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
Support the Blade as mainstream media bend the knee for Trump
From CBS to Washington Post, MAGA taking over messaging
We knew it would be bad. I’m referring, of course, to 2025 and the unthinkable return of Donald Trump to the White House.
We just didn’t know how bad. The takeover of D.C. police. ICE raids and agents shooting defenseless citizens in the face. The cruel attacks on trans Americans. A compliant and complicit right-wing Supreme Court and GOP rubberstamping all the criminality and madness.
Much of that was outlined in Project 2025 and was predictable. But what has proven surprising is the speed with which major companies, powerful billionaires, and media conglomerates have hopped on board the authoritarian train and kissed Trump’s ring. Tech giants like Apple and Meta and media companies like CBS and the Washington Post have folded like cheap tents, caving to MAGA pressure and enabling Trump’s evil agenda.
The guardrails collapsed in 2025. Congress has ceded its role as a formerly co-equal branch of government. Once trusted media outlets have betrayed their audiences’ trust and morphed into propaganda arms of the White House. As a lifelong journalist, this is perhaps the most shocking and disappointing development of the past year.
The Washington Post, which adopted the ominous tagline of “Democracy Dies in Darkness,” killed its endorsement of Kamala Harris in the final days of the 2024 campaign. Same thing at the Los Angeles Times. More recently, CBS’s vaunted “60 Minutes” spiked a story critical of Trump’s immigration policies under the direction of new editor-in-chief Bari Weiss, a Trump toady and the antithesis of a journalist.
Concurrently, media companies large and small are fighting to survive. Government grants have been rescinded and the Corporation for Public Broadcasting, responsible for funding NPR and PBS, announced plans to dissolve. The Pittsburgh Post-Gazette, a nearly century-old Pulitzer Prize-winning institution, announced this week it will close on May 3. The Washington Post has lost scores of talented journalists, including prominent LGBTQ voices like Jonathan Capehart. The Baltimore Sun was acquired by the same family that owns right-wing Sinclair Broadcasting, ending a nearly 190-year tradition of award-winning, independent journalism.
It is not a coincidence that Trump’s attacks on democracy, traditions, and norms are happening while the media industry collapses. News deserts are everywhere now. In 2024, 127 newspapers closed, leaving 55 million Americans with limited or no access to local news, according to a report by Medill.
There’s a reason the media are called the “Fourth Estate.” Journalism was considered so critical to the health of our democracy that the Founding Fathers spelled it out in the First Amendment. Democracy and our Constitution cannot survive without a free and robust press.
That’s why I felt compelled to write this appeal directly to our readers. For nearly 57 years, the Blade has told the stories of LGBTQ Washington, documenting all the triumphs and heartbreaks and writing the first draft of our own history. Today, we remain hard at work, including inside the White House. This week, we have a reporter on the ground in Colombia, covering the stories of queer Venezuelan migrants amid the crisis there; another reporter will be inside the Supreme Court for next week’s trans-related cases; on Sunday, we have a reporter on the red carpet at the Golden Globes ready to interview the stars of “Heated Rivalry.”
We do a lot with a little. As major companies pull back on their support of the LGBTQ community, including their advertising in the Blade, we turn to our readers. We have never charged a dime to read the Blade in print or online. Our work remains a free and trusted resource. As we navigate these challenges, we ask that you join us. If you have the resources, please consider making a donation or purchasing a membership. If not, please subscribe to our free email newsletter. To join, visit washingtonblade.com and click on “Fund LGBTQ Journalism” in the top right navigation.
Our community is known for its resilience. At the Blade, we’ve weathered the AIDS epidemic, financial crises, and a global pandemic. We are committed to our mission and will never bend to a wannabe dictator the way so many mainstream media outlets have done. The queer press is still here and with your help we will survive these unprecedented attacks on democracy and emerge stronger than before. Thank you for reading the Blade and for considering making a donation to support our work.
Kevin Naff is editor of the Washington Blade. Reach him at [email protected].
Opinions
Time has run out for the regime in Venezuela
American forces seized Nicolás Maduro, wife on Jan. 3
Time has run out for the regime in Venezuela.
I am fully aware that we are living through complex and critical days, not only for my country but also for the entire region. However, the capture of Nicolás Maduro has renewed hope and strengthened my conviction that we must remain firm in our cause, with the certainty that the valid reward will be to see Venezuela free from those who continue to cling illegitimately to power.
In light of this new reality, I adopt a clear, direct, and unequivocal position:
I demand the immediate release of all political prisoners.
I demand that all persons arbitrarily detained for political reasons be returned to their families immediately, without delay or conditions.
According to Foro Penal, as of Jan. 5, 2026, there are 806 political prisoners in Venezuela, including 105 women, 175 military personnel, and one adolescent, and a total of 18,623 arbitrary arrests documented since 2014. The same report documents 17 people who have died while in State custody and 875 civilians prosecuted before military courts, clearly evidencing the use of the judicial and security apparatus as instruments of political persecution. In parallel, the humanitarian system estimates that 7.9 million people in Venezuela require urgent assistance, further aggravating the impact of repression on daily life.
Behind these figures are shattered lives, separated families, and destroyed life projects. Students, activists, human rights defenders, political leaders, and members of the armed forces remain imprisoned without judicial guarantees, without due process, and without justice.
Since the capture of Nicolás Maduro, repression has not ceased. On the contrary, more than ten journalists have been arbitrarily detained, while others have been harassed, imprisoned, or mistreated for carrying out their duty to inform. Today, journalism in Venezuela has become a heroic and high-risk act.
This situation is further aggravated by a new attack on fundamental freedoms: an illegitimate decree of “external state of emergency”, whose purpose is to legalize state terrorism, expand the scope of repression, and deepen the criminalization of dissent and freedom of expression.
The destruction of freedoms cannot and must not be normalized, either by society or by the international community.
I do not forget the atrocities committed against people deprived of their liberty: systematic violations of due process, torture, cruel, inhuman, and degrading treatment, denial of medical care, and prolonged isolation.
These practices have been widely documented and denounced and are currently under investigation by international justice mechanisms.
In this regard, the United Nations Independent International Fact-Finding Mission on Venezuela has repeatedly expressed grave concern over the persistence of serious human rights violations, including the use of torture, enforced isolation, and the responsibility of State security forces in systematic abuses, as reflected in its statements and reports issued on Jan. 3, 2026, and throughout 2025.
From my unwavering commitment to human rights, I issue a firm and urgent call to Venezuelan citizens and to all people in the free and democratic world to stand together in defense of human dignity.
All political prisoners must be released now.
All torture and detention centers must be closed.
I am convinced that there can be no genuine democratic transition without the immediate release of political prisoners, the submission to justice of those responsible for arbitrary detentions, and the establishment of accountability mechanisms, guarantees of non-repetition, and full reparation for victims and their families. This is the only viable path toward a proper transition to democracy in Venezuela.
Today, more than ever, I stand in solidarity, inside and outside Venezuela, with the victims and their families.
This is a moment of definition, not of silence or hesitation.
I assume, together with millions of Venezuelans, that we are co-responsible for our collective reality and for the new Venezuela that we are called to rebuild.
Dignity, freedom, and justice cannot wait.
Freedom for Venezuela.
Juan Carlos Viloria Doria is president of the Global Alliance for Human Rights and vice president of Venezolanos en Barranquilla, an NGO based in Barranquilla, Colombia.
Opinions
Just say no to the felon in the White House
Democrats, media must do more to oppose Trump’s agenda
We have a clearly deranged, sick, felon as president, who can’t even remember if he had an MRI, or a CT. He says he takes enough aspirin to keep his blood running thin in his veins. He fakes health reports, and lies every time he opens his mouth. His brain appears foggier than Joe Biden’s ever was.
The felon arranged to get a fake Peace Prize from the soccer federation, while taking military actions around the world. He sanctioned American attacks on Nigeria, Iran, Syria, and now on the government, and people, of Venezuela. He has our military attacking boats, claiming they are carrying drugs, with no proof. He interferes in foreign elections, making the United States less safe. He obviously supports Putin in his war against Ukraine, and supports Netanyahu’s destruction of Gaza, and his starvation of the Palestinian people there. Because of all this it’s understandable why he calls his Secretary of Defense, his Secretary of War. That individual being unqualified with no competence, or decency — the perfect toady for the fascists surrounding Trump. He has a Secretary of State in Marco Rubio who clearly has no principles at all. Rubio previously said, “Donald Trump – a con artist – will never get control of this party…We cannot allow a con artist to get access to the nuclear codes of the United States of America.” He compared Trump to a “third-world strong man.” Now as Secretary of State he justifies all the illegal actions the felon takes.
I, and many others, question “Where is Congress in all this?” Do no Republicans in Congress have any cojones? Two Republican woman have criticized Trump — Marjorie Taylor Greene (R-Ga.) and Nancy Mace (R-S.C.). Both on the Epstein files, one on screwing the American people with regard to their health insurance. Both are now out of Congress, still MAGA, but found if you disagree with the felon, he sics his cult on you.
My other question is: When will any in the media really stand up to him? When do mainstream media call out every one of his lies, as he makes them? When do they show any guts, and repeat each day he is deranged? When do they have daily headlines, calling him out on things from his health reports, to lies about the economy? Where are the daily headlines calling out the Republican Congress for its lack of action? Why is there no representative clock on every TV network, ticking off the time Congress doesn’t take back their rightful place as an equal branch of government? When will they call out the Supreme Court, reminding people what Trump’s picks said during their confirmations, versus what they are doing now? When will they actually reclaim ‘The freedom of the press?’
Democrats must continue to speak out. I am aware they have little power in this Congress, but they must not remain silent. We have seen, when they do speak up, we win elections. They help the people to wake up, as they did in recent elections in New Jersey and Virginia. In races as distinct as the mayoralty of Miami, where a Democrat won for the first time in 30 years, and did so in a landslide; and Democrats won two special elections for State Senate in Mississippi. In Georgia, Democrats won two seats on the Georgia Public Service Commission, the first time in 20 years they won a statewide seat. And they won a State Senate seat in Iowa, and the redistricting vote in California.
To continue winning Democrats must remind people every day what the felon, and his fascist cohorts, are doing to destroy their lives. Latinos and Hispanics need a daily reminder, it is the felon who once said he supports them, whose government is now deporting them. Young people must be reminded every day, the felon is destroying the country they will inherit, their future, by denying climate change. Everyone needs daily reminders how he is destroying the health of the country. Ending research grants looking for cures for cancer, Alzheimer’s, Parkinson’s, and HIV/AIDS. Ending research grants into curing childhood diseases, development of mRNA vaccines, and other potential progress to protect Americans, and the world, when the next pandemic occurs, and it will. He is literally killing children by having his government speak out against vaccinations for illnesses like measles, considered eradicated before he came into office.
All of this needs to be headlined each day in our newspapers, and on TV, by the people who still can, and are willing, to do it. Those not bought off by, or afraid of, the felon, and his fascist cohorts. Those who don’t sit with him at Mar-a-Lago, and have become his enablers. We the people need to take to the streets and every time there is an election, use our vote to say to the sick, deranged, felon, and his fascist cohorts, ‘NO MORE’.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
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