MADISON – Exclusion of coverage for transgender healthcare needs is illegal and violates both Title VII and the Affordable Care Act, a federal judge ruled Tuesday.

Alina Boyden and Shannon Andrews, both State of Wisconsin employees and transgender women, sued over the state’s refusal to cover transition-related care, saying it constituted sex discrimination and went against provisions of the ACA. Judge William M. Conley of the United States District Court of Western Wisconsin concurred, using strong language in the ruling.

“I’m pleased the court recognized that denying coverage for my medical care was sex discrimination,” Andrews told Our Lives after the decision came down. “I, personally, was lucky to be in a position to have retirement funds and savings I could sell off to fund my medical care, but had I been less fortunate I would not be alive today. After the Group Insurance Board denied me coverage, I felt saddened that the state I loved and called home had decided I was worthy of providing medical care in my job but not worthy of receiving it. Today, I feel vindicated the court recognized what the state did was wrong. I hope that this will be a powerful signal that trans people are not fair game for discrimination and that our lives and health are not a political football.”

A similar decision was made in July for Wisconsin Medicaid recipients. In that case, Sarah Ann Makenzie of Baraboo and Cody Flack of Green Bay sued the state over its refusal to cover gender reassignment surgeries. Judge Conley ruled in that case as well, issuing the initial injunction against the state’s exclusion and ordering it to pay for the proceedures.

This comes in the wake of the state’s Group Insurance Board’s narrow vote to remove the exclusion for transgender healthcare coverage from its own policies. The new ruling means that any future possible effort to reinstate the exclusion would be met by a clear court decision rendering it illegal.

The ACA’s incorporation of Title VII in particular has met with various challenges regarding whether or not sex discrimination includes discrimination based on transgender status. Section 1557 of the ACA prohibits discrimination based on race, color, national origin, sex, age, or disability in health programs and activities that receive funding or are overseen by The Department of Health and Human Services. Under the Trump Administration, the anti-sex discrimination language was specifically removed from a HHS website, signaling a change in stance by the new, more conservative majority party. This came shortly after a conservative judge issued a nationwide preliminary injunction against enforcement of the anti-sex discrimination provision of the ACA. That will be directly challenged by rulings like those in Wisconsin and elsewhere, though the issue is unlikely to be firmly settled for some time, and could work its way all the way to the Supreme Court.