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4th Circuit rules gender identity is a protected characteristic

Ruling a response to N.C., W.Va. legal challenges

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Lewis F. Powell Jr. Courthouse in Richmond, Va. (Photo courtesy of the U.S. Courts/GSA)

BY ERIN REED | The 4th U.S. Circuit Court of Appeals ruled Monday that transgender people are a protected class and that Medicaid bans on trans care are unconstitutional.

Furthermore, the court ruled that discriminating based on a diagnosis of gender dysphoria is discrimination based on gender identity and sex. The ruling is in response to lower court challenges against state laws and policies in North Carolina and West Virginia that prevent trans people on state plans or Medicaid from obtaining coverage for gender-affirming care; those lower courts found such exclusions unconstitutional.

In issuing the final ruling, the 4th Circuit declared that trans exclusions were “obviously discriminatory” and were “in violation of the equal protection clause” of the Constitution, upholding lower court rulings that barred the discriminatory exclusions.

The 4th Circuit ruling focused on two cases in states within its jurisdiction: North Carolina and West Virginia. In North Carolina, trans state employees who rely on the State Health Plan were unable to use it to obtain gender-affirming care for gender dysphoria diagnoses.

In West Virginia, a similar exclusion applied to those on the state’s Medicaid plan for surgeries related to a diagnosis of gender dysphoria. Both exclusions were overturned by lower courts, and both states appealed to the 4th Circuit.

Attorneys for the states had argued that the policies were not discriminatory because the exclusions for gender affirming care ā€œapply to everyone, not just transgender people.ā€ The majority of the court, however, struck down such a claim, pointing to several other cases where such arguments break down, such as same-sex marriage bans ā€œapplying to straight, gay, lesbian, and bisexual people equally,ā€ even though straight people would be entirely unaffected by such bans.

Other cases cited included literacy tests, a tax on wearing kippot for Jewish people, and interracial marriage in Loving v. Virginia.

See this portion of the court analysis here:

4th Circuit rules against legal argument that trans treatment bans do not discriminate against trans people because ‘they apply to everyone.’

Of particular note in the majority opinion was a section on Geduldig v. Aiello that seemed laser-targeted toward an eventual U.S. Supreme Court decision on discriminatory policies targeting trans people. Geduldig v. Aiello, a 1974 ruling, determined that pregnancy discrimination is not inherently sex discrimination because it does not “classify on sex,” but rather, on pregnancy status.

Using similar arguments, the states claimed that gender affirming care exclusions did not classify or discriminate based on trans status or sex, but rather, on a diagnosis of gender dysphoria and treatments to alleviate that dysphoria.

The majority was unconvinced, ruling, ā€œgender dysphoria is so intimately related to transgender status as to be virtually indistinguishable from it. The excluded treatments aim at addressing incongruity between sex assigned at birth and gender identity, the very heart of transgender status.ā€ In doing so, the majority cited several cases, many from after Geduldig was decided.

Notably, Geduldig was cited in both the 6th and 11th Circuit decisions upholding gender affirming care bans in a handful of states.

The court also pointed to the potentially ridiculous conclusions that strict readings of what counts as proxy discrimination could lead to, such as if legislators attempted to use ā€œXX chromosomesā€ and ā€œXY chromosomesā€ to get around sex discrimination policies:

The 4th Circuit majority rebuts the state’s proxy discrimination argument.

Importantly, the court also rebutted recent arguments that Bostock applies only to “limited Title VII claims involving employers who fired” LGBTQ employees, and not to Title IX, which the Affordable Care Act’s anti-discrimination mandate references. The majority stated that this is not the case, and that there is “nothing in Bostock to suggest the holding was that narrow.”

Ultimately, the court ruled that the exclusions on trans care violate the Equal Protection Clause of the Constitution. The court also ruled that the West Virginia Medicaid Program violates the Medicaid Act and the anti-discrimination provisions of the Affordable Care Act.

Additionally, the court upheld the dismissal of anti-trans expert testimony for lacking relevant expertise. West Virginia and North Carolina must end trans care exclusions in line with earlier district court decisions.

The decision will likely have nationwide impacts on court cases in other districts. The case had become a major battleground for trans rights, with dozens of states filing amicus briefs in favor or against the protection of the equal process rights of trans people.Ā Twenty-one Republican statesĀ filed an amicus brief in favor of denying trans people anti-discrimination protections in healthcare, and 17 Democratic statesĀ joined an amicus brief in support of the healthcare rights of trans individuals.

Many Republican states are defending anti-trans laws that discriminate against trans people by banning or limiting gender-affirming care. These laws could come under threat if the legal rationale used in this decision is adopted by other circuits. In the 4th Circuit’s jurisdiction, West Virginia and North CarolinaĀ already have gender-affirming care bans for trans youth in place, andĀ South Carolina may consider a similar bill this week.

The decision could potentially be used as precedent to challenge all of those laws in the near future and to deter South Carolina’s bill from passing into law.

The decision is the latest in a web of legal battles concerning trans people. Earlier this month, the 4th Circuit also reversed a sports ban in West Virginia, ruling that Title IX protects trans student athletes. However, theĀ Supreme Court recently narrowedĀ a victory for trans healthcare from the 9th U.S. Circuit Court of Appeals and allowed Idaho to continue enforcing its ban on gender-affirming care for everyone except the two plaintiffs in the case.

Importantly, that decision was not about the constitutionality of gender-affirming care, but the limits of temporary injunctions in the early stages of a constitutional challenge to discriminatory state laws. It is likely that the Supreme Court will ultimately hear cases on this topic in the near future.

Celebrating the victory, Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan said in a posted statement, ā€œThe court’s decision sends a clear message that gender-affirming care is critical medical care for transgender people and that denying it is harmful and unlawful … We hope this decision makes it clear to policy makers across the country that health care decisions belong to patients, their families, and their doctors, not to politicians.ā€ 

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Erin Reed is a transgender woman (she/her pronouns) and researcher who tracks anti-LGBTQ+ legislation around the world and helps people become better advocates for their queer family, friends, colleagues, and community. Reed also is a social media consultant and public speaker.

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The preceding article was first published at Erin In The Morning and is republished with permission.

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Federal Government

Top Democrats reintroduce bill to investigate discrimination against LGBTQ military members

Takano, Jacobs, and Blumenthal sponsored measure

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U.S. Rep. Mark Takano (D. Calif.) speaks at a Hispanic Federation press conference outside U.S. Capitol on July 9, 2024. (Washington Blade photo by Michael Key)

Multiple high-ranking members of Congress reintroduced the Commission on Equity and Reconciliation in the Uniformed Services Act into the U.S. House of Representatives and the U.S. Senate, aiming to establish a commission to investigate discriminatory policies targeting LGBTQ military members.

Three leading Democratic members of Congress — U.S. Rep. Mark Takano (D-Calif.), who is the House Veterans’ Affairs Committee’s ranking member and chairs the Congressional Equality Caucus; U.S. Sen. Richard Blumenthal (D-Conn.), who is the Senate Veterans’ Affairs Committee’s ranking member; and U.S. Rep. Sara Jacobs (D-Calif.) — introduced the bill on Tuesday.

The bill, they say, would establish a commission to investigate the historic and ongoing impacts of discriminatory military policies on LGBTQ servicemembers and veterans.

This comes on the one-year anniversary of the Trump-Vance administration’s 2025 Executive Order 14183, titled ā€œPrioritizing Military Excellence and Readiness,ā€ which essentially banned transgender servicemembers from openly serving in the Armed Forces, leading to the forced separation of thousands of capable and dedicated servicemembers.

In a joint statement, Takano, Blumenthal, and Jacobs shared statistics on how many service members have had their ability to serve revoked due to their sexual orientation:

ā€œApproximately 114,000 servicemembers were discharged on the basis of their sexual orientation between WWII and 2011, while an estimated 870,000 LGBTQ servicemembers have been impacted by hostility, harassment, assault, and law enforcement targeting due to the military policies in place,ā€ the press release reads. ā€œThese separations are devastating and have long-reaching impacts. Veterans who were discharged on discriminatory grounds are unable to access their benefits, and under the Trump administration, LGBTQ+ veterans and servicemembers have been openly persecuted.ā€

The proposed commission is modeled after the Congressional commission that investigated and secured redress for Japanese Americans interned during World War II. Takano’s family was among the more than 82,000 Japanese Americans who received an official apology and redress payment under that commission.

The press release notes this is a major inspiration for the act.

ā€œQualified servicemembers were hunted down and forced to leave the military at the direction of our government,ā€ said Takano. ā€œThese practices have continued, now with our government targeting transgender servicemembers. The forced separation and dishonorable discharges LGBTQ+ people received must be rectified, benefits fully granted, and dignity restored to those who have protected our freedoms.ā€

ā€œLGBTQ+ servicemembers have long been the target of dangerous and discriminatory policies—resulting in harassment, involuntary discharge, and barriers to their earned benefits,ā€ said Blumenthal. ā€œEstablishing this commission is an important step to understand the full scope of harm and address the damage caused by policies like ā€˜Don’t Ask, Don’t Tell.’ As LGBTQ+ servicemembers and veterans face repugnant and blatant bigotry under the Trump administration, we will keep fighting to secure a more equitable future for all who serve our country in uniform.ā€

ā€œInstead of righting wrongs and making amends to our LGBTQ+ service members and veterans who’ve suffered injustices for decades, I’m ashamed that the Trump administration has doubled down: kicking trans folks out of the military and banning their enlistment,ā€ said Jacobs. ā€œWe know that LGBTQ+ service members and veterans have faced so much ugliness — discrimination, harassment, professional setbacks, and even violence — that has led to unjust discharges and disparities in benefits, but we still don’t have a full picture of all the harm caused. That needs to change. That’s why I’m proud to co-lead this bill to investigate these harms, address the impacts of discriminatory official policies like ā€˜Don’t Ask, Don’t Tell’ and the transgender military ban, and ensure equity and justice for our LGBTQ+ service members and veterans.ā€

Takano and Jacobs are leading the bill in the House, while Blumenthal is introducing companion legislation in the Senate.

Takano’s office has profiled and interviewed LGBTQ servicemembers who were harmed by discriminatory policies in the uniformed services.

The Commission on Equity and Reconciliation in the Uniformed Services Act is supported by Minority Veterans of America, Human Rights Campaign, Equality California, SPARTA, and the Transgender American Veterans Association.

In recent weeks, thousands of trans military members were forcibly put into retirement as a result of Trump’s executive order, including five honored by the Human Rights Campaign with a combined 100 years of service, all due to their gender identity: Col. Bree B. Fram (U.S. Space Force), Commander Blake Dremann (U.S. Navy), Lt. Col. (Ret.) Erin Krizek (U.S. Air Force), Chief Petty Officer (Ret.) Jaida McGuire (U.S. Coast Guard), and Sgt. First Class (Ret.) Catherine Schmid (U.S. Army).

Multiple career service members spoke at the ceremony, including Takano. Among the speakers was Frank Kendall III, the 26th U.S. Air Force secretary, who said:

ā€œWe are in a moment of crisis that will be worse before it is better. Members of my father’s and mother’s generation would ask each other a question: what did you do during the war? Someday we will all be asked what we did during this time. Please think about the answer that you will give.ā€

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Trump-appointed EEOC leadership rescinds LGBTQ worker guidance

The EEOC voted to rescind its 2024 guidance, minimizing formally expanded protections for LGBTQ workers.

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Equal Employment Opportunity Commission seal, gay news, Washington Blade

The U.S. Equal Employment Opportunity Commission voted 2–1 to repeal its 2024 guidance, rolling back formally expanded protections for LGBTQ workers.

The EEOC, which is composed of five commissioners, is tasked with enforcing federal laws that make workplace discrimination illegal. Since President Donald Trump appointed two Republican commissioners last year — Andrea R. Lucas as chair in January and Brittany Panuccio in October — the commission’s majority has increasingly aligned its work with conservative priorities.

The commission updated its guidance in 2024 under then-President Joe Biden to expand protections to LGBTQ workers, particularly transgender workers — the most significant change to the agency’s harassment guidance in 25 years.

The directive, which spanned nearly 200 pages, outlined how employers may not discriminate against workers based on protected characteristics, including race, sex, religion, age, and disability as defined under federal law.

One issue of particular focus for Republicans was the guidance’s new section on gender identity and sexual orientation. Citing the 2020 U.S. Supreme Court’s Bostock v. Clayton County decision and other cases, the guidance included examples of prohibited conduct, such as the repeated and intentional use of a name or pronoun an individual no longer uses, and the denial of access to bathrooms consistent with a person’s gender identity.

Last year a federal judge in Texas had blocked that portion of the guidance, saying that finding was novel and was beyond the scope of the EEOC’s powers in issuing guidance.

The dissenting vote came from the commission’s sole Democratic member, Commissioner Kalpana Kotagal.

ā€œThere’s no reason to rescind the harassment guidance in its entirety,ā€ Kotagal said Thursday. ā€œInstead of adopting a thoughtful and surgical approach to excise the sections the majority disagrees with or suggest an alternative, the commission is throwing out the baby with the bathwater. Worse, it is doing so without public input.ā€

While this now rescinded EEOC guidance is not legally binding, it is widely considered a blueprint for how the commission will enforce anti-discrimination laws and is often cited by judges deciding novel legal issues. 

Multiple members of Congress released a joint statement condemning the agency’s decision to minimize worker protections, including U.S. Reps. Teresa Leger FernĆ”ndez (D-N.M.), Grace Meng (D-N.Y.), Mark Takano (D-Calif.), Adriano Espaillat (D-N.Y.), and Yvette Clarke (D-N.Y.) The rescission follows the EEOC’s failure to respond to or engage with a November letter from Democratic Caucus leaders urging the agency to retain the guidance and protect women and vulnerable workers.

ā€œThe Equal Employment Opportunity Commission is supposed to protect vulnerable workers, including women, people of color, and LGBTQI+ workers, from discrimination on the job. Yet, since the start of her tenure, the EEOC chair has consistently undermined protections for women, people of color, and LGBTQI+ workers. Now, she is taking away guidance intended to protect workers from harassment on the job, including instructions on anti-harassment policies, training, and complaint processes — and doing so outside of the established rule-making process. When workers are sexually harassed, called racist slurs, or discriminated against at work, it harms our workforce and ultimately our economy. Workers can’t afford this — especially at a time of high costs, chaotic tariffs, and economic uncertainty. Women and vulnerable workers deserve so much better.ā€

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Holiday week brings setbacks for Trump-Vance trans agenda

Federal courts begin to deliver end-of-year responses to lawsuits involving federal transgender healthcare policy.

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While many Americans took the week of Christmas to rest and relax, LGBTQ politics in the U.S. continued to shift. This week’s short recap of federal updates highlights two major blows to the Trump-Vance administration’s efforts to restrict gender-affirming care for minors.

19 states sue RFK Jr. to end gender-affirming care ban

New York Attorney General Letitia James announced on Tuesday that the NYAG’s office, along with 18 other states (and the District of Columbia), filed a lawsuit to stop U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. from restricting gender-affirming care for minors.

In the press release, Attorney General James stressed that the push by the Trump-Vance administration’s crusade against the transgender community — specifically transgender youth — is a ā€œclear overreach by the federal governmentā€ and relies on conservative and medically unvalidated practices to ā€œpunish providers who adhere to well-established, evidence-based careā€ that support gender-affirming care.

ā€œAt the core of this so-called declaration are real people: young people who need care, parents trying to support their children, and doctors who are simply following the best medical evidence available,ā€ said Attorney General James. ā€œSecretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should lose access to medically necessary health care because their federal government tried to interfere in decisions that belong in doctors’ offices. My office will always stand up for New Yorkers’ health, dignity, and right to make medical decisions free from intimidation.ā€

The lawsuit is a direct response to HHS’ Dec. 18 announcement that it will pursue regulatory changes that would make gender-affirming health care for transgender children more difficult, if not impossible, to access. It would also restrict federal funding for any hospital that does not comply with the directive. KFF, an independent source for health policy research, polling, and journalism, found that in 2023 federal funding covered nearly 45% of total spending on hospital care in the U.S.

The HHS directive stems directly from President Donald Trump’s Jan. 28 Executive Order, Protecting Children From Chemical and Surgical Mutilation, which formally establishes U.S. opposition to gender-affirming care and pledges to end federal funding for such treatments.

The American Medical Association, the nation’s largest and most influential physician organization, has repeatedly opposed measures like the one pushed by President Trump’s administration that restrict access to trans health care.

ā€œThe AMA supports public and private health insurance coverage for treatment of gender dysphoria and opposes the denial of health insurance based on sexual orientation or gender identity,ā€ a statement on the AMA’s website reads. ā€œImproving access to gender-affirming care is an important means of improving health outcomes for the transgender population.ā€

The lawsuit also names Oregon, Washington, California, Colorado, Connecticut, Delaware, the District of Columbia, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Mexico, Pennsylvania, Rhode Island, Vermont, and Wisconsin as having joined New York in the push against restricting gender-affirming care.

At the HHS news conference last Thursday, Jim O’Neill, deputy secretary of the department, asserted, ā€œMen are men. Men can never become women. Women are women. Women can never become men.ā€

DOJ stopped from gaining health care records of trans youth

U.S. District Judge Cathy Bissoon blocked an attempt by the Department of Justice (DOJ) to gain ā€œpersonally identifiable information about those minor transgender patientsā€ from the University of Pittsburgh Medical Center (UPMC), saying the DOJ’s efforts ā€œfly in the face of the Supreme Court.ā€

Journalist Chris Geidner originally reported the news on Dec. 25, highlighting that the Western District of Pennsylvania judge’s decision is a major blow to the Trump-Vance administration’s agenda to curtail transgender rights.

ā€œ[T]his Court joins the others in finding that the government’s demand for deeply private and personal patient information carries more than a whiff of ill intent,ā€ Bissoon wrote in her ruling. ā€œThis is apparent from its rhetoric.ā€

Bissoon cited the DOJ’s ā€œincendiary characterizationā€ of trans youth care on the DOJ website as proof, which calls the practice politically motivated rather than medically sound and seeks to ā€œā€¦mutilate children in the service of a warped ideology.ā€ This is despite the fact that a majority of gender-affirming care has nothing to do with surgery.

In United States v. Skrmetti, the Supreme Court ruled along party lines that states — namely Tennessee — have the right to pass legislation that can prohibit certain medical treatments for transgender minors, saying the law is not subject to heightened scrutiny under the Equal Protection Clause of the Fourteenth Amendment because it does not involve suspect categories like race, national origin, alienage, and religion, which would require the government to show the law serves a compelling interest and is narrowly tailored, sending decision-making power back to the states.

ā€œThe government cannot pick and choose the aspects of Skrmetti to honor, and which to ignore,ā€ Judge Bissoon added.

The government argued unsuccessfully that the parents of the children whose records would have been made available to the DOJ ā€œlacked standingā€ because the subpoena was directed at UPMC and that they did not respond in a timely manner. Bissoon rejected the timeliness argument in particular as ā€œdisingenuous.ā€

Bissoon, who was nominated to the bench by then-President Obama, is at least the fourth judge to reject the DOJ’s attempted intrusion into the health care of trans youth according to Geidner.

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