The ACLU recently filed a federal lawsuit in the U.S. District Court in Seattle on behalf of Pax Enstad, a 17-year-old who identifies as a transgender boy, against Pax’s mother’s former employer, PeaceHealth St. Joseph Medical Center (“PeaceHealth”), alleging sex and gender identity discrimination in violation of the Patient Protection and Affordable Care Act, and the Washington Law Against Discrimination.
“The Plan singles out transgender beneficiaries for unequal treatment by categorically depriving them of all medical care for gender dysphoria, regardless of whether those treatments are medically necessary.”
According to the complaint, Pax was diagnosed with gender dysphoria, and “[i]n accordance with widely accepted standards of care, Pax’s doctors prescribed testosterone hormone therapy and chest reconstruction surgery to bring his body into greater alignment with his gender identity and alleviate the clinically significant distress.”
“On September 6, 2016, Pax’s surgeon requested preauthorization for the Plan to cover his medically necessary chest reconstruction surgery.” The next day, the Enstad’s were informed that their health plan did not include “coverage for any transgender services.” On September 20, 2016, Pax “underwent a medically necessary chest-reconstruction surgery.”
The complaint contends that “[a]s a result of the exclusion for “transgender services,” Cheryl and her husband were forced to pay over $10,000 for the medically necessary care that Pax needed. In order to do so, she had to use some of Pax’s college savings funds and take out a second mortgage on her house” (emphasis added).
The lawsuit seeks relief in the form of a declaration that PeaceHealth’s employee health plan, which declines to cover “transgender services,” violates state and federal laws that prohibit sex discrimination. It also seeks unspecified compensatory and punitive damages for the plaintiffs.