Aetna has agreed to settle a lawsuit that accused the health insurer of discriminating against LGBTQ customers in need of fertility treatment.
Under the deal announced Friday, the insurer will make coverage of artificial insemination standard for all customers nationally and work to ensure that patients have equal access to more expensive in-vitro fertilization procedures, according to the National Women’s Law Center, which represented plaintiffs in the case.
Aetna, the health insurance arm of CVS Health Corp., covers nearly 19 million people with commercial coverage, including employer-sponsored health insurance.
The insurer will set aside a $2 million fund to reimburse people who had coverage from some of its commercial insurance plans in New York and were denied reimbursement for artificial insemination, a procedure in which sperm is placed directly in a woman’s uterus.
A CVS Health spokesman said the company was pleased to resolve the case and “committed to providing quality care to all individuals regardless of their sexual orientation or gender identity.”
A federal judge still must approve the deal.
The settlement stems from a 2021 lawsuit filed in a federal court in New York. Emma Goidel said she and her spouse, Ilana Caplan, spent more than $50,000 on fertility treatments to conceive their second child after Aetna rejected several requests for coverage.
The couple had insurance through a Columbia University student health plan.
Their plan required people who cannot conceive a child naturally to first pay thousands of dollars for cycles of artificial insemination before the insurer would start covering fertility treatments.
The lawsuit noted that heterosexual couples didn’t have the same costs. They just had to attest that no pregnancy had occurred after several months of unprotected sex before they got coverage.
“You never know when you start trying to conceive and you have to do it at the doctor, how long it’s going to take and how much it’s going to cost,” Goidel said. “It was unexpected, to say the least.”
Goidel became pregnant with the couple’s second child after six cycles of artificial insemination — which each cost a few thousand dollars — and one unsuccessful, $20,000 attempt at in vitro fertilization, where an embryo is created by mixing eggs and sperm in a lab dish.
Goidel said she’s “thrilled” that Aetna changed its policy as part of the settlement, and she expects to be reimbursed.
Fertility treatment coverage has grown more common in recent years, especially among employers eager to recruit and retain workers.
The benefits consultant Mercer says 45% of employers with 500 or more workers offered IVF coverage last year. That’s up from 36% in 2021. Many place limits on the number of treatment cycles or set a lifetime maximum for the benefit.
Many insurers also cover artificial insemination as a standard benefit for all policyholders, according to Sean Tipton of the American Society for Reproductive Medicine.
An Arkansas transgender advocacy group’s community center was vandalized this week for at least the fifth time in the past year, the group’s executive director said.
InTRANSitive, the only trans community center in the state, has become increasingly visible in recent years due to its activism against a wave of state legislation targeting trans people, Rumba Yambú, the founder and executive director, said.
InTRANSitive’s Little Rock-based community center has seen repeated acts of vandalism since it opened in December 2021, said Yambú, who uses they/them pronouns. Starting last year, someone has damaged the pipes outside of the building at least four times, they said. Cameras have also disappeared and plants have been damaged. This past weekend, the same pipes that had been repeatedly damaged were completely removed from the ground and taken from the premises.
The first four times the pipes were damaged, the group spent an estimated $900-$1,200 to repair them each time, Yambú said. This most recent act of vandalism cost about $1,400 to fix the pipes and another $900 to install a protective cage over the them, they added. The group is fundraising to cover the cost since Yambú had to pay for it using a credit card. Yambú said they also expect the group’s water bill to be much higher due to flooding caused by the damage.
“We just can’t afford to be closed for too long,” Yambú said. “It just puts a pause on everything that we do and all the people that we serve.”
The pipes outside of InTRANSitive’s community center after they were vandalized for the fourth time.Courtesy Rumba Yambú
Yambú said the FBI called them Wednesday and asked to have an in-person meeting to talk about the incident, though Yambú said they did not report it to the bureau.
A spokesperson for the FBI said the bureau “is aware of the situation,” but in keeping with long-standing policy “we can neither confirm nor deny the existence of an investigation. As always, we encourage individuals to immediately report suspicious or unlawful activity to law enforcement.”
Yambú said they have not reported any of the incidents of vandalism to local police because the group and its members have experienced police harassment. Yambú said officers with the Little Rock Police Department repeatedly patrol in front of the center and have tried to enter while asking how many children are inside — a question that Yambú said echoes language coming from conservative advocates in the state and nationwide who have called trans advocates “pedophiles” and “groomers.”
Mark Edwards, a spokesperson for the Little Rock Police Department, said Friday the department only has three incident reports from the community center’s address, and only one of those is during the time that InTRANSitive has occupied the space. In that May 2023 incident, he said, someone called 911 and when police got there, officers didn’t speak with anyone.
Regarding officers patrolling in front of the center and asking about children on the premises, Edwards said, “There’s nothing on our side that shows proof we’ve been there” outside of the three incidents.
“If we’ve driven in the area, it’s because we patrol the area,” he added. “There are thousands of businesses we patrol, and there are some businesses we do the same patrolling, they say they’ve never seen us. Unless there’s an incident report number that I can actually go to and look at, it’s kind of hard to comment.”
The removal of pipes outside of InTRANSitive’s community center resulted in flooding.Courtesy Rumba Yambú
Yambú said people on social media have suggested that the act was unrelated to the group’s work, but Yambú disagrees.
“It all started with the visibility that we’re getting, how much anti-trans hate is being pushed by our legislators,” they said, noting that they purposely don’t have a sign that says the group’s name on the building in an effort to minimize harassment.
In 2021, the same year InTRANSitive opened its community center, Arkansas became the first state in the country to pass a ban on transition-related care, including puberty blockers, hormone therapy and surgery, for minors. A federal judge declared the law unconstitutional last year. However, Arkansas is also one of 25 states that have passed a measure barring transgender students from competing on school sports teams that align with their gender identities, and that law is in effect.
Yambú said that every time the center is vandalized and has to close, it makes it harder for the group to do its daily work, which includes providing free food every Tuesday, a space for people who don’t have affirming homes or families to hang out for a few hours, free HIV testing and free assistance to people who need help navigating the immigration process.
Yambú said the group plans to raise funds for better lights outside of the building and for security cameras, because the current cameras are solar powered and only activate when there’s movement and enough light. However, regardless of the additional security measures, they said they expect the vandalism to continue.
“Our folks know that we’re here,” Yambú said. “The more work that we’ve been doing, the more visible that we’ve been in sessions, the more our name is getting out there, the more that this is happening.”
More states have announced lawsuits against the Biden administration over its new Title IX rules mandating anti-discrimination protections for LGBTQ+ students, bringing the total number of states suing the administration to 14.
Last week, Alabama, South Carolina, Florida, and Georgia filed a joint lawsuit against the administration, along with the Independent Women’s Network, Parents Defending Education, Speech First, and the Independent Women’s Law Center. In a separate lawsuit, Texas Attorney General Ken Paxton (R) also announced a challenge to the new rules.
Now the state of Tennessee is leading a lawsuit against the new rules and is joined by Kentucky, Indiana, Ohio, West Virginia, and Virginia in its complaint. A separate lawsuit has also been filed by the attorneys general of Louisiana, Mississippi, and Idaho.
The new rules interpret Title IX, which bans discrimination on the basis of sex in education, as a legal protection against anti-LGBTQ+ school policies. The idea is that it’s impossible to discriminate on the basis of sexual orientation or gender identity without taking sex into account, a legal argument that the Supreme Court has already used in its 2020 Bostock v. Clayton Co. ruling with respect to job discrimination.
With these rules, any school that receives federal funding will no longer be able to discriminate against LGBTQ+ students. This could affect states and school districts with policies to out LGBTQ+ students to their parents or ban trans students from using bathrooms that correspond with their gender. The new rules could also give students who face discrimination recourse in federal courts.
In a press conference, Tennessee Attorney General Jonathan Skrmetti (R) invoked the late Supreme Court Justice Ruth Bader Ginsburg as justification for his fight to discriminate against trans youth.
“Title IX has protected women for 50 years,” Skrmetti said, as reported by The Tennessean. “It is a law… built around the idea of men and women, sex binary. As Justice Ruth Bader Ginsburg noted, enduring differences between the sexes necessitate things like separate bathrooms, separate locker rooms, separate living facilities, separate sports teams. This is something that our law has recognized for decades.”
The rules, however, do not suggest that schools eliminate single-gender spaces. Rather, they simply require schools to include everyone who identifies as a boy in boys’ spaces and everyone who identifies as a girl in girls’ spaces.
While GOP attorneys general are up in arms about the effect the rules will have on athletics, they do not actually discuss transgender student-athletes and which teams they can play on. The DOE is reportedly planning to issue a separate rule regarding what Title IX means for sports participation.
Skrmetti, however, claimed that with the rules, “a boy can walk into a girl’s locker room at a school and if the girl complains that his presence makes her uncomfortable, she can be brought up for investigation and potential penalties for violating civil rights. The new rules is entirely inconsistent with the text of Title IX and its adoption violates the United States Constitution.”
Montana Attorney General Austin Knudsen (R) claimed in a press release that the rules will “ultimately prohibit schools from distinguishing between males and females in athletic and educational opportunities” as well as “put women at an unfair disadvantage” and “force boys and girls to share bathrooms, locker rooms, dorms, and even overnight lodging while on a school trip.”
He also said it is designed to “federally coerce schools into indoctrinating students in gender identity theories popular among progressive parents but that ignore science.”
Florida Gov. Ron DeSantis (R) wrote on X that President Joe Biden is “abusing his constitutional authority to push an ideological agenda that harms women and girls and conflicts with the truth.”
“We will not comply,” DeSantis continued, “and we will fight back against Biden’s harmful agenda.”
Conservative parent organizations have also spoken out against the new rules. Fifty-three groups signed a letter led by Parents Defending Education (PDE) claiming trans inclusivity “poses a grave threat to the safety and opportunities of women and girls and thwarts students’ First Amendment rights” by forcing them to use accurate pronouns for trans and nonbinary students even if they don’t want to.
The letter also accused the Biden administration of pandering to “a small yet vocal group of extreme activists.”
On Monday, out White House press secretary Karine Jean-Pierre said she could not speak about the new rule too much due to the all the litigation. “So I’ll just say every student has the right to feel safe in school,” she said.
The new rules are set to take effect on August 1 and invalidate numerous anti-transgender policies developed under former President Donald Trump. The Trump administration spent four years fighting against the legal argument that laws that ban discrimination “based on sex” ban anti-LGBTQ+ discrimination, particularly in schools. In 2017, then-Secretary of Education Betsy DeVos issued guidance to schools saying that Title IX did not protect LGBTQ+ students, shortly after she and Attorney General Jeff Sessions revoked a guidance from the administration of former President Barack Obama that said the opposite.
The Biden administration had promised to present the newly unveiled rules by January, but the DOE said its release was delayed due to an unprecedented number of over 240,000 comments submitted during the new rules’ 30-day public response period.
In contrast to the conservative backlash, LGBTQ+ organizations have celebrated the announcement, though they also say more is needed.
In a statement both celebrating and criticizing the newly unveiled rules, the National Women’s Law Center wrote, “As we celebrate this milestone, we recognize that this regulation does not go far enough in making the law’s protections clear for all student-athletes.” The statement was signed by 22 other organizations, including LGBTQ+ advocacy groups like GLSEN, the Human Rights Campaign, PFLAG National, and the National Center for Transgender Equality.
Out gay Rep. Mark Takano (D-CA) wrote, “The Education Department and Biden Administration showed real courage today, delivering on a long-held promise to ensure that the federal government does more to protect all Americans—especially LGBTQ Americans—from discrimination. This groundbreaking rule is a major victory, but we still have much to do. We need to enshrine and expand its protections by passing the Equality Act because for too many Americans, their rights and protections depend on the zip code they live in.”
The United Methodist Church on Wednesday removed a ban on gay clergy that was in place for more than 40 years, voting to also allow LGBTQ weddings and end prohibitions on the use of United Methodist funds to “promote acceptance of homosexuality.”
Overturning the policy forbidding the church from ordaining “self-avowed practicing homosexuals” effectively formalized a practice that had caused an estimated quarter of U.S. congregations to leave the church.
The New York Times notes additional votes “affirming L.G.B.T.Q. inclusion in the church are expected before the meeting adjourns on Friday.” Wednesday’s measures were passed overwhelmingly and without debate. Delegates met in Charlotte, N.C.
According to the church’s General Council on Finance and Administration, there were 5,424,175 members in the U.S. in 2022 with an estimated global membership approaching 10 million.
The Times notes that other matters of business last week included a “regionalization” plan, which gave autonomy to different regions such that they can establish their own rules on matters including issues of sexuality — about which international factions are likelier to have more conservative views.
Rev. Kipp Nelson of St. Johns’s on the Lake Methodist Church in Miami shared a statement praising the new developments:
“It is a glorious day in the United Methodist Church. As a worldwide denomination, we have now publicly proclaimed the boundless love of God and finally slung open the doors of our church so that all people, no matter their identities or orientations, may pursue the calling of their hearts.
“Truly, all are loved and belong here among us. I am honored to serve as a pastor in the United Methodist Church for such a time as this, for our future is bright and filled with hope. Praise be, praise be.”
The Biden-Harris administration announced Friday that it had finalized an essential update to Section 1557 of the Affordable Care Act, significantly strengthening protections against discrimination in health care, especially for the LGBTQ+ community. This pivotal rule change reverses prior rollbacks under the Trump administration and establishes a new benchmark for inclusivity in health care access. Advocacy groups have praised the move.
What is Section 1557?
Section 1557 of the ACA is a critical nondiscrimination statute prohibiting discrimination based on race, color, national origin, sex, age, or disability in health programs or activities. It plays a vital role in ensuring equity within the U.S. health care system. The definition of “sex” under this section has been subject to changes in interpretation, expanding and contracting under various administrations.
What did the Trump-era rules change?
The Trump administration’s 2020 amendments redefined “sex discrimination” to exclude gender identity and sexual orientation, effectively removing explicit protections for transgender and nonbinary people under federal law. This interpretation allowed health care providers and insurers to legally deny services based on an individual’s gender identity, significantly impeding access to necessary medical care for the LGBTQ+ community.
What is the rule change?
The Biden administration’s update to Section 1557 restores and expands protections that had been rescinded. It reaffirms that discrimination “on the basis of sex” includes sexual orientation and gender identity. This change not only counters previous setbacks but also explicitly incorporates protections against discrimination based on sex characteristics and sex stereotyping, crucial for intersex and transgender individuals, respectively.
The rule also strengthens protections for people with disabilities and those with limited English proficiency, ensuring more inclusive health care access. It requires all health programs and activities that receive federal funding and health insurers to comply with these nondiscrimination requirements.
How does the rule affect LGBTQ+ people, especially transgender people?
This rule change is a significant advancement for the LGBTQ+ community, particularly transgender patients, who often encounter discrimination in health care settings — from denial of routine care to refusals of critical gender-affirming treatments such as hormone therapies or surgeries. The updated rule prohibits such discrimination under federal law, guaranteeing access to health care without fear of rejection due to gender identity.
Moreover, the rule mandates that services and coverage are provided nondiscriminatorily, including specific stipulations that insurance policies do not exclude care related to gender transition, addressing a prevalent barrier for transgender individuals in accessing necessary treatments.
What are advocacy groups and lawmakers saying?
Responses from LGBTQ+ advocacy groups have been overwhelmingly positive, recognizing the updated rule as a vital move toward eliminating health care discrimination.
Lambda Legal counsel and health care strategist Omar Gonzalez-Pagan noted the significance of these restored protections.
“The rule released today restores critical regulatory nondiscrimination protections for those who need them most and ensures a legally proper reading of the Affordable Care Act’s healthcare nondiscrimination law,” he said in a statement. “This marks a significant reversal of the harmful, discriminatory policies set by the previous administration.”
Human Rights Campaign President Kelley Robinson praised the update: “Today we mark a crucial step forward by the Biden-Harris administration in the fight for complete health equity for LGBTQ+ Americans. This milestone underscores years of advocacy by HRC and our partners, steadfast in refusing any form of discrimination against LGBTQ+ people.”
GLAAD president and CEO Sarah Kate Ellis commented on the rule’s immediate impact.
“This reversal of Trump-era discriminatory rules that sought to single out Americans based on who they are and make it difficult or impossible for them to access necessary medical care will have a direct, positive impact on the day-to-day lives of millions of people,” Ellis said in a statement. “Health care is a human right that should be accessible to all Americans equally without unfair and discriminatory restrictions. LGBTQ Americans are grateful for this step forward to combat discrimination in health care so no one is barred from lifesaving treatment.”
The rule change marks the 334th action of the Biden-Harris administration in support of LGBTQ+ people, according to GLAAD.
The Congressional Equality Caucus also welcomed the update, with Chair U.S. Rep. Mark Pocan, a WisconsinDemocrat, affirming the rule’s importance.
“All people deserve to access healthcare without fear of discrimination,” Pocan said. “This rule’s explicit nondiscrimination protections for our community will improve health outcomes and ensure countless LGBTQI+ people are not denied care just because of who they are. I thank President Biden and Secretary Becerra for their steadfast commitment to LGBTQI+ health equity and look forward to continuing our work together to improve access to care for all Americans, regardless of their identity.”
In the summer of 2015, an 8-year-old Choctaw child named Twelve walked in their first Two-Spirit LGBTQ Pride parade, recognizing Native people with a male and female spirit within them. They wore their hair in braids and a black suit, their mother and auntie by their side. Out and proud adults waved hello to Twelve from their colorfully decorated floats. The streets of Oklahoma City were filled with music, dancing and drag performances. It was a celebration that seemed like a step toward a future of acceptance for Oklahoma’s Indigenous queer community.
“That memory sticks in my mind — seeing someone that young and seeing loving parents be so supportive,” said Auntie Sage, youth leader at Cousins, a group for queer Indigenous youth in the state. “I had not seen that in my lifetime.”
Nine years later, queer and Two-Spirit youth in Oklahoma have witnessed the introduction of more than 50 bills targeting LGBTQ people this year alone — more than any other state — from bans on gender-affirming health care to penalizing public school employees for asking a student their pronouns.
In addition, LGBTQ communities continue to reel from the death of Nex Benedict, a 16-year-old transgender student who lived on a Cherokee reservation in Oklahoma and reportedly faced bullying over their gender identity.
“With all these anti-LGBTQ bills going on right now, it is very dangerous and it is a very sad time for Oklahoma,” Auntie Sage said.
Today, Twelve is a member of Cousins, which has been offering a sanctuary for queer Indigenous youth in a time of rising anti-LGBTQ hostility. Through outdoor activities, out-of-state trips, theater shows, monthly counseling, group talks and mentor pairing, the group is cultivating a community.
“Cousins is a place of education, fun, community, support, love and all this good stuff,” Twelve said. “But at the end of the day, it’s also a safe space for kids who need it.”
Reeling from the death of ‘our relative’
Sarah Adams, the mother of Twelve, and Kendra Wilson Clements — both of whom are Choctaw and Two-Spirit — co-founded Cousins in 2022 after observing a lack of support systems in Oklahoma for queer Indigenous youth. That year, U.S. lawmakers proposed a record 238 bills that would limit the rights of Two-Spirit, lesbian, gay, bisexual, transgender, queer and/or questioning (2SLGBTQ) Americans, including religious exemptions to discriminate against queer people, and limits on trans people’s ability to play sports and receive gender-affirming health care.
“We wanted it to be a safe place for us to be able to celebrate what it is to be LGBTQ in the Indigenous community,” Adams said. “When you feel safe, then you can be exactly who you are. You can remove all those masks that you put on from your day to day.”
Adams and Clements began reaching out to local queer leaders to find mentors and advocates for queer Indigenous youth. Mentors can share their experiences, show kids they are not alone and let them know they are supported.
“We want [our youth] to be strong. We want them to be inspired,” said Auntie Sage. “And we want them to know what it looks like to be visible and out and proud.”
Through word of mouth, the group has become home to over a dozen youth ages 12 to 22, representing numerous tribes. With the help of donations, grants and volunteers, the group goes hiking, takes self-defense classes and attends virtual meet-ups.
When Benedict died in February, it shook the community. Police bodycam video showed Benedict in a hospital bed recounting how they were attacked by three students after standing up to their bullying at school. The next day, Benedict died. A full autopsy report ruled the death a suicide.
Benedict’s death sparked global interest and criticism from LGBTQ advocates who link their alleged bullying to anti-LGBTQ legislation in Oklahoma and other states. In the weeks following Benedict’s death, the Rainbow Youth Project, a national LGBTQ nonprofit focused on youth suicide prevention, saw a 238% increase in crisis calls from Oklahoma. The Centers for American Indian and Alaska Native Health reported last year that 60% of Indigenous youth have experienced severe mental distress.
“I was already dealing with so much of my own mental health stuff, and then hearing [about Benedict’s death], it just made me hate so much more about the state we live in and the world we live in and how people don’t care until someone dies,” said Bear, 15, a Cousins member.
Cousins members say they are concerned about discrimination in their schools, which has only been highlighted by Benedict’s death.
“There’s no amount of safety here that can really make me feel confident enough in the public school system at this point, especially after what happened with Nex,” said Angelina Steinmeyer, 21, a Cousins mentor and member.
In response to safety concerns from the group, Dan Isett, director of communications at the Oklahoma State Department of Education, told NBCU Academy in an email: “The safety of every student in Oklahoma schools is prioritized equally, with equal care taken for all our students.”
Shortly after Benedict’s death, Adams brought in a grief counselor during Cousins’ monthly circle talks. Members learned how to recognize grief and how it might show up in their lives. Twelve said they were coping through writing.
“We wanted to help them through this moment, this terrible, horrible moment when we lost a relative,” Adams said. “Nex is our relative, that’s how I see it.”
Raising the next generation of leaders
To open up the lines of support, Cousins recently decided to make some of their events inclusive to all LGBTQ youth in the state, not just those who are Indigenous.
“My son said, ‘We don’t have the luxury of cherry-picking anymore. We have to make sure that everybody has spaces,’” said Adams. “And now we’re trying to figure out how we do that.”
In February, the group took a trip to San Francisco to participate in the Bay Area American Indian Two-Spirit Powwow. The event honored traditional Indigenous culture through song, dance, drumming and contests; it also offered a supportive gender-affirming experience for the diverse Two-Spirit community and allies.
“I was just like looking all around myself and I was like, ‘Wow, they made it,’” said Twelve. “‘Oh my God, there’s so many people like me around here.’”
Auntie Sage said she wants to take members away from spaces that often exclude 2SLGBTQ people and put them into environments where they can see possibilities and take pride in who they are.
“I hope they can have those kinds of stories for themselves one day,” Auntie Sage said. “They spread their little wings and they fly.”
In the meantime, the group will continue to host open conversations, expand its space and counsel queer Indigenous youth and others in the face of rising tensions in schools and opposition to 2SLGBTQ events in the state.
“If there were to be an end goal, I hope that the end is us breaking the cycle,” said Steinmeyer, adding that it’s important to “teach children what it’s like to be different.”
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 “apply to everyone, not just transgender people.” 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 “applying to straight, gay, lesbian, and bisexual people equally,” 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, “gender 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.” 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 “XX chromosomes” and “XY chromosomes” 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. Twenty-one Republican states filed an amicus brief in favor of denying trans people anti-discrimination protections in healthcare, and 17 Democratic states 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 Carolina already have gender-affirming care bans for trans youth in place, and 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, the Supreme Court recently narrowed 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, “The 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.”
While the ad is comical, online dating apps continue to provide an uneven experience for trans, nonbinary, and genderfluid users. Most dating websites and smartphone apps didn’t initially offer gender descriptions for these users to authentically present themselves to others. Even with expanded gender presentation options, non-cisgender users say that ignorance and transphobia continue to make online dating feel unsafe.
A brief (incomplete) history of LGBTQ+ online dating
The earliest days of LGBTQ+ online dating harken back to the late 80s and early 90s, when gay men used dial-up modems to connect through bulletin board systems (BBSs) like Backroom and Gay.net. Back then, some lesbians also used an e-mail listserv called Sappho and, later, the website lesbian.org, which contained personals, discussion forums, web links for lesbian-oriented non-profits, and even a lesbian literary journal called Sapphic Ink.
In the early to late 90s, web services like Compuserve and America Online (AOL) provided real-time M4M, W4W, and “transexual” chatrooms where queer love-seekers could connect, talk dirty, and spend hours uploading and downloading pixelated photographs of themselves via very-slow internet connections.
“I think LGBTQ+ people were always really early adopters to online dating,” Michael Kaye, the one-time director of brand marketing and communications for OkCupid told QSaltLake. “Speaking from experience, we are limited to the safe spaces that we have available.”
In the 2000s, some popular heterosexual dating sites like eHarmony didn’t allow gay and lesbian profiles, leaving queer users to look elsewhere like OkCupid, a personal ad site for gay, lesbian, bisexual, and cis-het people that appeared in 2004. OkCupid helped facilitate LGB dating by including a unique feature: It let users choose only to be visible to other queer folks, reducing the likelihood that gay men or lesbian women would receive messages from a bunch of eager and unwitting heterosexuals.
However, the biggest revolution in online dating occurred in 2009 with the advent of Grindr, one of the first third-party apps for Apple’s iPhone. While the app — and similar ones — facilitated countless quick hook-ups and longer-term relationships, the apps weren’t initially inclusive of trans, nonbinary, and gender-fluid users because they offered a limited range of self-identifying gender options and transphobic responses from other cisgender users.
Over time, trans-inclusive apps like Tser appeared. Tser specifically marketed itself as a place where trans people could find community and support, but trans users found that the app still contained transphobia: It categorized cis individuals as “men” and “women,” invalidating trans women and trans men as not “real” women and men. It also used the outdated term “transsexual.”
Expanding gender options is a good start, but not enough
In 2016, Tindr offered users the option of entering any term that best describes their gender identity for display on their profiles. Grindr and Hinge took similar paths by offering more gender description options — like “trans man,” “trans woman,” “non-binary,” “non-conforming” and “queer” — in 2017.
In 2023, eHarmony also began offering an expanded list of genders — including options like “agender,” “bigender,” “genderqueer,” “pangender,” “questioning,” “trans masculine/feminine nonbinary,” and “Two-Spirit.”
The app Bumble also expanded its options to be more inclusive of nonbinary users in 2022, but the app’s “women make the first move” feature — which was created to reduce creepy unwanted advances from men — didn’t allow nonbinary people to message others who identified as women.
“I applaud them for trying to be inclusive, but they’re just completely missing the point,” one user named Kay told NBC News. “I get that their whole shtick is women message first. But if that’s the case, don’t add the gender-inclusive options if you’re going to make nonbinary people feel like they are being squished into a woman or man category.”
Non-cisgender users of Tinder and Hinge also had another issue: after self-identifying as their preferred gender description, the sites would then reductively ask if they’d like to be paired with people who were looking for “men” or women,” the independent cultural site The Skinny reported.
Other users expressed frustration that dating sites often group people by gender rather than by sexuality, making it impossible for searchers to filter out heterosexual users. Others found that, even when apps and sites had inclusive gender options, they had very few non-cisgender users, making the dating “community” feel isolating.
Taking a stand against transphobia
In 2015, when the women’s dating app HER launched, founder Robyn Exton said, “All of the online platforms for women [before 2015] were just reskins of sites built for gay men but turned pink, asking you how much body hair you had, or straight sites that were filled with guys asking you [to have a three-way]. It felt crazy to me, at the time, that no one had truly made a dating product for women.”
HER eventually branded itself as a community and dating app for the FLINTA [female, lesbian, intersex, trans, and agender] community. In 2023, it used Lesbian Visibility Day to send out an announcement to all users reiterating its “no TERFs” policy against transphobes, something it felt was particularly important considering the rise of right-wing anti-trans laws and rhetoric.
“[Trans-exclusionary radical feminists’] harmful and transphobic mentality negates the experiences and identities of our trans and gender non-conforming community, fosters their marginalization, and contributes to discrimination and [harm],” the announcement declared. “Besides being sad, hateful clowns who spew out a lot of misinformation, TERFs are also a genuine threat to the LGBTQIA+ community. And that’s just not going to fly here.”
Despite the announcement, HER still found that its trans, nonbinary, and genderfluid users still faced challenges when using the app, including people expressing trans-exclusionary preferences, misgendering, invasive questions, different forms of fetishization, ignorance about the trans experience, and even other users maliciously reporting their profiles as somehow violating the app’s user policies.
Apps like Grindr, Scruff, and OkCupid have since expanded by allowing users to express the range of genders they’re attracted to, making their profiles easier for non-cis users to find.
Two other platforms, Taimi and Lex, take different approaches by centering non-cis users and not focusing solely on gender as a way of matching users. Taimi lets users say whether they’re looking for trans, intersex, or nonbinary users. Lex is a text-based app that’s primarily for “womxn, trans, genderqueer, intersex, two-spirit and non-binary ppl” where users can describe what kind of people and social interactions they’re craving.
As HER and other dating website and apps figure out how to be more welcoming for non-cis users, HER’s non-cis users said the app would feel safer if it provided more education about trans experiences, better profile filtering, more ways to self-identify one’s gender, better account verification methods, and better safety protocols to prevent and penalize transphobia.
“Even in spaces built for all queer folks, there is much work to be done,” Exton wrote.
A transgender high school athlete has told a New Hampshire state legislature that she did not join women’s sports with the goal of “dominating competition” in powerful testimony.
16-year-old trans high jump state champion, Maelle Jacques, told politicians that sports had become a place that allowed her to “be seen as normal,” and that rescinding her right to compete would be devastating.
“If banned from sports teams and locker rooms, joining male teams wouldn’t be a choice for me,” she said.
Her speech came during a Tuesday (23 April) debate on a bill which would have forced New Hampshire trans athletes to compete in male-only competitions.
During the Education Committee vote, Jacques said that she was in opposition to the bill, as it would stop her from enjoying something she has loved “throughout my entire life.”
“Playing soccer since the age of three, when I began my transition in the sixth grade my school welcomed me into the girls’ team,” she said.
“This act of being part of the team allowed me to skip through the phase of social ostracisation. The other girls accepted me as who I was.
“Being part of the team allowed me to be seen as normal, where everywhere else I could be perceived as a pariah.”
She continued that she didn’t join sports “with the goal of dominating competition or being better than anyone else,” but to feel a sense of belonging.
“No one would go through the bullying and self hatred of transition purely to win a sport, especially woman’s sports, which are under-appreciated in our nation.
“I joined because it is something I am passionate about and enjoy.”
New Hampshire votes to kill sports bill
Following Maelle Jacques and testimony from several other people, the bill was killed by the Education Committee in a 19-1 vote.
A similar bill, HB 1205, is still in processing after passing through the House in March, according to local outlet, Seacoast Online. It would explicitly prohibit transgender girls from entering female locker rooms and block them from competition.
Committee chairman and Republican representative, Rick Ladd, said the bill was shot down because the House bill has already passed, and the newly implemented bill extends its remit, which he said the GOP “did not support when we passed our initial bill.”
New Hampshire state capitol. (Getty)
Republican Mike Belcher, said: “I don’t mind the idea of telling colleges and universities what we need to be doing on this, but my hang-up here is that in this bill, there is an exception that allows young women to participate on boys’ teams.
“I believe that is somewhat inconsistent with the goal of preventing injury,” he said, commenting on trans men participating in male competition. “I also think boys’ sports deserve to be protected.“
Democratic House representative David Luneau said the bill, and those like it, should be thrown out of New Hampshire state legislature entirely.
“We think [the bill] doesn’t have any place, doesn’t have any business in New Hampshire,” he said. “And frankly, what we heard from almost 40 people yesterday that, hey, these kids just want to play and be part of the team.”
Rev. Andi Woodworth has been co-pastor of Neighborhood Church, a United Methodist congregation in Atlanta, since 2016. This year, on March 11, she became the first out trans clergy member to address the Georgia House of Representatives during its morning prayer. She had been invited by her state rep, Democrat Saira Draper.
“My hunch is just being there humanized me and humanized my community,” Woodworth says.
Georgia lawmakers had been considering several pieces of anti-LGBTQ+ and specifically anti-trans legislation, mostly tacked on to other bills, she notes. The most concerning ones included a trans athlete ban, restrictions on sex education, parental notification on library books children check out, and a ban on puberty blockers for trans minors (a Georgia law being challenged in courtprohibits other gender-affirming treatment for youth). But the session closed March 28 with none of them passing.
“I want to say this had something to do with my presence at the capitol,” Woodworth says, but she gives primary credit to all the activists and citizens who worked against this legislation.
While at the capitol, she had a good conversation with House Speaker Jon Burns, a Republican. “We found some commonality,” she says.
She points to what’s long been known — if you know a person who is a member of the LGBTQ+ community, you’re more likely to be supportive of their rights.
Woodworth has been representing for trans people since her transition in 2020. “My church has been incredibly accepting, and we have grown,” she says. “We’re finding a new connection with the LGBTQ community.”
She was one of the founders of the church, and the goal was always for it to be an LGBTQ-affirming, anti-racist congregation. She eventually realized that when she said, “All of who you are is welcome here,” she was talking not just about others but about herself.
Her co-pastor is Rev. Anjie Woodworth, to whom she was married before transitioning. The change in their relationship went smoothly, however. “The way we think about it is if we weren’t married, we’d still be best friends,” Andi Woodworth says. And they Andi Woodworth are.
Andi Woodworth had been a minister for seven years before helping to found Neighborhood Church. She always loved thinking about God, she says, and she was a religion major in college. “I just ate it up,” she recalls.
The United Methodist Church has been seen arguments over LGBTQ+ inclusion for several years. Its Book of Discipline has explicitly excluded noncelibate gay and lesbian people from the ministry since 1972, and the church doesn’t allow same-sex marriages. But the rules don’t address trans people, so that loophole has let Woodworth continue in the ministry with no problem.
The denomination has often debated lifting these antigay rules, and many progressive congregations ignore them. With the expectation that delegates to the church’s General Conference this year will end these policies, many conservative congregations have left the denomination. Neighborhood Church will keep its United Methodist affiliation, Woodworth says.
There was an uproar among right-wing Christians over Transgender Day of Visibility falling the same day as Easter Sunday this year — March 31 — and President Joe Biden recognizing it. But being Christian, or a faithful adherent of any religion, doesn’t have to mean being anti-trans, Woodworth points out. Her church used the coincidental date in its message that day, noting that Easter is when Jesus “came out” of his tomb.
Woodworth and the church spread a wide-ranging message of inclusion. “I’m not publicly partisan, but I’m certainly political,” she says, explaining that her mission is to “work for liberation of all humans.”
“We’re going to point to what is right, particularly for the marginalized and the poor,” she says. “We do a lot of anti-racism work, reproductive justice, gun reform. … We’re showing up to advocate for policies that lead to a better life for everybody.”
Regarding this year’s presidential election, “I want to be extremely hopeful and optimistic,” she says. “The election represents a chance for us to remember who we are.” And the vast majority of Americans are pro-LGBTQ+, she adds.
She’ll continue reminding people of that, and she takes joy in being an out, proud, and outspoken trans Christian. “I’m out here and really enjoying my life,” she says. “I feel blessed.”