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Dr. Russell Toomey is an Associate Professor of Family Studies and Human Development at the University of Arizona, researching issues of prejudice, stereotyping, and discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents and Latinx youth. Dr. Toomey is also a transgender man, who transitioned to live consistently with his male identity in 2003 and sought a hysterectomy in 2018.
His healthcare plan, provided by the state to state university employees, refused to cover the surgery, and, in fact, denies all coverage or "[g]ender reassignment surgery." Dr. Toomey has since filed a class action lawsuit against the state, and the University of Arizona, claiming the healthcare plan discriminates against transgender employees "because of ... sex" in violation of Title VII of the Civil Rights Act deprives transgender employees of equal treatment under the Equal Protection Clause of the Fourteenth Amendment. Here's a look.
Medically Necessary, but Not Necessarily Covered
Dr. Toomey's treating physicians recommended that he receive a hysterectomy as a medically necessary treatment for gender dysphoria, as provided by the World Professional Association for Transgender Health's standards of care. Arizona's healthcare plan provides coverage for the same surgery when prescribed as medically necessary treatment for other medical conditions. And, all four of the plan's medical providers adopted internal policies and guidelines that authorize hysterectomies as medically necessary for gender dysphoria. Still, the plan does not cover hysterectomies when performed as part of transition-related care.
According to Dr. Toomey's lawsuit:
The Plan generally provides coverage for medically necessary care, but singles out transgender employees for unequal treatment by categorically denying all coverage for "[g]ender reassignment surgery" regardless of whether the surgery qualifies as medically necessary treatment. As a result, transgender individuals enrolled in the Plan have no opportunity to demonstrate that their transition-related care is medically necessary, and they have no opportunity to appeal any adverse determination to an independent reviewer.
"Arizona provides the same discriminatory health plan to nearly all state employees and their dependents," Dr. Toomey wrote on the ACLU's "Speak Feely" blog. "That means hundreds, if not thousands, of transgender state employees or transgender dependents of state employees cannot receive medically necessary care."
State of Coverage
Coverage for transgender surgery can vary from insurance plan to insurance plan, and from state to state. Federal judges have ruled that Wisconsin can't block insurance companies from covering transgender healthcare costs, and that Massachusetts was required to provide gender reassignment surgery for prison inmates.
Dr. Toomey's lawsuit, which could include hundreds or thousands of state employees, is asking the state to remove the exclusion for gender reassignment surgery, and adopt a standard policy for assessing medical necessity of surgeries associated with transgender healthcare.