January 3, 2019

The ACLU of Washington and PeaceHealth, a Catholic healthcare organization, have reached a settlement in a lawsuit filed by the ACLU-WA, Enstad v. PeaceHealth.

The lawsuit asserted that the PeaceHealth employee medical plan’s exclusion of coverage for a mastectomy and chest reconstruction surgery for Paxton Enstad, a 16 year old transgender boy, was discriminatory and illegal.  Pax Enstad is a young man who is transgender, meaning that the sex assigned to him at birth was female and he has a male gender identity.  His mother, Cheryl Enstad, was a PeaceHealth employee for over twenty years and the Enstad family was covered by PeaceHealth’s employee medical benefits plan.  When PeaceHealth’s plan did not cover the mastectomy and chest reconstruction surgery that Pax’s doctor prescribed for him, citing a lack of coverage for “transgender services,” the Enstads brought a lawsuit alleging discrimination under the Patient Protection and Affordable Care Act (ACA) and the Washington Law Against Discrimination (WLAD).

PeaceHealth changed its medical plan effective January 1, 2017 to cover transgender services determined to be medically necessary pursuant to Aetna’s Gender Reassignment Surgery policy.  Subsequently, the parties reached a mutually agreeable settlement of the litigation.

Under PeaceHealth’s amended medical plan, PeaceHealth’s 15,000-plus employees will have access to transition-related care under the plan. Aetna’s Gender Reassignment Surgery policy does not provide coverage for mastectomies and chest reconstruction surgery as a treatment for gender dysphoria for individuals under the age of 18.  However, because Pax is no longer a minor, the Enstads cannot challenge the amended medical plan as part of this lawsuit.

"This is a bitter-sweet result for us,” said Cheryl Enstad, who filed the lawsuit on behalf of her son, Pax. "Our number one priority in bringing this case was to ensure access to gender affirming care for transgender people, and we are pleased PeaceHealth changed its policy.  But we hope that Peace Health eventually removes the age-related limitation on coverage.” 

The World Professional Association for Transgender Health (WPATH) publishes standards of care that have been recognized as the authoritative standards of care by the leading medical organizations, including the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics.  Under the WPATH standards, it may be medically necessary for some transgender people to undergo treatment to affirm their gender identity and transition from living as one gender to another. This treatment, often referred to as transition-related care, may include hormone therapy, surgery, and other medical services that align individuals’ bodies with their gender identities.

“We applaud PeaceHealth’s decision to include coverage for transition-related care in their employee medical plan, and hope it will set a good example for other employers to follow suit,” said Lisa Nowlin, Staff Attorney with the ACLU of Washington.

Enstad v. PeaceHealth, was filed in U.S. District Court in the Western District of Washington, in October 2017.
 
In addition to Nowlin, attorneys for the Enstads include Josh Block and Leslie Cooper with the ACLU LGBT & HIV Project and Denise Diskin and Beth Touschner of Teller & Associates.

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