Georgia County Pays $1.2 Million to Fight Gender-Affirming Care Suit

A county in central Georgia paid a private law firm $1.2 million in legal fees rather than cover the cost of gender-affirming surgery for a decorated sheriff’s deputy.

Houston County Sgt. Anna Lange sued the county after she was denied coverage for the procedure. The county initially claimed including gender-affirming medical care would substantially increase its health care costs, but earlier this month a federal court disagreed with an appeal filed by the county and ordered the county to cover the services.

“It was a slap in the face, really, to find out how much they had spent,” Lange told ProPublica. “They’re treating it like a political issue, obviously, when it’s a medical issue.”

Lange came out to her employer in 2017 after over a decade of service in the department. One of her superiors, Sheriff Cullen Talton, initially thought she was joking and laughed at the news. He then told Lang he didn’t “believe in” gender dysphoria, but that her job was secure if she continued performing her duties well.

Problems arose when Lange discovered gender-affirming care was not covered under her employer's health care coverage. The county specifically included “services and supplies for a sex change” on a list of excluded coverage. As a result, while her hormonal medicine was covered, the lab work to monitor her body’s response to the medicine was denied coverage.

ProPublica reports that Houston County leaders had rejected an attempt by the country's insurance administrator to change the policy to fit with a federal nondiscrimination rule.

For the next two years, Lange sought to have gender-affirming care removed from the list of exclusions, first via a letter-writing campaign to her insurer and employer, and then through a direct appearance at a county board of commissioners hearing in 2019. At the hearing she listened as a neighbor questioned the validity of gender-affirming care, comparing it to cosmetic surgery, whether it was a work-related expense, and why the taxpayer should pay for the coverage. Lange said a commissioner at the hearing assured her neighbor there would be no changes to the health plan that year.

“You knew right then and there that no matter what I said, that it wouldn’t matter,” she recalled. “It’s a really helpless feeling.”

Lange next turned to the courts, filing a federal lawsuit claiming her medical care was inferior and discriminatory. In response to the lawsuit, Houston County paid $1.2 million to a single law firm for legal services, including expert witness research and testimony, and far more than the estimated cost of providing coverage for gender-affirming medical services. For comparison, Lange estimated the cost of her next surgery at roughly $25,000 or more. The county’s expert said that since its insurance was self-funded and fully paid by the county, it could not cover gender-affirming care. An expert hired by Lange disputed the claims finding instead the cost would be statistically small.

The court ruled in Lange’s favor, but the country quickly filed an appeal, according to ProPublica. In its appeal, the county’s expert used an article, How Ben Got His Penis, which references a far more costly surgery that does not apply to transgender women. The court again ruled in Lange’s favor and she is hopeful she can finally have the surgery.

Despite her string of court victories, Lange said she remains cautious. There’s still a chance the county will file another appeal despite the financial costs

“Until the case is done-done and over with, that’s when I can have some relief,” she said.