The court’s unanimous decision struck down the administrative code governing Medicaid in Iowa that classifies transition-related surgeries as “cosmetic, reconstructive or plastic surgery” and explicitly bans “surgeries for the purpose of sex reassignment.”
Transgender surgeries can range from $20,000 to $100,000, putting it out of reach of individuals who qualify for the assistance.
In affirming a district judge’s decision, Justice Susan Christensen wrote that the “express ban on Medicaid coverage for gender-affirming surgical procedures” contradicted the gender-identity protections in the Iowa Civil Rights Act.
Or, as Rita Bettis Austen, the ACLU of Iowa’s legal director, put it: “Any discriminatory ban on care — whether that’s from a medical provider, which is less likely, or it’s from an insurance provider, which is more likely — is illegal in Iowa.”
Advocates believe the decision is the first by a state’s highest court to hold that transgender people have the right to use public money for transition-related surgeries. As issues of LGBT rights swirl nationally, the decision could help open the door for challenges to bans in other states, about half of which have language like Iowa’s in their administrative codes.
Gender identity — or the deeply held sense of who one is, which may differ from the sex organs with which one was born — and sexual orientation were added to the Iowa Civil Rights Act as protected classes in 2007.
Under that statute, transgender Iowans have legal protections against discrimination in education, employment, housing, and public accommodations. Medicaid, a state and federally funded program, is considered a public accommodation.
But the court stopped short of ruling that this was a violation of the equal protection clause in the Iowa Constitution. Polk County Chief District Judge Arthur Gamble held in his June ruling that it did. Christensen said that question wasn’t necessary to decide to resolve this case.
That leaves the door open to legislators to change laws that would put Friday’s decision in the balance, said Sharon Malheiro, a Des Moines-based lawyer and LGBT advocate.
“It still leaves the question of transgender rights up in the air,” said Malheiro. “And the Iowa Civil Rights Act can be amended to remove gender identity, leaving those lives in fear that the rights they enjoy today may not be here tomorrow.”