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.
Jay helped run a years long campaign to persuade the university to add gender identity to its nondiscrimination and anti-harassment policy. In 2012 he left school to focus on his transition.
He found work at the college’s hotel and conference center, starting as an hourly worker. In 2015 he was promoted to a position that offered health insurance. Since the school had changed its nondiscrimination policy, Jay said he expected the plan would cover his chest surgery. But it didn’t. He said the realization caused severe depression.
“They’re saying on one piece of paper, official document, that they’re not going to discriminate, and then on another document they’re very explicitly discriminating,” Jay said. “That pretty much floored me.”
The University System of Georgia moved to dismiss his legal complaint. Oral arguments on the motion are scheduled for Feb. 6.
LGBTQ rights have been a flashpoint in Georgia politics. The state legislature, which controls the size of the university system’s budget, advanced a religious-liberty bill giving businesses the right to deny service to gays and lesbians. It was vetoed by Governor Nathan Deal, whose second term ended this month. His successor, fellow Republican Brian Kemp, promised to resurrect similar legislation.
A growing body of evidence, and the judgment of professional groups such as the American Medical Association, favors insurance coverage for gender transition treatments.
Starting in 2016, federal employee health plans ended exclusions for transition care. Medicare, the government health plan that insures 59 million elderly and disabled Americans, removed its blanket exclusion in 2014 and covers gender reassignment surgeries on a case-by-case basis.
Twenty states and the District of Columbia prohibit health plans from carving out transgender-related health care, and most of those also require state Medicaid plans to cover it as well.
Georgia isn’t one of those states. Jay filed his lawsuit in June in Athens federal court under his legal last name, Musgrove. The complaint names the board of regents, several university officials and the health-plan administrator.
Jay said he’s seeking coverage, not just for himself, but for other transgender employees as well. “Without it, lives are lost,” he said.
Plaintiffs in Minnesota, Wisconsin and New York have succeeded with claims similar to Jay’s. But the Georgian may be the only plaintiff who has frequent contact with defendants as part of his job welcoming them to university events.
“As a trans person in general, my existence is currently political,” he said. “But I have to put that huge smile on and just make people feel welcome.”
— Read New York Says Health Insurers Must Cover Transgender Individuals, on ThinkAdvisor.