Anna Lange, an employee with the Houston County Sheriff’s Office, sought “male-to-female sex change surgery.” The county’s employer-provided health insurance policy covered some treatments for gender dysphoria, but it excluded drugs, services, and supplies for a “sex-change” (among other categories). Lange sued, claiming the policy discriminated based on sex and transgender status in violation of Title VII. The district court, affirmed by an Eleventh Circuit panel, held that the policy facially violated Title VII under Bostock v. Clayton County. On rehearing en banc, the Eleventh Circuit reversed, holding that the county’s policy, which drew a line between which treatments it covers, “is not facial discrimination based on protected status.”
Lange v. Houston County, decided on September 9, 2025, is one of the first circuit court decisions to apply the Supreme Court’s June 2025 decision in United States v. Skrmetti, which held that Tennessee’s law prohibiting healthcare providers from administering puberty blockers or hormones to transition a minor's gender did not discriminate based on sex or transgender status in violation of the Equal Protection Clause of the Fourteenth Amendment.
Join Christopher Mills and Rachel Morrison for a discussion of Lange, its application of Skrmetti and Bostock, and its implications for Title VII and insurance coverage.
Featuring:

Christopher E. Mills, Principal, Spero Law LLC
(Moderator) Rachel N. Morrison, Fellow, Ethics and Public Policy Center