Sgt. Anna Lange came out as transgender in 2017 after working in the Houston County Sheriff’s Office since 2006. She has taken hormone therapy and outwardly changed her appearance over the past three years to treat gender dysphoria, the distress resulting from the mismatch between her sex assigned at birth and her gender identity.

Her next step was going to be gender-affirmation surgery, but that plan came to a halt when her insurance provider based on an exclusion specified by her employer.

Now, Lange is suing the Houston County Board of Commissioners to remove that exclusion. Early Wednesday, she and her lawyer, Noah Lewis of the Transgender Legal Defense and Education Fund, filed suit in U.S. District Court in Macon, Ga., alleging unlawful discrimination under federal and state equal protection clauses, Title VII of the Civil Rights Act and the Americans With Disabilities Act.

County officials did not return calls for comment.

Lange’s case is the latest in the U.S. to challenge the exclusion of transgender care from state and municipal employee insurance plans ― and it could create legal precedents for cases across the South.

Other transgender people have won similar fights elsewhere. The managers of Wisconsin’s state employee insurance program excluded transgender employees from coverage but later reversed that decision. Separately, two University of Wisconsin employees the state and won. Another lawsuit successfully transgender exclusions in Wisconsin’s Medicaid plan.

Earlier this year, Jesse Vroegh, a transgender employee of the Iowa Department of Corrections, won a he filed after being denied coverage by his employer’s health insurance plan.

And in Georgia, the state’s university system an insurance exclusion claim for gender-affirmation surgery filed by Skyler Jay, known for his appearance on the Netflix series “Queer Eye.” In addition to changing its employee health plan to be inclusive of transgender care, the university system paid Jay $100,000 in damages.

“The university clearly agreed that it was discrimination,” said Lewis, who also represented Jay. “That’s why they wanted to do the right thing and remove the exclusion.”

In 2011, another Georgia case, , set the legal precedent protecting transgender people from employment discrimination. However, that case did not address discrimination in employee benefits and, like Jay’s, many of the cases that deal with benefits have been settled out of court, according to Lewis.

The Affordable Care Act, which took effect in 2014, specifically prohibits discrimination by health insurance issuers on the basis of gender identity, and Title VII of the Civil Rights Act has also been interpreted to prohibit such discrimination.

Despite broad legal that transgender insurance exclusions are unlawful, state and local governments continue to pursue expensive legal fights to preserve them. The issue remains .

“Ultimately, what’s happening is that, politically, I presume they think it’s unpopular or they think they have to defend” the law or regulation, said John Knight, an attorney with the American Civil Liberties Union.

Resisting payment for such care can be more expensive than providing it. Not including the costs of state attorneys’ salaries or appeals, Wisconsin’s litigation against the employees of its university system cost the state more than $845,000, while Iowa’s cost about $125,000.

Furthermore, the cost of managing untreated gender dysphoria can the costs of providing transgender-inclusive health care, according to a 2015 study. “Given the small number of people who actually need this kind of care and the large pool of people, it will have absolutely no impact on the total cost of insurance for any state,” Knight said.

While settlements like Jay’s may be good for individuals, they do not require institutions to admit wrongdoing and do not result in a legal precedent that other, lower courts must follow.

“The court doesn’t have to look at that settlement and say, ‘Oh, this was discrimination,’” said Lewis. “Transgender workers in the South are being left behind, which is why we’re seeking a court ruling to clearly establish that this conduct is unlawful throughout the South.”

Lange’s suit argues that the county’s exclusion of transgender health care from coverage was deliberate: In documents Lewis obtained under the Freedom of Information Act, Kenneth Carter, the county’s personnel director, opted out of compliance with Section 1557 of the Affordable Care Act, which prohibits discrimination by health programs on the basis of gender identity.

“Houston County will be responsible for any penalties that result if the plan is determined to be non-compliant,” he wrote in a letter to a representative of Anthem Blue Cross and Blue Shield, which administers the plan.

Carter did not return calls for comment.

Lange’s case could end up before the 11th U.S. Circuit Court of Appeals, yielding a decision that could influence other courts in Alabama, Florida and Georgia. And, if the ruling is in Lange’s favor, Lewis said that would signal that transgender exclusions should be removed nationwide.

In its next term, the U.S. Supreme Court will hear three cases that will determine workplace protections of LGBTQ individuals, including one case involving a transgender woman.

Lange said she merely wants the same protections everyone else has. The co-workers with whom she shares a health plan might have used “something on the policy that I may never use or need, but it’s covered,” she said. “When it’s finally something that I need that one of my co-workers will probably never use or need, mine’s excluded. And that’s just not fair.”

This <a target="_blank" href="/courts/georgia-deputy-sheriff-lawsuit-transgender-insurance-coverage/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

California’s Board of Education updated its statewide framework in May for teaching comprehensive sex education that prioritizes medical accuracy and sensitivity to diverse sexualities.

And in Virginia, a measure signed into law in March requires school-based sex education to include instruction on human trafficking.

The 2019 state legislative season is producing a bumper crop of sex education bills across the U.S., with at least 79 bills introduced in the legislatures of 32 states and the District of Columbia, according to a recent by the Guttmacher Institute, a sexual and reproductive health research and advocacy organization. Most of the bills have been aimed at expanding youth education around healthy sexuality and relationships — and reducing the reach of the abstinence-only ideology that had become part of many sex ed classes over the past four decades.

But it wasn’t just socially liberal states reconsidering the approach to sex education this year. Several conservative states were among those taking steps toward broader sex ed that, while not as far-reaching as California’s, represent important shifts that could lead to more comprehensive policies down the line.

In Tennessee, for example, where Republicans control the Senate, House and governor’s office, lawmakers passed a bill encouraging schools to provide education on sexual violence awareness.

And in Utah, where Republicans hold a veto-proof majority in both chambers, the state’s Republican governor signed a law allowing educators to in public school classrooms.

Mississippi, Georgia and Arkansas lawmakers attempted bills, too, although theirs did not pass.

Renewed interest in the issue was fueled in part by legislative flips during last November’s midterm elections that brought into office more Democrats — and more female lawmakers — but also by questions about sexual assault and consent raised by the #MeToo movement.

Although women hold fewer than 30% of state legislative seats, they introduced five out of every seven state bills updating sex education standards that were enacted in the past year, according to a recent by the left-leaning Center for American Progress think tank. Women also introduced more than half of the bills to modernize sex education in this year’s sessions.

“When you have different, new people, you’re going to have new conversations and new ideas,” said Elizabeth Nash, senior state issues manager at the Guttmacher Institute.

The Birds And The Bees Evolve

Although U.S. House and Senate versions of new sex education standards have been reintroduced this year, too, they are unlikely to pass, according to Jennifer Driver, state policy director at the Sexuality Information and Education Council of the United States, an organization that advocates for comprehensive sex education.

Decisions on such curriculum choices in public schools are largely determined by the states. do not require sex education, according to the , and only 13 require it to be medically accurate.

Attitudes about sex ed have been politically polarized since at least the 1960s, hinging on whether premarital abstinence should be taught as the , or as one of to avoid unwanted pregnancy and sexually transmitted diseases.

Since the in 1981, according to the SIECUS advocacy group, more than $2 billion in taxes has been spent on disseminating those programs even as they have been linked to or, at best, for unwanted pregnancies and STDs.

But an uptick in public conversations about the danger of unhealthy relationships is changing the game. First came a spate of highly publicized episodes of dating violence, followed by several episodes of on college campuses, and then #MeToo, when powerful men were called out for sexual violence and harassment. With each wave of outrage, state legislators began passing — if not healthy sexuality.

“That has meant more energy around an issue that has long been lacking in sex education, which is consent,” said Nash.

Conversations about teaching and learning consent led to conversations about control over one’s own body and the right to accurate, nonjudgmental information about health and sexuality. That has led back to conversations about comprehensive sex education. “It’s not quite a circle, but this is the path that it’s moved on,” said Nash.

When several state legislatures then shifted leftward with the 2018 elections, the wheels began turning quickly.

Changing The Conversation In Red States

It was two weeks after those elections when Jaime Winfree first decided Georgia needed a sex education bill.

Winfree, director of the Georgia Coalition for Advancing Sex Education, was at a reproductive rights conference when she heard a presentation from advocate Jennifer Chou, an attorney with the Northern California affiliate of the American Civil Liberties Union.

Chou was detailing the 2015 passage of the California Healthy Youth Act, which requires schools to provide middle and high school students with comprehensive sex education that medical accuracy and sensitivity to diverse values and beliefs on sexuality. She told the conference the bill was the result of 20 years of incremental change.

“I almost fell out of my chair,“ Winfree recalled.

If the process took 20 years in California, it’s going to take 200 years in Georgia, Winfree thought. But both states had to start somewhere. She decided Georgia’s first step should be the same as California’s: pass a requirement that any sex education taught in public schools be medically accurate.

It seemed like an easy sell, but it wasn’t. The bill that Winfree and her colleagues helped author was sponsored by several Democratic legislators and ultimately died in committee. It was disappointing, she said, but her fight is far from over — Winfree is already plotting her pre-filing strategy for next year’s version of the bill.

In Mississippi, a bill was introduced this year that would have made school sex education opt-out instead of opt-in, mandated consent education and required more frequent updates to the curriculum.

Recent high school graduate Ava Davis of Jackson helped shape the language of the bill as a member of the Mississippi Youth Council, which advocates for comprehensive sex education in the state.

“It’s important for students to be heard, because education is directly affecting us,” she said.

The bill did not pass, but to Nash, it still represented progress. “Five years ago, six years ago, there were very few legislators who would say that they were for comprehensive sex ed in Mississippi,” she said. “Now, to get to a bill? There’s a lot of building happening there.”

This <a target="_blank" href="/public-health/how-metoo-is-changing-sex-ed-policies-even-in-red-states/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Sgt. Anna Lange came out as transgender in 2017 after working in the Houston County Sheriff’s Office since 2006. She has taken hormone therapy and outwardly changed her appearance over the past three years to treat gender dysphoria, the distress resulting from the mismatch between her sex assigned at birth and her gender identity.

Her next step was going to be gender-affirmation surgery, but that plan came to a halt when her insurance provider based on an exclusion specified by her employer.

Now, Lange is suing the Houston County Board of Commissioners to remove that exclusion. Early Wednesday, she and her lawyer, Noah Lewis of the Transgender Legal Defense and Education Fund, filed suit in U.S. District Court in Macon, Ga., alleging unlawful discrimination under federal and state equal protection clauses, Title VII of the Civil Rights Act and the Americans With Disabilities Act.

County officials did not return calls for comment.

Lange’s case is the latest in the U.S. to challenge the exclusion of transgender care from state and municipal employee insurance plans ― and it could create legal precedents for cases across the South.

Other transgender people have won similar fights elsewhere. The managers of Wisconsin’s state employee insurance program excluded transgender employees from coverage but later reversed that decision. Separately, two University of Wisconsin employees the state and won. Another lawsuit successfully transgender exclusions in Wisconsin’s Medicaid plan.

Earlier this year, Jesse Vroegh, a transgender employee of the Iowa Department of Corrections, won a he filed after being denied coverage by his employer’s health insurance plan.

And in Georgia, the state’s university system an insurance exclusion claim for gender-affirmation surgery filed by Skyler Jay, known for his appearance on the Netflix series “Queer Eye.” In addition to changing its employee health plan to be inclusive of transgender care, the university system paid Jay $100,000 in damages.

“The university clearly agreed that it was discrimination,” said Lewis, who also represented Jay. “That’s why they wanted to do the right thing and remove the exclusion.”

In 2011, another Georgia case, , set the legal precedent protecting transgender people from employment discrimination. However, that case did not address discrimination in employee benefits and, like Jay’s, many of the cases that deal with benefits have been settled out of court, according to Lewis.

The Affordable Care Act, which took effect in 2014, specifically prohibits discrimination by health insurance issuers on the basis of gender identity, and Title VII of the Civil Rights Act has also been interpreted to prohibit such discrimination.

Despite broad legal that transgender insurance exclusions are unlawful, state and local governments continue to pursue expensive legal fights to preserve them. The issue remains .

“Ultimately, what’s happening is that, politically, I presume they think it’s unpopular or they think they have to defend” the law or regulation, said John Knight, an attorney with the American Civil Liberties Union.

Resisting payment for such care can be more expensive than providing it. Not including the costs of state attorneys’ salaries or appeals, Wisconsin’s litigation against the employees of its university system cost the state more than $845,000, while Iowa’s cost about $125,000.

Furthermore, the cost of managing untreated gender dysphoria can the costs of providing transgender-inclusive health care, according to a 2015 study. “Given the small number of people who actually need this kind of care and the large pool of people, it will have absolutely no impact on the total cost of insurance for any state,” Knight said.

While settlements like Jay’s may be good for individuals, they do not require institutions to admit wrongdoing and do not result in a legal precedent that other, lower courts must follow.

“The court doesn’t have to look at that settlement and say, ‘Oh, this was discrimination,’” said Lewis. “Transgender workers in the South are being left behind, which is why we’re seeking a court ruling to clearly establish that this conduct is unlawful throughout the South.”

Lange’s suit argues that the county’s exclusion of transgender health care from coverage was deliberate: In documents Lewis obtained under the Freedom of Information Act, Kenneth Carter, the county’s personnel director, opted out of compliance with Section 1557 of the Affordable Care Act, which prohibits discrimination by health programs on the basis of gender identity.

“Houston County will be responsible for any penalties that result if the plan is determined to be non-compliant,” he wrote in a letter to a representative of Anthem Blue Cross and Blue Shield, which administers the plan.

Carter did not return calls for comment.

Lange’s case could end up before the 11th U.S. Circuit Court of Appeals, yielding a decision that could influence other courts in Alabama, Florida and Georgia. And, if the ruling is in Lange’s favor, Lewis said that would signal that transgender exclusions should be removed nationwide.

In its next term, the U.S. Supreme Court will hear three cases that will determine workplace protections of LGBTQ individuals, including one case involving a transgender woman.

Lange said she merely wants the same protections everyone else has. The co-workers with whom she shares a health plan might have used “something on the policy that I may never use or need, but it’s covered,” she said. “When it’s finally something that I need that one of my co-workers will probably never use or need, mine’s excluded. And that’s just not fair.”

This <a target="_blank" href="/courts/georgia-deputy-sheriff-lawsuit-transgender-insurance-coverage/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

California’s Board of Education updated its statewide framework in May for teaching comprehensive sex education that prioritizes medical accuracy and sensitivity to diverse sexualities.

And in Virginia, a measure signed into law in March requires school-based sex education to include instruction on human trafficking.

The 2019 state legislative season is producing a bumper crop of sex education bills across the U.S., with at least 79 bills introduced in the legislatures of 32 states and the District of Columbia, according to a recent by the Guttmacher Institute, a sexual and reproductive health research and advocacy organization. Most of the bills have been aimed at expanding youth education around healthy sexuality and relationships — and reducing the reach of the abstinence-only ideology that had become part of many sex ed classes over the past four decades.

But it wasn’t just socially liberal states reconsidering the approach to sex education this year. Several conservative states were among those taking steps toward broader sex ed that, while not as far-reaching as California’s, represent important shifts that could lead to more comprehensive policies down the line.

In Tennessee, for example, where Republicans control the Senate, House and governor’s office, lawmakers passed a bill encouraging schools to provide education on sexual violence awareness.

And in Utah, where Republicans hold a veto-proof majority in both chambers, the state’s Republican governor signed a law allowing educators to in public school classrooms.

Mississippi, Georgia and Arkansas lawmakers attempted bills, too, although theirs did not pass.

Renewed interest in the issue was fueled in part by legislative flips during last November’s midterm elections that brought into office more Democrats — and more female lawmakers — but also by questions about sexual assault and consent raised by the #MeToo movement.

Although women hold fewer than 30% of state legislative seats, they introduced five out of every seven state bills updating sex education standards that were enacted in the past year, according to a recent by the left-leaning Center for American Progress think tank. Women also introduced more than half of the bills to modernize sex education in this year’s sessions.

“When you have different, new people, you’re going to have new conversations and new ideas,” said Elizabeth Nash, senior state issues manager at the Guttmacher Institute.

The Birds And The Bees Evolve

Although U.S. House and Senate versions of new sex education standards have been reintroduced this year, too, they are unlikely to pass, according to Jennifer Driver, state policy director at the Sexuality Information and Education Council of the United States, an organization that advocates for comprehensive sex education.

Decisions on such curriculum choices in public schools are largely determined by the states. do not require sex education, according to the , and only 13 require it to be medically accurate.

Attitudes about sex ed have been politically polarized since at least the 1960s, hinging on whether premarital abstinence should be taught as the , or as one of to avoid unwanted pregnancy and sexually transmitted diseases.

Since the in 1981, according to the SIECUS advocacy group, more than $2 billion in taxes has been spent on disseminating those programs even as they have been linked to or, at best, for unwanted pregnancies and STDs.

But an uptick in public conversations about the danger of unhealthy relationships is changing the game. First came a spate of highly publicized episodes of dating violence, followed by several episodes of on college campuses, and then #MeToo, when powerful men were called out for sexual violence and harassment. With each wave of outrage, state legislators began passing — if not healthy sexuality.

“That has meant more energy around an issue that has long been lacking in sex education, which is consent,” said Nash.

Conversations about teaching and learning consent led to conversations about control over one’s own body and the right to accurate, nonjudgmental information about health and sexuality. That has led back to conversations about comprehensive sex education. “It’s not quite a circle, but this is the path that it’s moved on,” said Nash.

When several state legislatures then shifted leftward with the 2018 elections, the wheels began turning quickly.

Changing The Conversation In Red States

It was two weeks after those elections when Jaime Winfree first decided Georgia needed a sex education bill.

Winfree, director of the Georgia Coalition for Advancing Sex Education, was at a reproductive rights conference when she heard a presentation from advocate Jennifer Chou, an attorney with the Northern California affiliate of the American Civil Liberties Union.

Chou was detailing the 2015 passage of the California Healthy Youth Act, which requires schools to provide middle and high school students with comprehensive sex education that medical accuracy and sensitivity to diverse values and beliefs on sexuality. She told the conference the bill was the result of 20 years of incremental change.

“I almost fell out of my chair,“ Winfree recalled.

If the process took 20 years in California, it’s going to take 200 years in Georgia, Winfree thought. But both states had to start somewhere. She decided Georgia’s first step should be the same as California’s: pass a requirement that any sex education taught in public schools be medically accurate.

It seemed like an easy sell, but it wasn’t. The bill that Winfree and her colleagues helped author was sponsored by several Democratic legislators and ultimately died in committee. It was disappointing, she said, but her fight is far from over — Winfree is already plotting her pre-filing strategy for next year’s version of the bill.

In Mississippi, a bill was introduced this year that would have made school sex education opt-out instead of opt-in, mandated consent education and required more frequent updates to the curriculum.

Recent high school graduate Ava Davis of Jackson helped shape the language of the bill as a member of the Mississippi Youth Council, which advocates for comprehensive sex education in the state.

“It’s important for students to be heard, because education is directly affecting us,” she said.

The bill did not pass, but to Nash, it still represented progress. “Five years ago, six years ago, there were very few legislators who would say that they were for comprehensive sex ed in Mississippi,” she said. “Now, to get to a bill? There’s a lot of building happening there.”

This <a target="_blank" href="/public-health/how-metoo-is-changing-sex-ed-policies-even-in-red-states/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">