Alabama Attorney General Urges Eleventh Circuit to Reconsider Ruling on Healthcare Coverage for Gender Reassignment Surgery

Montgomery, AL – Alabama Attorney General Steve Marshall has filed an amicus brief with the full Eleventh Circuit Court of Appeals, requesting the court to overturn a district court’s decision that would require employers offering healthcare coverage to employees to include payment for gender reassignment surgery. The district court ruling, initially affirmed by a 2-1 decision from a three-judge panel of the Eleventh Circuit, would impose liability under Title VII of the Civil Rights Act of 1964 if employers did not cover such procedures.

In response, Attorney General Marshall, on behalf of 23 states, urged the Eleventh Circuit to rehear the case en banc, which would involve all 12 active judges of the court. The Eleventh Circuit granted this request, vacated the panel’s decision, and scheduled oral arguments for February 2024.

Marshall framed the issue as one of distinguishing between different types of medical treatments, arguing that Title VII does not mandate employers to cover gender reassignment surgery if they cover other types of procedures, such as reconstructive surgery following childbirth.

“The question for the Eleventh Circuit is whether an employer’s health insurance plan must pay for a male employee’s sex-change surgery simply because the plan pays for a mother to receive reconstructive surgery following childbirth. To state the obvious: the two treatments are not the same, and it is not unlawful discrimination to treat the two procedures differently,” said Attorney General Marshall. He added that Alabama, Florida, and Georgia, the three states within the Eleventh Circuit, oppose the district court’s interpretation of Title VII, which they believe could lead to increased employer liability and confusion regarding the law’s reach.

The case in question, Lange v. Houston County, Georgia , involves an employee seeking coverage for gender reassignment surgery after being informed that the employer’s insurance provider would not pay for the procedure. The employee filed a lawsuit under Title VII, which prohibits discrimination in the workplace based on race, color, religion, sex, or national origin. A divided Eleventh Circuit panel ruled that the employer could be liable for violating Title VII by not covering the surgery.

Alabama, along with Florida and Georgia, is leading the effort to challenge the initial ruling, as the outcome will directly affect employers in the Eleventh Circuit. These states argue that the district court’s decision rewrites Title VII and could have far-reaching implications for employer-provided healthcare coverage across the region.

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