Lambda Legal Sues on Behalf of Teen Over Trans Exclusion in Health Benefits

Today, Lambda Legal and Sirianni Youtz Spoonemore Hamburger PLLC filed a federal lawsuit challenging Blue Cross Blue Shield of Illinois's ("BCBSIL") administration of a blanket exclusion of gender-affirming care in an employer-provided health insurance plan provided by Catholic Health Initiatives Franciscan.

The lawsuit was filed in the United States District Court for the Western District of Washington in Tacoma on behalf of a 15-year-old transgender boy, "C.P.," and his parents, and argues the exclusion is in direct violation of the nondiscrimination provisions under Section 1557 of the Affordable Care Act.

"My son needs the medical care that will allow him to live, be healthy, and to thrive. However, because he is transgender, I have to fight and jump through hoops for him to have access to the care that he needs, is legally entitled to and that he deserves," said Pattie Pritchard, C.P.'s mother and the primary beneficiary on the employer-provided health benefit plan that BCBSIL administers. "This denial also sends a message to my son and all transgender people, that their health care needs aren't real or they're not worthy of care. I won't accept that."

BCBSIL is a "covered health entity" under the ACA, which means BCBSIL cannot, and it has represented that it does not, discriminate on the basis of race, national origin, sex, age and disability. The ACA's Section 1557, which BCBSIL agrees it must abide by, prohibits discrimination on the basis of sex and gender identity, such as in the provision of transition-related care. As such, BCBSIL cannot administer the discriminatory terms of the health plan provided by Pattie Pritchard's employer–St. Michael Medical Center in Bremerton, Washington, which is part of the Catholic Health Initiatives Franciscan Health System, now known as CommonSpirit Health.

"The law is clear, Blue Cross Blue Shield of Illinois cannot deny C.P., or any transgender person, the health care that he needs," said Omar Gonzalez-Pagan, Senior Attorney and Health Care Strategist for Lambda Legal. "Section 1557 of the ACA expressly prohibits categorical bans on gender-affirming care because it is discrimination on the basis of sex, plain and simple. BCBSIL cannot adopt or administer discriminatory terms on behalf of others. As a covered entity under the ACA, BCBSIL has to play by the same rules as everyone else, no exceptions."

"BCBSIL cannot hide behind a defense that it was 'just following orders' when Pritchard's employer told BCBSIL to apply the illegal exclusion," said Eleanor Hamburger of Sirianni Youtz Spoonemore Hamburger who has worked with C.P. and his parents during the past three years to prepare this case for litigation. "BCBSIL has a separate legal, contractual and fiduciary duty to C.P. and others in the health plans it administers, to comply with the anti-discrimination law."

C.P. is a dependent on his mother's employer-provided health insurance plan and began receiving medically necessary gender-affirming care three years ago. Recently, however, C.P. and his family were informed that some of his care would not be covered because of an exclusion of any care "for or leading to gender reassignment surgery", including the same care and medical interventions that other cisgender patients receive without question or problem. C.P.'s family has had to pay out-of-pocket for his care, causing unnecessary financial stress.

"Although it is a heavy burden on our family, we are lucky that we can pay for C.P.'s critical health care while we fight, but I shudder to think of the families that cannot," added Pritchard. "What is a family who cannot afford this very expensive care for their child supposed to do? This is a matter of life and death for many transgender people and children, and I hate to think of the difficult and scary decisions families are forced to make; it's not fair, and it's not right."

The case is C.P. v. Blue Cross Blue Shield of Illinois and is being litigated by Lambda Legal Senior Attorney and Health Care Strategist Omar Gonzalez-Pagan, Law and Policy Director Jennifer C. Pizer and Eleanor Hamburger of Sirianni Youtz Spoonemore Hamburger PLLC, in Seattle, Washington.