A Cincinnati woman today sued the Cincinnati public library and the corporate parent of Anthem Blue Cross and Blue Shield for refusing to cover her sex-reassignment surgery.

The insurer's refusal violates the Affordable Care Act's guarantee of coverage for medically necessary treatment, and the employer's requirement under federal law to treat employees equally, regardless of gender, says Rachel Dovel's lawsuit, filed in U.S. District Court in Cincinnati.

If the case proceeds, it could be the first establishing or denying an insurer's requirement to cover transgender surgery under the Affordable Care Act, better known as Obamacare.

There has been other litigation over other transgender rights, however. Those include a legal settlement that established a right for some California inmates to get state-paid gender-conversion surgery. Local government-based requirements for schools to honor students' gender identity in bathroom choice are working their way through courts across the country.

"We may be the first because most insurers and most employers cover the service," said Jennifer Branch, a partner at Gerhardstein & Branch, a Cincinnati law firm that handles civil liberties cases exclusively. The firm's other clients have included Jim Obergefell, whose demand that his gay marriage be legally recognized helped establish gay marriage rights across the country with a landmark 2015 U.S. Supreme Court decision.

Chris Rice, a representative of the Public Library of Cincinnati and Hamilton County, declined comment, saying he had not seen the court filing and could not discuss a matter in litigation. But Anthem Blue Cross and Blue Shield said in a statement late Monday that the company fully complies with Obamacare's requirements, suggesting any denial of coverage for Dovel's surgery was a result of the library's insurance-buying decisions.

"We're sensitive to the issues raised by Ms. Dovel in this case," said Anthem spokesman Jeff Blunt. "All of Anthem's health plans are fully compliant with the Affordable Care Act and they have been reviewed and approved by appropriate state regulators.  As is the industry standard, coverage for transgender surgery is available as an optional rider, or add-on coverage, that employers may purchase."

Here's what the case is about.

The background:

Dovel, 34, was born male and had the name Nathan until after a diagnosis in 2014 of gender dysphoria, or severe and unremitting emotional pain due to incongruity with the sex assigned or assumed at birth, according to the lawsuit.

She began hormone therapy, which was covered by insurance, and started changing her outward appearance. In 2015, she changed her name from Nathan Bradley Dovel to Rachel Katrina Dovel.

To that point, the library treated her well, said Dovel, a 2005 University of Toledo graduate who works in the library's catalog and processing department. But the library, where she has worked nearly 11 years, balked when it came to the next stage of Dovel's treatment.

The insurer's and employer's decision:

Her doctors said sex-reassignment surgery was medically necessary to treat her gender dysphoria, the lawsuit says. But Anthem Blue Cross Blue Shield, the public name of the corporate entity Community Insurance Company, said sex-reassignment surgery is not covered under the library's group policy.

Dovel learned "that the library's insurance policy allows coverage for surgical procedures when medically necessary but categorically excludes "[s]ervices and supplies related to sex transformation and/or the reversal thereof . . . regardless of origin or cause," the lawsuit says. 

Dovel appealed to the library's board of trustees and asked the board to update its coverage with a rider to its insurance policy. The board's minutes show that in June, the trustees voted not to.

The medical rationale:

If Dovel had needed foot surgery instead, the insurer and employer would have covered it, Dovel said in a phone interview from her lawyers' offices. 

And the library's policy would cover an orchiectomy for a non-transgender male employee who was diagnosed with testicular cancer, or a vaginoplasty for a non-transgender female employee who was diagnosed with Mayer-Rokitansky-Kuster-Hauser syndrome, the lawsuit says.

Surgery to treat gender dysphoria is necessary too, Dovel and her lawyers said. "The sex reassignment surgery is a procedure that is both medically necessary and consistent with well-established standards of care for the treatment of gender dysphoria," the lawsuit says.

Dovel told cleveland.com that "I just want the library to support its queer employees. Specifically, I would like the library to support its trans employees by recognizing that we have legitimate medical needs and they should be treated fairly."

The alleged rights violations:

Failing to do so violates federal employment anti-discrimination law, the lawsuit says, because the law forbids discrimination in compensation, terms, conditions, or privileges of employment.

It also violates Dovel's constitutional right to equal protection under the 14th Amendment, and it violates the Affordable Care Act, the lawsuit says. That's because Obamacare prohibits discrimination in any health program that receives federal money.

Anthem sells Obamacare health insurance policies in Ohio and receives federal compensation. Therefore, its treatment of patients under employer-provided policies is covered under that law, the lawsuit says.

What's next:

Dovel has scheduled surgery in November at the Pappillon Gender Wellness Center near Philadelphia. She said the costs of her surgery will be about $21,000, not counting travel and room and board, and she'll face considerable debt if the insurer and library don't change their minds.

They have 60 days to respond to the lawsuit.

Dovel wants a jury trial, compensatory damages and a court order than bans the library from maintaining insurance coverage that denies transition-related care. She also wants the court to ban Anthem from selling such coverage.

FreeState Justice will conduct a legal clinic twice a month at the offices of the GLBT Community Center (GLCCB), 2530 N. Charles St., 3rd Floor in Baltimore. The sessions occur on the Wednesday after the second and fourth Friday of each month from 3-5 p.m.

The clinic is an outgrowth of FreeState Justice’s Transgender Action Group (TAG) project, which targets trans people engaged in sex work.  However, the legal clinic is open to anyone who is Trans with a need to update their name or gender marker or needing assistance with expungement of criminal records or access to public benefits and housing.

“Identity documents that are not consistent with a person’s gender identity, criminal records for ‘nuisance’ charges that never resulted in a conviction and lack of access to health services and public benefits present significant barriers for many transgender people, especially those who are low-income.” Jer Welter, managing attorney for FreeState Justice, told the Blade.

“FreeState Justice, Homeless Persons Representation Project, and our partners in the TAG are excited to join with the GLCCB to make it even easier to overcome these barriers by bringing our legal services into the community,” Welter said.

On Tuesday afternoon, Beck, who is transgender and a retired Navy SEAL, was bound for Kansas City to give a speech to federal employees about gender sensitivity. It's what she does, since she stopped going by her birth name, Christopher Beck, wrote a book about her life as a member of SEAL Team 6 and was featured in the CNN series, "Lady Valor."

Beck told CNN she arrived at Reagan National Airport with enough time to spare, but not too much. Beck entered the security checkpoint, put her bags on the conveyor belt and stepped into the body scanner, as she's done countless times before.

When flagged for secondary screening, she took it in stride. She said she waited for one of two Transportation Security Administration agents -- a man and a woman -- to step forward and pat her down. Instead, they turned their backs to her and started whispering.

But to Beck, it was clear what was happening. Despite her makeup, long hair and low-cut blouse, the agents thought she was a man. It wouldn't be the first time since she began publicly living as a woman.

But it still was humiliating, Beck said. It never gets easier.

"I'm a female," she said she told them. "It's no big deal."

Apparently, it was enough to prompt the agents to call their supervisor, she said. When he arrived, the supervisor directed the male agent to pat "him" down in front of the security line, as everyone waited.

"These are my real boobs, he's not going to pat me down," she recalls telling agents.

"This is wrong. I'm a female, it says female on my Maryland driver's license. This is the real me."

According to Beck, the supervisor responded, "Then somebody pat him down."

The female agent stepped forward and did the pat-down, Beck says. After that, Beck went on her way, holding back tears. She pulled out her phone and recounted the experience in a Facebook post.

"I'm sad, for TSA, our country, our future ... Why is this so difficult?" she wrote. She noted the irony of her destination, to a conference where she would give a speech to federal employees on human rights.

The TSA did not respond to requests for comment.

Beck told the story the next day in her speech. Afterward, she said TSA employees came up to her and apologized. Not all employees are like that, they told her.

She believes it. She says she knows people who work for the TSA. Some of them saw her post and shared it with their leadership, who contacted Beck about the incident, she said.

She's glad it happened to her, a mature combat veteran who has steeled herself against the trials of being transgender, instead of someone vulnerable, someone who's starting their journey.

Beck hopes it becomes a teachable moment, a prompt for more training and education.

"The TSA does a great job 99 percent of the time. This is a 1 percent error," she said. "They have a tough job but they need to continue training and continue to do better."

A Canadian teen is making waves as his high school football teams first openly transgender player

Kennedy Cooley said he transferred to Halifax West High School in Halifax, Canada for his senior year because he’d heard that students there would be more accepting of his gender identity than his previous school, CTV News reports

The 17-year-old, who wants to become a graphic designer or a firefighter, said he was initially apprehensive about joining Halifax West’s football team. Once he did, however, he found that his teammates weren’t fazed by his presence. 

“I’d heard that a lot of the guys are like family. They really get along together, they all know each other, and they’re really close friends,” he said. “Everybody was so accepting, it’s amazing.”

Kennedy’s father, Robert Cooley, told ABC News that he hopes his son’s story will encourage other parents of transgender kids to embrace their differences. 

“It isn’t always easy, but at the end of the day, your goal as a parent is to make sure your child is a productive citizen in society,” he said. “When we look at him, we see that he is a good kid.”

Head coach David Kelly told CTV News that Cooley “seems to get along with everybody,” and is helping to give his teammates “a perspective that they probably would not have had before.” 

Even at a time when more professional athletes are identifying as LGBT, it’s still heartening to hear stories like Kennedy’s.

Jeffrey Tambor won the Emmy for Outstanding Lead Actor in a Comedy Series for Transparent for the second consecutive year, and much likeshowrunner Jill Soloway, who won for Outstanding Directing a few awards prior, he celebrated by paying tribute to the transgender community.

“Please give transgender talent a chance,” said Tambor, who plays a trans woman on Soloway’s critically acclaimed Amazon comedy. “Give them auditions. Give them their story.”

Recently, in response to Matt Bomer’s casting as a transgender sex worker in forthcoming film Anything, trans actress Jen Richards launched a conversation about the problems with cisgender men being cast as transgender women. Soloway told the Cut that while she doesn’t regret casting Tambor in the role, it’s essential to have more trans actors onscreen going forward, and Tambor shares the sentiment.

“I would be happy if I were the last cisgender male to play a transgender female,” he said.

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