CHARLESTON, W.Va. (AP) — West Virginia's and North Carolina's refusal to cover certain health care for transgender people with government-sponsored insurance is discriminatory, a federal appeals court ruled Monday in a case likely headed to the U.S. Supreme Court.
The Richmond-based 4th U.S. Circuit Court of Appeals ruled 8-6 in the case involving coverage of gender-affirming care by North Carolina’s state employee health plan and the coverage of gender-affirming surgery by West Virginia Medicaid.
Specifically, North Carolina’s policy bars treatment or studies “leading to or in connection with sex changes or modifications and related care," while West Virginia’s bars coverage of “transsexual surgery.”
“The coverage exclusions facially discriminate on the basis of sex and gender identity, and are not substantially related to an important government interest,” Judge Roger Gregory, first appointed by former President Bill Clinton and re-appointed by former President George W. Bush, wrote in the majority opinion.
Similar cases are under consideration in courts across the country, but Monday's is the first U.S. Court of Appeals decision to consider government-sponsored coverage exclusions of gender affirming medical care — and whether those exclusions are lawful.
The ruling follows a decision earlier this month by 4th Circuit judges that West Virginia's transgender sports ban violates the rights of a teen athlete under Title IX, the federal civil rights law that prohibits sex-based discrimination in schools.
Like with the transgender sports law ruling, West Virginia Attorney General Patrick Morrisey said his office planned to appeal Monday's health care case decision.
“Decisions like this one, from a court dominated by Obama- and Biden-appointees, cannot stand: we’ll take this up to the Supreme Court and win,” Morrisey said in a statement.
North Carolina State Treasurer Dale Folwell, whose department oversees the state’s health plan, said in a news release that Monday’s majority decision was in “direct conflict” with other decisions from federal appeals courts and hopefully will be corrected by the U.S. Supreme Court.
Folwell said the State Health Plan is threatened by financial challenges as the plan’s member grows older and their health declines.
“Accordingly, the Plan cannot be everything for everyone,” Folwell said. “Untethered to the reality of the Plan’s fiscal situation, the majority opinion opens the way for any dissatisfied individual to override the Plan’s reasoned and responsible decisions and drive the Plan towards collapse.”
In the majority opinion, judges said the cost of treatment is not a sufficient argument to support upholding a policy found to be discriminatory.
“Especially where government budgets are involved, there will frequently be a ‘rational’ basis for discrimination,” Judge Gregory wrote.
Both states appealed separate lower court rulings that found the denial of gender-affirming care to be discriminatory and unconstitutional. Two panels of three Fourth Circuit judges heard arguments in both cases last year before deciding to intertwine the two cases and see them presented before the full court.
In June 2022, a North Carolina trial court demanded the state 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.
The North Carolina state insurance plan provides medical coverage for more than 750,000 teachers, state employees, retirees, lawmakers and their dependents.
In August 2022, a federal judge ruled West Virginia’s Medicaid program must provide coverage for gender-affirming care for transgender residents.
An original lawsuit filed in 2020 also named state employee health plans. A settlement with The Health Plan of West Virginia Inc. in 2022 led to the removal of the exclusion on gender-affirming care in that company’s Public Employees Insurance Agency plans.
The states' lawyers argued that treatments for gender dysphoria — all treatments in North Carolina and surgical treatments in West Virginia — are excluded from coverage for everyone, regardless of their gender identity. They claimed only a subset of transgender people suffer from gender dysphoria, a diagnosis of distress over gender identity that does not match a person’s assigned sex.
Before offering pharmaceutical or surgical intervention, medical guidelines call for thorough psychological assessments to confirm gender dysphoria before starting any treatment.
In his opinion, Gregory said that in his view, gender dysphoria is “so intimately related to transgender status as to be virtually indistinguishable from it.”
“We hold that gender dysphoria, a diagnosis inextricable from transgender status, is a proxy for transgender identity,” the judge wrote. “And coverage exclusions that bar treatments for gender dysphoria bar treatments on the basis of transgender identity by proxy.”
Unlike North Carolina, West Virginia has covered hormone therapy and other pharmaceutical treatments for transgender people since 2017. Gregory noted that West Virginia’s program partially or fully covers surgeries to remove and reconstruct sexual organs for non-gender dysphoria-related diagnoses, such as cancer.
After the ruling, West Virginia plaintiff Shauntae Anderson, a Black transgender woman and West Virginia Medicaid participant, called her state's refusal to cover her care “deeply dehumanizing.”
"I am so relieved that this court ruling puts us one step closer to the day when Medicaid can no longer deny transgender West Virginians access to the essential healthcare that our doctors say is necessary for us,” Anderson said in a statement.
FILE - Connor Thonen-Fleck addresses reporters while his parents stand by his side, March 11, 2019, in Durham, N.C. West Virginia and North Carolina's refusal to cover certain health care for transgender people with government-sponsored insurance is discriminatory, a federal appeals court ruled Monday, April 29, 2024 in a case likely headed to the U.S. Supreme Court. (AP Photo/ Jonathan Drew, FIle)
BALTIMORE (AP) — Adley Rutschman’s two-run homer in the bottom of the ninth inning gave Baltimore a 3-2 victory over the Toronto Blue Jays on Wednesday, enabling the Orioles — yet again — to avoid a sweep.
Baltimore split the two-game set with the Blue Jays — the middle game Tuesday was rained out — and has now gone 105 straight regular-season series of at least two decisions without being swept. That’s tied for the third-longest run in major league history.
The Orioles were swept in last year’s AL Division Series against Texas, but the most recent time it happened in the regular season was from May 13-15, 2022, at Detroit. The streak almost ended exactly two years later, but after defensive replacement Isiah Kiner-Falefa misplayed Jordan Westburg’s grounder for an infield single to start the Baltimore ninth, Rutschman connected off Jordan Romano.
BREWERS 10, PIRATES 2
MILWAUKEE (AP) — William Contreras went 3 for 5 with four RBIs and hit one of Milwaukee’s five homers off Martín Pérez in Milwaukee's blowout of Pittsburgh.
The NL Central-leading Brewers won two of three from the Pirates before beginning a season-long, nine-game trip Friday at Houston. The Brewers also will visit Miami and Boston before coming back home May 27 for a four-game series with the Chicago Cubs that marks ex-Brewers manager Craig Counsell’s return to Milwaukee.
Gary Sánchez, Sal Frelick, Joey Ortiz and Jackson Chourio also homered off Pérez, who gave up 11 hits and nine runs before leaving with nobody out in the sixth inning.
The Brewers tied a franchise record for homers off a single pitcher in one game. They also hit five home runs off Cincinnati’s Chris Reitsma in 2002 and Cincinnati’s Hunter Greene in 2022.
WHITE SOX 2, NATIONALS 0
CHICAGO (AP) — Korey Lee went 3 for 3 with an RBI, Garrett Crochet tossed five scoreless innings as the Chicago White Sox topped Washington for their second straight win.
Tommy Pham and Andrew Benintendi each singled and doubled for last-place Chicago. Pham drove in the White Sox’s first run as they won their second straight series and improved to 11-8 since a 3-22 start to the season. It was the White Sox’s second consecutive shutout of Washington after a 4-0 win over the Nationals in the second game of Tuesday’s doubleheader.
Crochet (4-4) allowed three hits and left after 89 pitches, 56 for strikes. The 6-foot-6 left-hander gave up struck out six and matched his season high with three walks.
The White Sox bullpen was dominant after that to complete the three-hitter.
MARLINS 2, TIGERS 0
DETROIT (AP) — Bryan De La Cruz homered, Trevor Rogers pitched five scoreless innings as Miami beat Detroit.
Miami (13-32) has won two straight and three of four after a four-game losing streak. They shut out the Tigers on Tuesday and Wednesday to win the three-game series.
Four relievers finished, with Tanner Scott pitching the ninth for his fifth save. Two-out singles by Javier Baez and Carson Kelly put runners on the corners, but Riley Greene struck out.
One day after Ryan Weathers pitched eight shutout innings, Rogers (1-6) held the Tigers scoreless for five innings. He allowed three hits and two walks while striking out six.
DIAMONDBACKS 2, REDS 1
PHOENIX (AP) — Brandon Pfaadt threw seven stellar innings, Lourdes Gurriel Jr. hit a tiebreaking RBI double in the eighth and Arizona beat Cincinnati.
The D-backs took two of three in the series and five of six from the Reds this season.
Pinch hitter Pavin Smith started the D-backs’ rally with a two-out double to right field. Gurriel followed with another double to right, which wasn’t hit as hard, but still fell just out of the reach of a sliding Jake Fraley.
Paul Sewald retired the Reds in order in the ninth for his second save of the season. Ryan Thompson (1-1) threw a scoreless eighth.
Cincinnati lefty Andrew Abbott matched Pfaadt through seven, giving up one run and four hits. He struck out four and walked two. Fernando Cruz (1-4) took the loss, giving up the game-deciding doubles.
MARINERS 4, KANSAS CITY 2
SEATTLE (AP) — The Mariners took two of three from the Royals and have won eight of their last nine series. Seattle will head out on a key 10-game road trip on the East Coast four games above .500 and leading the AL West.
France hit a solo shot off Kansas City starter Alec Marsh in the fourth inning to give Seattle a 2-0 lead. France also homered on Monday in the series opener.
Seattle also got an unearned run in the second inning after Adam Frazier was unable to cleanly field Luis Urías’ grounder behind third base with the bases loaded, and the Mariners added on two key runs late. Josh Rojas had a two-out RBI single in the seventh inning and Luke Raley added an RBI single in the eighth.
Woo struck out five and walked only one. His first start of the season last Friday had been cut short due to tightness in his right forearm following a long inning in the dugout.
ROCKIES 8, PADRES 0
SAN DIEGO (AP) — Austin Gomber allowed two hits in six innings, Brenton Doyle and Jordan Beck homered and Colorado beat San Diego to complete a three-game sweep with their seventh straight victory.
Gomber (1-2) struck out five and walked two before three relievers finished a four-hitter. It was the first time last-place Colorado (15-28), which has won six road games all season, swept a three-game set in San Diego since 2013.
Beck, who had four RBIs and two extra-base hits, smacked his first major league homer in the sixth with a drive deep into the left-field seats. He extended his hitting streak to a career-high five games.
Michael King (3-4) had a rocky outing for the Padres, giving up his big league-high 11th homer to Doyle in a three-run second. Beck, who finished with three hits, also delivered a two-run double.
PHILLIES 10, METS 5
PHILADELPHIA (AP) — Bryce Harper homered, doubled and drove in three runs, unbeaten Ranger Suárez became the first eight-game winner in the majors and the streaking Philadelphia defeated the New York Mets 10-5.
Cristian Pache added two RBIs for Philadelphia, which has won three straight against the Mets and 16 of 19 overall to improve baseball’s best record to 31-13.
J.D. Martinez homered late for the struggling Mets, who have lost five of six and dropped 11 games behind the first-place Phillies in the NL East.
Suárez (8-0) lowered his ERA to 1.37, allowing four hits and two unearned runs in five innings with three strikeouts and two walks.
RAYS 4, RED SOX 3
BOSTON (AP) — Yandy Díaz snapped a sixth-inning tie with a two-run single and Tampa Bay held off Boston.
Taj Bradley (1-1) pitched five solid innings in his second major league start this year, giving up two runs on four hits and a walk with six strikeouts.
Kevin Kelly fanned two in a perfect ninth for his second career save and first this season.
Wilyer Abreu and Rafael Devers homered for Boston. Tanner Houck (3-5) allowed three runs — one earned — and five hits in 5 2/3 innings. He struck out seven and walked three.
The right-hander threw a career-high 112 pitches, most by a Red Sox starter since Nick Pivetta threw 112 in his shutout against Houston on May 18, 2022.
CUBS 7, BRAVES 1
ATLANTA (AP) — Javier Assad pitched six shutout innings and the Chicago Cubs avoided their first sweep of the season by beating Atlanta.
Assad (4-0) allowed just four hits and walked one while matching a season high with seven strikeouts. He lowered his ERA to 1.49 through nine starts.
Pete Crow-Armstrong went 2 for 4 with a triple, two RBIs and a run scored, and Seiya Suzuki and Mike Tauchman homered for the Cubs, who had 13 hits after mustering just eight while being shut out in the first two games of the series.
Nick Madrigal had three hits and Michael Busch scored two runs.
Charlie Morton (3-1) lasted just three innings for the Braves, giving up four runs — three earned — and five hits with three walks and four strikeouts.
YANKEES 4, TWINS 0
MINNEAPOLIS (AP) — Aaron Judge followed a 467-foot home run with three hard-hit doubles, driving in two runs for the New York Yankees in a victory over Minnesota on Wednesday night.
Marcus Stroman (3-2) threw six scoreless innings for his first win in four starts, allowing only a double, a single and three walks as the Yankees kept up their decades-long dominance of the Twins.
Anthony Volpe had a sacrifice fly and Giancarlo Stanton added an RBI single for the Yankees (29-15), who collected eight of their 13 hits from Judge, Alex Verdugo and Stanton in the third, fourth and fifth spots.
Twins starter Pablo López (4-3) surrendered a season-high 10 hits in 6 1/3 innings. He gave up three runs.
ASTROS 3, ATHLETICS 0
HOUSTON (AP) — Framber Valdez struck out eight in seven strong innings and combined with Seth Martinez for a two-hitter, and Houston beat Oakland for their season-high fourth straight victory.
Valdez (3-1) allowed both hits and walked two. The left-hander recorded 11 groundouts.
Valdez has yielded two runs or fewer in four of his last five starts. Martinez earned his first save of the season.
Oakland’s only hits off Valdez were a weak infield single by J.D. Davis in the fourth and Shea Langeliers’ single in the seventh. The A’s have lost four straight.
Jose Altuve singled leading off the first, had reached third on Kyle Tucker’s double and scored on a throwing error by Zack Gelof, who was trying to get Tucker at second. Tucker scored on Bregman’s sacrifice fly two batters later.
Mauricio Dubón added a sacrifice fly in the fourth to make it 3-0.
RANGERS 4, GUARDIANS 0
ARLINGTON, Texas (AP) — Jon Gray pitched four-hit ball into the seventh inning and Texas got two-run homers from Marcus Semien and Adolis García to beat Cleveland, stopping a five-game losing streak.
Gray (2-1) allowed only one runner beyond first base while throwing 94 pitches in 6 1/3 innings. He’s limited opponents to seven earned runs in 48 2/3 innings over eight starts since giving up five runs in 3 2/3 innings during his season debut.
The defending World Series champion Rangers (23-22) have never been under .500 since Bruce Bochy became their manager before last season. This was their seventh victory this year while at .500.
ANGELS 7, CARDINALS 2
ANAHEIM, Calif. (AP) — Griffin Canning pitched six innings of one-run ball, Nolan Schanuel hit his first career leadoff homer and the Los Angeles Angels snapped their three-game skid with a victory over the St. Louis.
Willie Calhoun had three hits, including an RBI double during the Angels’ four-run first, while Zach Neto and Taylor Ward homered later in the Angels’ seventh win in 26 games. Kevin Pillar had his fourth consecutive multi-hit game for Los Angeles, which pounded out 14 hits while salvaging the finale of a 2-5 homestand against Missouri’s two major league teams.
Canning (2-4) had another sharp start for the Halos, finishing the homestand with 11 2/3 innings of one-run ball over two outings. St. Louis managed five hits and three walks off Canning, but the right-hander stranded six runners and held the Cards scoreless for his first five innings.
Paul Goldschmidt homered in the sixth for the Cardinals, whose three-game winning streak ended. St. Louis still hasn’t swept a series this season.
Lance Lynn (1-2) gave up four runs and eight hits with two walks over five innings for St. Louis. The veteran has allowed at least four earned runs in all three of his starts in May.
GIANTS 4, DODGERS 1
SAN FRANCISCO (AP) — Logan Webb pitched six scoreless innings and Mike Yastrzemski hit a two-run homer as San Francisco beat the Los Angeles Dodgers to avoid a three-game sweep.
Webb (4-4) limited Los Angeles to three hits, striking out five and walking three to help the Giants snap a six-game losing streak against their longtime rivals.
The right-hander got some help from his defense in the fourth when center fielder Luis Matos leaped and reached over the wall to rob Teoscar Hernández of a home run.
Yastrzemski took Los Angeles starter Elieser Hernández deep to right in the third for his fourth home run of the season.
Heliot Ramos added an RBI double in the sixth to make it 3-0.
Hernández (0-1) permitted three runs and four hits in six innings, striking out three and walking one in his Dodgers debut. The right-hander had his contract selected from Triple-A Oklahoma City earlier Wednesday.
Max Muncy drove in the Dodgers’ run on a sacrifice fly in the eighth.
Baltimore Orioles' Anthony Santander, left, is tagged out at home by Toronto Blue Jays catcher Danny Jansen, right, during the eighth inning of a baseball game, Wednesday, May 15, 2024, in Baltimore. The Orioles won 3-2. (AP Photo/Nick Wass)
