ACLU sues PeaceHealth, says it didn’t cover transgender care
SEATTLE (AP) — A longtime worker for a Catholic health care system in the Northwest sued the organization Thursday, saying its employee insurance plan refused to cover gender-reassignment surgery for her teenage son.
The American Civil Liberties Union of Washington filed the discrimination lawsuit against PeaceHealth in federal court on behalf of Cheryl Enstad of Bellingham and her son, Paxton Enstad, 17. She said she and her husband eventually took out a second mortgage and dipped into Paxton’s college fund to pay more than $10,000 for his surgery last fall.
“PeaceHealth was telling me my son was undeserving of medical care simply because he’s transgender,” Cheryl Enstad told a news conference Thursday. “It’s heartbreaking. It is not fair.”
The lawsuit cites violations of the federal Affordable Care Act as well as Washington state anti-discrimination law.
PeaceHealth is a nonprofit based in Vancouver, Washington, and operates 10 medical centers in Oregon, Washington and Alaska. A statement issued by the company did not address whether its self-funded health plan for employees covers gender reassignment surgery. A PeaceHealth spokesman, Jeremy Rush, said he was seeking more information about its policies and what happened in the Enstads’ case.
“PeaceHealth is committed to creating an inclusive healthcare environment,” the statement said. “Throughout our 126-year heritage, we have been dedicated to embracing and celebrating the diversity of our communities, our caregivers and the individuals we are privileged to serve.”
In 2014, Washington Insurance Commissioner Mike Kreidler told health insurance carriers in Washington that the carriers regulated by his office must cover such transgender care if they also cover medically necessary care for others. Because it’s self-funded, PeaceHealth’s plan is not regulated by the commissioner’s office, but the ACLU chapter says the plan’s exclusions for gender reassignment surgery nevertheless violate the state and federal laws.
The plan was administered by Regence Insurance until it switched to Aetna this year. Both have policies of covering medically necessary gender reassignment surgeries, the lawsuit said, but PeaceHealth has instructed them not to cover the procedures.
Cheryl Enstad said in the lawsuit that she was a medical social worker at PeaceHealth St. Joseph Medical Center in Bellingham from 1996 until last April. She continues working there on an on-call basis.
She was stunned to learn PeaceHealth wouldn’t cover Paxton’s chest-reconstruction surgery, which his doctors had determined was medically necessary to treat his gender dysphoria and its effects, including severe depression, she said.
Paxton began suffering from depression, anxiety and lack of sleep when he started going through puberty at age 11. He wore a chest binder almost around the clock to flatten his chest, even though it can restrict breathing and cause long-term medical problems, the lawsuit says.
“Existing in a body that didn’t feel like mine was unbearable,” he told reporters.
The surgery improved his life dramatically, he said. He no longer hides in his room or hunches, trying to hide his breasts under many layers of clothing, and he has started swimming again.
“It definitely was a weight lifted — literally and metaphorically,” he said. “They removed six pounds.”
Paxton said he feels privileged to have the support of his parents — his father, Mark, a yacht technician in Bellingham, repeatedly said during the news conference how proud he is of his son — and the family resources to be able to pay for the surgery out of pocket. But, he said, he wanted to file the lawsuit to ensure others have access to such care if they need it.
“It’s just really important and life-saving,” he said.
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