decade, the Center Arts Gallery has grown into a true home for our LGBTQ+ siblings, a place illuminating our joy, resistance, and resilience through the power of art.

Art is so much more than decoration. It can be a powerful protest, a keeper of memories, a testament to survival, and a vivid reminder that our lived experiences deserve to be seen, heard, and deeply valued. When we created the Center Arts Gallery, our goal was to remove barriers so that queer artists could feel welcomed, supported, and completely free to express themselves. Now, as we mark the incredible 10th anniversary of Center Arts, love truly comes full circle as many of those same amazing artists and creatives are giving back by donating their artwork for a special benefit auction.

On Saturday, Oct. 17, 2026, The DC LGBTQ+ Community Center will host our annual Fall Reception and Art Auction, celebrating 10 years of Center Arts Gallery at 1827 Wiltberger St., N.W., with an ambitious fundraising target of $25,000. 

Appropriately themed “The Art of Belonging,” this milestone celebration will bring our community together with intention, uniting multiple forms of local queer creativity under one roof. The evening promises to be an unforgettable experience. 

We are thrilled to have the celebration hosted by award-winning spoken word artist, poet, and educator Charity Blackwell. Attendees will enjoy smooth jazz selections performed by 2nd Independence — a jazz combo from the DC Different Drummers — alongside delicious heavy hors d’oeuvres provided by Shaw Tavern and exquisite dessert offerings by celebrity chef Patrick Vanas.

Throughout the night artwork will be created live on site, joining the online pieces generously donated by local artists.

Most importantly, every dollar raised during the reception and auction goes directly toward sustaining The DC Center’s life-affirming programs and supportive services. From food assistance providing nourishing meals, the free food pantry, and behavioral health counseling, to trauma-informed case management, resource navigation, HIV/STI testing, and essential hygiene services like showers, laundry, and a clothing boutique, our doors remain open because

of community support. These funds also support our cyber lounge, mail and locker services, harm reduction supplies, and critical wellness programs.

To ensure that everyone in our community can fully participate, ASL interpretation will be provided during the event program. We offer flexible ways to join us: General Admission is free (currently at capacity), with custom signature cocktails, wine, and beer available for purchase.

For those looking for an elevated evening, our $75 VIP Experience includes early admission at 6 p.m., early online auction access, complimentary Champagne (6-7 p.m.), an intimate opportunity to mingle with participating artists, a special swag bag, plus an open beer and wine bar throughout the entire evening.

For 10 years, Center Arts Gallery has shown us that belonging is an art form we create together. As we look back on a decade of community and look forward to the future, I invite you to join us, support local queer artists, and invest in the essential programs that keep our community thriving. Let’s come together to ensure that The DC Center can continue to educate, empower, uplift, and connect us all for generations to come.


Kimberley Bush is executive director of The DC LGBTQ+ Community Center.

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