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Transgender rights advocates are celebrating a major legal victory


A federal appeals court has ruled in favor of transgender patients in North Carolina and West Virginia. Now, advocates say it's a huge victory, especially since state bills restricting trans rights have been on the rise, but it's not the final word. The case could be appealed to the U.S. Supreme Court. NPR's health policy correspondent Selena Simmons-Duffin is here to tell us more about the ruling. Selena, so what's the background on these cases?

SELENA SIMMONS-DUFFIN, BYLINE: Well, one was brought by North Carolina state employees and their dependents who are transgender and who were unable to get coverage for gender-affirming care on the state's health plan. The lead plaintiff is Maxwell Kadel. He's a transgender man who works for the University of North Carolina at Chapel Hill.

And the other case came from West Virginians who are trans and on Medicaid, the state's health insurance program for low-income people. They could get coverage for some treatments, like hormones, but not surgery, so they sued to try to get coverage for this care. They were represented by Lambda Legal. And in both cases, they won at the district court level, and then the states appealed.

So the states argued that the health plans don't cover all medical care - they have discretion to cover some things and not others - and that they were not covering gender-affirming care because of cost, not because they were discriminating against the plaintiffs for being trans.

MARTÍNEZ: OK, so the appeals court ruled in favor of the trans patients. What did the ruling say?

SIMMONS-DUFFIN: So it was an 8-6 decision, and the reasoning went, these plans actually do cover this care for others enrolled in the plan. For instance, women with breast cancer have coverage for mastectomies. Lots of people take sex hormones for various medical issues, so then denying the same care when it's in treatment of gender dysphoria is discrimination. I spoke with Lambda Legal's Tara Borelli. She said the plaintiffs were thrilled with the ruling.

TARA BORELLI: They're incredibly gratified that the court has recognized that this kind of discrimination is unlawful and doesn't have any place in the way that the government treats its people.

SIMMONS-DUFFIN: Both the attorney general of West Virginia and the state treasurer of North Carolina condemned the ruling as judicial activism and suggested they plan to appeal to the Supreme Court.

MARTÍNEZ: So how does this ruling fit in with all the news about restrictions on trans people's rights?

SIMMONS-DUFFIN: You know, it's really a patchwork. Whether you have access or not is really tied to the state you live in. Lindsey Dawson directs LGBTQ health policy at the research group KFF. She runs a tracker of state laws and policies limiting youth access to gender-affirming care. And she says these bans have just exploded in the last two years.

LINDSEY DAWSON: We're talking about 24 states that have enacted laws, 17 of which are facing lawsuits.

SIMMONS-DUFFIN: She says some courts are upholding restrictions. Some are rolling them back. And that's going to continue until the Supreme Court weighs in.

MARTÍNEZ: OK, so what might happen if, indeed, this case does reach the Supreme Court?

SIMMONS-DUFFIN: Well, the justices have been sending some mixed messages here. Earlier this month, they allowed Idaho's ban on gender-affirming care for youth to take effect, but they've declined to hear other cases. There was one about a trans student's access to bathrooms at school, another about trans student participation in sports. And court watchers read that back-and-forth as a reluctance to step into the fray. But there is so much disagreement over in the lower courts, so many new laws being passed on trans issues, Dawson says it's just inevitable that one of these cases will reach the Supreme Court.

MARTÍNEZ: All right. That's NPR's Selena Simmons-Duffin. Selena, thanks.

SIMMONS-DUFFIN: Thank you. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

A Martínez
A Martínez is one of the hosts of Morning Edition and Up First. He came to NPR in 2021 and is based out of NPR West.
Selena Simmons-Duffin
Selena Simmons-Duffin reports on health policy for NPR.