ACLU sues to challenge Iowa denial of transgender surgery

April 22, 2021 GMT

DES MOINES, Iowa (AP) — The American Civil Liberties Union filed a lawsuit Thursday against the state of Iowa challenging a 2019 law that allows Medicaid to deny payment for sex reassignment surgeries for transgender residents.

The lawsuit was filed in state court by the ACLU of Iowa and the national ACLU LGBTQ & HIV Project on behalf of Aiden Vasquez. It is similar to a lawsuit filed by Vasquez and Mika Covington that also asked the courts to declare the state’s practice of denying coverage unconstitutional.

That case was dismissed by the Iowa Court of Appeals in August 2020 because the plaintiffs had not first sought and been denied coverage by the Iowa Department of Human Services.

Since then the Iowa DHS has denied coverage to Vasquez, so a new lawsuit can proceed. Covington’s case is still before DHS. If it denies her coverage too, she’ll join the litigation.


The ACLU lawyers will argue that denying the surgery to transgender Iowans violates equal protection rights guaranteed in the Iowa Constitution and is intentionally discriminatory against people because they are transgender, said Rita Bettis Austen, ACLU of Iowa legal director.

“We know Iowans, especially transgender Iowans, are tired of the state continuing these discriminatory denials, forcing us to litigate this issue over and over again. But the ACLU is committed to fighting this discrimination as long as it takes to ensure a fair Medicaid system that treats everyone the same,” she said.

When the ACLU first filed a lawsuit to challenge Iowa Medicaid denial of transgender surgery in 2017, a state court judge found the policy violated the Iowa Civil Rights Act and the Iowa Supreme Court in 2019 upheld that decision. The court concluded that Iowa’s Medicaid program may not categorically discriminate against transgender people seeking gender-affirming, medically necessary care.

Shortly after the court ruling, Republicans in the Iowa Legislature passed an amendment as part of a last-minute addition to a human services budget bill in response to the court’s ruling that said any government agency in Iowa may decline to use taxpayer money for “sex reassignment surgery” or “any other cosmetic reconstructive or plastic surgery procedure related to transsexualism, hermaphroditism, gender identity disorder, or body dysmorphic disorder.”

Gov. Kim Reynolds signed it in May 2019, arguing it only narrowly clarifies that Iowa’s Civil Rights Act does not require taxpayer dollars to pay for sex reassignment and other similar surgeries.

Bettis said ACLU lawyers also will argue in the lawsuit filed Thursday that the 2019 change to state civil rights law is unconstitutional and unenforceable because it intentionally discriminates against transgender Iowans.


Vasquez said he desperately needs the surgery.

“I would like everyone to understand that we are not talking about cosmetic surgery or something superficial. This has affected my whole life in a negative way and has threatened my mental well-being. I am a man, but in a body that does not reflect who I am. That’s why this surgery will be life-changing. I have seen too many other transgender people suffer because they are unable to get the care they need,” he said.

In 2014, the U.S. Department of Health and Human Services invalidated its previous ban on Medicare coverage for surgery and other transition-related care.

Bettis said many states have since eliminated their bans on Medicaid coverage for the health care transgender people need.

“Iowa is becoming an outlier when it comes to this discriminatory denial,” she said.

A spokesman for Reynolds did not immediately respond to messages.

Republican Sen. Mark Costello, chairman of the Health and Human Services Appropriations Subcommittee and floor manager of the 2019 law defended the legislature’s action.

“The Department of Human Services had a policy not to force taxpayers to fund transgendered surgeries. In 2018, the courts got involved and again tried to legislate from the bench. My colleagues and I do not believe taxpayers should be forced to pay for those surgeries and passed a law reinstating the previous policy,” he said.

A spokesman for the Iowa attorney general’s office, which will likely represent the state, declined to comment.