By Peyton Majors
Christian Action League
May 3, 2024
Federal appeals court this week struck down North Carolina’s ban on transgender surgeries within its state employee health care plan, ruling in a narrow 8-6 split that the prohibition is discriminatory and violates the U.S. Constitution.
An appeal to the U.S. Supreme Court is likely.
The case involves bans in North Carolina on “sex changes or modifications and related care” for state employees and in West Virginia on “transsexual surgery” within Medicaid. The decision from the U.S. Fourth Circuit Court of Appeals broke down along political ideology, with all eight votes in the majority coming from judges who were nominated by Democratic presidents and the six votes in the minority from judges nominated by Republican presidents.
“Do healthcare plans that cover medically necessary treatments for certain diagnoses but bar coverage of those same medically necessary treatments for a diagnosis unique to transgender patients violate either the Equal Protection Clause or other provisions of federal law? We hold that they do,” wrote Judge Roger Gregory, a nominee of President Bill Clinton, for the majority.
“[W]e hold that the coverage exclusions facially discriminate on the basis of sex and gender identity, and are not substantially related to an important government interest,” Gregory wrote.
It is the first such decision by a U.S. appeals court.
Judge J. Harvie Wilkinson wrote a minority decision criticizing the majority’s ruling. He was nominated by President Ronald Reagan.
“Of course, the controversies surrounding transgender status will reach the courts,” he wrote. “But how they reach us is the all-important thing. There is a big difference between, say, reading a statute and discovering a novel unenumerated constitutional right.”
Decisions such as the majority’s opinion, Wilkinson said, “politicize the court.”
“Had the majority’s result been reached through the democratic process, it would have been perceived as the product of a process in which many good people of many varied views had had their voices heard,” he wrote.
North Carolina Treasurer Dale R. Folwell also criticized the opinion.
“Today’s majority decision is in direct conflict with multiple decisions from other federal appeals courts and, hopefully, will be corrected by the U.S. Supreme Court,” he wrote.
Rev. Mark Creech, executive director of the Christian Action League, expressed hope that the Supreme Court overturns the Fourth Circuit.
“By mandating state insurance plans cover elective sex-change surgeries that I and millions of others find morally objectionable, this decision defies common sense and takes a sledgehammer to constitutional prudence,” Creech said. “Further, it disregards the rights of taxpayers who are now compelled to fund procedures that clash with their faith and beliefs. Great moral questions such as these should be decided by public discourse and legislative action, and not imposed through the courts. I pray that the U.S. Supreme Court recognizes the profound implications of this ruling and steps in to correct this overreach.”