Gender-Affirming Care Decision Leaves Uncertainty in Its Wake

Sept. 12, 2025, 3:07 PM UTC

A federal appeals court ruling that an employee health plan excluding coverage for gender-affirming surgery wasn’t discriminatory on its face perhaps is more compelling for what it didn’t decide: whether transgender status is a protected classification under federal anti-bias laws.

By ducking that issue, the full panel of US Court of Appeals for the Eleventh Circuit judges left open the possibility for increased litigation over whether categorical exclusions are unlawful as applied to specific individuals—instead of a single, wholesale determination.

Plaintiffs could still prove their cases “the old-fashioned way” through evidence that an employer or plan deliberately singled them out ...

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