The Fourth Circuit Court of Appeals recently issued an important ruling on transgender healthcare and the Equal Protection Clause. The case, Kadel v. Folwell, (No. 22-1721, 4th Cir. Apr. 29, 2024), involved the North Carolina and West Virginia State Health Plans. In recent years, the state administrators of both healthcare insurance plans made changes to affirmatively exclude coverage for certain gender-affirming healthcare recommended for and needed by transgender individuals.
Medical professionals, years ago, reached a consensus on the proper treatment of those individuals whose gender identity does not align with their sex assigned at birth. With certain people – estimated to be roughly 1.4 million individuals in the U.S. alone – their innate gender identity does not match the sex assigned at birth. Research and studies have demonstrated that gender – how someone feels, and the identity that they themselves know to be true – is not the same as biological sex – that determination typically made at birth and based upon physical characteristics. Those persons for whom that is true – transgender individuals – can experience distress and sometimes self-loathing because of the discomfort in trying to be something they are not.
The medical term used to describe those whose gender identity does not align with their birth-assigned sex is “gender dysphoria.” Left untreated, individuals who experience that gender incongruence can suffer extreme depression, despair, and are at high risk of self-harm. Gender-affirming care has proven immensely successful in helping transgender individuals live happy, productive lives and to be valuable members of society. In Kadel, the Fourth Circuit held that healthcare plans that deny medically necessary treatments for transgender patients violate the 14th Amendment’s Equal Protection Clause because those prohibitions discriminate on the basis of sex and gender identity.
The decision makes sense and is good law. If we get past the derisive and divisive talking points and try to imagine a loved one as transgender, we’d likely get to that same point. We’d want them to be happy and we’d still love and value them as people we want to remain in our lives. We’d want them to get the healthcare they need – to be around, to enjoy life, to keep living. This decision helps ensure that they can get that care and support.
