Transgender Catering Manager Tests Georgia's Health Insurance Rules

Skyler Jay, a University of Georgia catering manager, organizes VIP parties for top school officials. In court, he’s suing them to get his health insurance to cover sex reassignment treatment.

“Being an actual face to these people, and not just another name in the system, I feel called to do this,” Jay said.

His lawsuit puts him in the center of a national legal fight over the medical care of America’s estimated 1.4 million transgender adults. Increasingly, employers cover treatments such as hormone therapy or the $8,000 double mastectomy Jay underwent in May 2017. When they don’t, transgender people must decide whether to skip care, pay their own way or fight to change the health plan.

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Jay, 31, decided to fight. While an increasing number of plaintiffs have won such cases, courts have disagreed on the issue.

“The trend is to move toward coverage in this area,” said Jonathon Rabin, an attorney with Hall, Render, Killian, Heath & Lyman in Troy, Michigan, who represents employers and health organizations. He’s not involved in the case. There’s enough ambiguity in the law that employers in some states can decline coverage “without committing some kind of knowing violation of civil rights laws,” he said. That’s a risky decision, “because the litigation can be quite costly” compared with the cost of medical claims.

About 750 big companies tracked by Human Rights Campaign cover medically necessary transition-related care, according to the group’s Corporate Equality Index. That’s up from fewer than 50 a decade ago. Among them are the six largest U.S. private employers: Walmart Inc., Amazon.com Inc., United Parcel Service Inc., Kroger Co., Home Depot Inc. and International Business Machines Corp., which together have 4.5 million employees.

Big Georgia-based employers such as Delta Air Lines Inc. and Coca-Cola Co. also provide coverage.

The University System of Georgia is represented by state Attorney General Chris Carr in Jay’s case. The school and the attorney general’s office declined to comment, as did the system’s health insurance provider, Anthem Inc. subsidiary Blue Cross Blue Shield of Georgia. Anthem covers gender transitions for its own employees.

The U.S. Supreme Court on Tuesday allowed President Donald Trump to forbid transgender people from openly serving in the military. Trump had in part cited the costs of medical care. A Rand Corp. analysis found that covering transgender health care would increase premiums by less than one-tenth of 1 percent. On a typical employer health plan that costs about $7,000 a year, the benefit could add 31 cents to monthly premiums, using the high end of Rand’s estimated range.

A Pentagon report said that since June 2016, about 900 people on active duty have been diagnosed with gender dysphoria, the medical term for a conflict between one’s physical gender and the gender with which the person identifies.

Jay’s struggle with the recovery from his surgery was featured recently on the Netflix series Queer Eye, in which a quintet of lifestyle gurus help contestants remake themselves.

At the same time Jay was deciding how much facial hair to sport, he was also dealing with his family’s hostility and his inability to pay for surgery to remove his breasts. He’d been binding his chest to make his appearance more masculine.

Jay said that when he arrived at the university as an undergraduate more than a decade ago, he began exploring what it was like to present as a man. He did it first at drag events and parties and, gradually, in some classes, too. He said he had a history of bulimia, anorexia and cutting himself. That stopped after he started testosterone therapy in 2012.

“After a while, I really did realize that my happiness and my well-being was so much more at peace when I was presenting as male,” he said.