PHILADELPHIA - In Pennsylvania, a Republican lawmaker plans a bill that finalizes a person's sex at birth, while a major insurance company says gender-affirming procedures targeting waist size are cosmetic and not medically necessary.
On Jan. 10, Rep. Stephanie Borowicz, who serves Clinton County and part of Union County, said she will introduce legislation requiring the state and its political subdivisions to treat transgender individuals as the sex they were determined to be at birth.
Twelve days later in Philadelphia federal court, Independence Blue Cross fought the lawsuit of a transgender man who wants the insurer to pay for masculinization procedures that were part of his gender-affirmation plan.
The John Doe alleges discrimination led to coverage for these procedures being denied.
"No discrimination could have occurred, however, because no person insured under this plan, regardless of sex or gender identity, is eligible for coverage for cosmetic procedures, including masculinizing body-contouring procedures, absent certain functional impairments that Plaintiff does not claim to have," the motion to dismiss say.
New President Donald Trump has already signed an executive order declaring there are only two biological sexes. The order requires the federal government to use the term "sex" instead of "gender" and says "women are biologically female, and men are biologically male."
Borowicz's planned legislation also purports to protect women. She says, "We must protect women and girls from biological males seeking to compete with them and to enter their private spaces. The amendment will clarify that Pennsylvania's Constitution recognizes only the sexes of male and female as determined by biological sex at birth."
Democrats hold majorities in both houses of the Pennsylvania legislature, so it remains to be seen if Borowicz's bill will do anything other than generate headlines. In 2022, she introduced a bill that would ban talk of gender identity in schools through the fifth grade, but it was never acted on by fellow lawmakers.
Philadelphia attorney Justin Robinette represents several transgender individuals in court whose gender-affirming procedures were rejected by their insurers. He filed the above-mentioned suit Nov. 5, seeking up to $150,000 to compensate John Doe for money his client paid out-of-pocket for masculinizing body contouring.
The suit says Doe was diagnosed with gender dysphoria that hampered his ability to function in social and occupational situations.
Doe sought a body lift, abdominoplasty, panniculectomy, thigh lift and liposuction to change what his doctor called a female "A-frame" body shape. His therapist submitted a letter that he feels established the medical need for these alterations.
"Defendant applied its cosmetic-surgery exclusion in a discriminatory manner against Plaintiff, discriminating against him based on his sex, gender identity, gender stereotyping, and disability (gender dysphoria)," Robinette wrote.
Independence responded that these procedures were done to remove excess fat and skin around the waist and that its benefits plan actually covers some gender-affirming care, like the removal of tissue under certain circumstances.
"(T)he removal of fat and skin around the waist is not considered medically necessary unless other medical conditions are present, such as skin irritation or hernias, which are not alleged here," Independence said.
"Independence does not conform to Plaintiff's stereotypical perception of how men and women should look. To require coverage for such cosmetic procedure would be tantamount to an adjudication that the size of one's waist is an indication of their masculinity or femininity, or a factor in what makes a man or a woman, and is necessary to transition one's gender.
"This issue is not for the courts to decide."