Des Moines, Iowa — Today the ACLU of Iowa and national ACLU LGBT and HIV Project filed a lawsuit to block implementation of a recently passed Iowa law that specifically allows denial of coverage under Medicaid of essential, gender-affirming surgery to transgender Iowans.
The lawsuit was filed on behalf of One Iowa, Mika Covington, who lives in central Iowa, and Aiden Vasquez*, who lives in southeast Iowa. Both Mika and Aiden are transgender, qualify for Medicaid, and their doctors agree they need gender-affirming surgery to treat their gender dysphoria.
In April, Iowa lawmakers passed legislation that amended the Iowa Civil Rights Act’s protections against discrimination for transgender people in public accommodations that were put into place in 2007. The new law created a new exception to those nondiscrimination protections, specifically allowing Medicaid to deny coverage to transgender Iowans for their medically necessary gender-affirming surgery.
Every mainstream medical association, including the American Medical Association, have deemed it as critical, life-saving care for some people suffering from gender dysphoria. In May, Gov. Kim Reynolds signed the bill into law, which went into immediate effect.
The new law was passed in response to an Iowa Supreme Court unanimous decision in March that found that an Iowa Medicaid regulation which excluded coverage for medically necessary gender-affirming surgery while providing coverage for all other medically necessary surgery violated the Iowa Civil Rights Act by discriminating on the basis of gender identity. That ruling required that Medicaid must indeed cover such medically necessary surgery for transgender people. The March Supreme Court ruling also determined that public accommodations include Medicaid, which is the government-funded health insurance available to low-income Iowans.
Rita Bettis Austen, ACLU of Iowa Legal Director, said, "This law reverts the State of Iowa back to its longstanding discriminatory policy and practice of denying transgender Iowans on Medicaid coverage for gender-affirming surgery. The law brings significant harm to our clients and others who rely on Medicaid and who desperately need this surgery. This is a matter of life and death.”
"This cruel amendment has no basis in medicine or science. Every major medical association agrees gender dysphoria is a serious medical condition and that surgical treatment is medically necessary for some transgender people. That includes the American Medical Association, the American Psychological Association, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the National Association of Social Workers, and the World Professional Association of Transgender Health (WPATH)," Bettis Austen said.
It is a clear violation of equal protection under the Iowa Constitution because it facially and intentionally discriminates against people simply because they are transgender," Bettis Austen said.
Daniel Hoffman-Zinnel, executive director of One Iowa, which advocates transgender rights, said it's important to take action to push back on politician's harmful actions. "Through our work, we have seen firsthand how powerful, life-changing, and necessary surgical care to treat gender dysphoria can be for transgender people. Transgender Iowans are our friends, family members, and fellow community members. No one should be denied the medical care they need, and that includes transgender individuals."
Zinnel-Hoffman also said, "A patient’s health should always come first. Denying transgender people the medically necessary health care they need, as directed by their doctor, can contribute to depression, anxiety and increased risk of suicidal thoughts. Make no mistake, this law threatens lives."
Aiden Vasquez, of southeast Iowa, said he's bringing the lawsuit for himself and others. "I am participating in this lawsuit to get the medical care I desperately need, and to pave the way for other transgender Iowans who need it too. I've spent my whole life living in a body that wasn't mine, feeling fake and hopeless."
"Now it's time to join the front lines to stand up for my equality and wholeness, as well as for the rights of other transgender Iowans," Aiden said. "Tragically, society shames transgender people just for being who they are. But I'm not hiding anymore. I'm determined to help myself, and in that way, help others.”
Mika said, “It’s been a decade since I have come out as a transgender woman, though I have known I was female long before that. Those who are not transgender often do not understand what it is like to live in a body that does not align with the gender you are in your heart and your mind. It affects every aspect of my life."
"Gender-affirming surgery is not cosmetic surgery. Getting the gender-affirming surgery that my doctors have determined is medically necessary for me will do nothing less than give me my life back. It will help me build a life in which my body is in harmony with my gender, so I can overcome the depression, lack of confidence, isolation, and other problems my gender dysphoria causes," she added.
"It was very painful for me when the Iowa legislature passed this law. All Iowans, regardless of income level, have the right to have medically necessary health care without discrimination because of who they are. It's wrong to deny Iowans on Medicaid like me their medically necessary care just because we are transgender. This surgery is literally life-saving," Mika said.
It's important to note that the new Iowa law doesn't affect the nondiscrimination requirements in place under the sections of the Iowa Civil Rights Act that govern employer-provided health insurance benefits. Those include the health insurance benefits that the State of Iowa provides for state employees, private health insurance available on the marketplace, or health insurance provided by any private employers. That's because unlike Medicaid, employer-provided insurance is covered by different parts of the Iowa Civil Rights Act: section 216.6 (employment discrimination) and 216.6A (wage and benefit discrimination). The new law amended only section 216.7, the part of the Iowa Civil Rights Act requiring nondiscrimination in public accommodations.
In February, in another ACLU case brought under the employment discrimination protections of the Iowa Civil Rights Act, Vroegh v. Iowa Department of Corrections et al., a jury in Polk County awarded a former state employee $20,000 in damages for the state’s denial of his medically necessary gender-affirming surgery.
Attorneys Seth Horvath, Tina B. Solis, and F. Thomas Hecht, Litigation Partners at the Chicago office of the national firm Nixon Peabody LLP, are cooperating attorneys volunteering countless hours and expertise on the case. They were also cooperating attorneys in the Good case decided by the Iowa Supreme Court in March 2019.
The complaint filed today can be found here.
Photos of Aiden and Mika, taken by and property of the ACLU of Iowa, are available for public use in the media, are here.
*Aiden's legal last name is currently DeLathower, and so we are obligated to file legal documents under that name. However, his preferred last name is Vasquez, as explained more fully in the Petition, and we request that media use that name.