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Georgia taxpayers will fund the costly “gender-affirming” surgery of a law enforcement officer because an Obama-appointed federal judge ruled that a county in the state’s central region violated the Civil Rights Act when its insurance company denied the operation. The chief judge of the U.S. District Court for the Middle District of Georgie, Marc Treadwell, writes in his opinion that the exclusion for the surgery, which is complicated and can cost tens of thousands of dollars, “plainly discriminates because of transgender status.” Enacted in 1964, the Civil Rights Act prohibits employment discrimination based on race, color, religion, sex, and national origin.

In a 33-page ruling issued last week Treadwell compares the county’s health insurance excluding “all treatment for gender dysphoria” (including sex-change surgery and drugs related to the procedure) to surgery for breast cancer and hormone therapy for menopausal women. “The fact of the matter is, for example, that the plan pays for mastectomies when medically necessary for cancer treatment but not when mastectomies are medically necessary for sex change surgery,” the judge writes. “And the plan pays for hormone replacement therapy medically necessary for the treatment of menopause, but not hormone replacement therapy medically necessary for “sex change.” The undisputed, ultimate point is that the Exclusion applies only to transgender members, and it applies to Lange [the plaintiff] because she is transgender.”

In 2019 a veteran male deputy sheriff in Houston County with a population of around 155,300, sued his employer after being denied a vaginoplasty, a complex surgical procedure in which surgeons may remove the penis and testes and use tissue to construct a vagina. It is also known as penile inversion and can cost up to $25,000. In 2017, after serving years in uniform as a man, the officer who now goes by the name Anna Lange, came out as transgender and was subsequently diagnosed with gender dysphoria. Lange takes hormone replacement therapy and paid thousands of dollars for breast augmentation surgery to feminize his chest. But Lange continues to suffer significant distress and anxiety due to the incongruence between his female gender identity and his remaining male physical characteristics, according to the court document. “When such symptoms persist, gender-confirming surgery is considered “medically necessary,” the recent ruling states, adding that an endocrinologist, two psychologists and a surgeon recommended Lange have a vaginoplasty, which is also known as “bottom surgery” to treat his gender dysphoria.

In 2018, Lange tried to get the surgery covered by the county insurance but was denied and a year later the Transgender Legal Defense & Education Fund (TLDEF), a nonprofit that aims to end discrimination and achieve equality for transgender people, sued the county on his behalf. The group stresses that the World Professional Association for Transgender Health, a nonprofit that evidently is considered the authority on such issues, recommends gender affirming care whenever a person is diagnosed with gender dysphoria. “The Court’s decision makes clear that depriving transgender people of healthcare is not only immoral but also illegal,” said the legal director of TLDEF in a statement celebrating last week’s ruling. “An employer cannot refuse health coverage to a transgender employee who needs access to medically necessary, life-saving care. This ruling will have transformative impact on the quality of life for countless transgender people who live in the South.”

Although less than one percent of the American population is transgender, the Biden administration has launched a fierce governmentwide effort to provide special accommodations with key federal agencies implementing significant measures to support those who identify as transgender. This includes the U.S. Census Bureau spending $10 million to research how to best add questions about sexual orientation and gender identity on surveys. The State Department is allowing all American citizens to select an X as their gender marker on U.S. passport applications. The Department of Health and Human Services (HHS), the first federal agency to fly a transgender pride flag above its headquarters, will soon reveal its plan to “best serve LGBTQI+ Americans” based on a comprehensive study on “Measuring Sex, Gender Identity, and Sexual Orientation” conducted by the National Institutes of Health (NIH), the nation’s medical research agency. HHS is also using another “groundbreaking” taxpayer-funded study on how transgender Americans want to see themselves reflected on federal identifications. The Social Security Administration is eliminating a rule requiring transgender people to provide legal or medical documentation of their identity on official records. The Equal Employment Opportunity Commission (EEOC), the federal agency that enforces the nation’s workplace discrimination laws, will promote greater equity and inclusion for members of the transgender community by providing the option to select an X gender marker during the initial intake process of filing a discrimination charge. The Department of Education will update federal student aid forms to include gender identity when applying for federal financial aid, which the administration asserts will inform the agency about barriers “transgender and non-binary students face in the financial aid process.”

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