Lawyer defends North Carolina's transgender care exclusions

RALEIGH, N.C. (AP) — A lawyer representing the leaders of North Carolina's state employee health plan defended its exclusion of gender-affirming treatments on Wednesday before a federal appeals court, facing a barrage of criticisms from its chief judge.

State Treasurer Dale Folwell and the State Health Plan’s executive administrator are seeking to overturn a trial court order demanding that the plan pay for “medically necessary services,” including hormone therapy and some surgeries, for transgender employees and their children. The judge had ruled in favor of the employees and their dependents, who said in a 2019 lawsuit that they were denied coverage for gender-affirming care under the plan.

Attorney John Knepper told a three-judge panel of the 4th U.S. Circuit Court of Appeals in Richmond, Virginia, that the plan routinely excludes some medically necessary procedures based on cost, but does not make any of those determinations based on sex or gender.

“The plan is broke," Knepper said. “In this case, again, the State Health Plan provides full coverage for all health risks. There are just some health risks it doesn’t cover."

Overseen by Folwell’s office, the plan provides medical coverage for more than 750,000 teachers, state employees, retirees, lawmakers and their dependents. While it provides counseling for gender dysphoria and other diagnosed mental health conditions, it does not cover treatment “in connection with sex changes or modifications and related care.”

Chief Circuit Judge Roger Gregory said the exclusions unnecessarily single out a protected class, despite Knepper’s repeated assertions that gender identity is not a factor.

“Why pick on transgender dysphoria” to balance the books, asked Gregory, a recess appointment of President Bill Clinton who was...