County could say no to insuring gender reassignment despite federal law

July 01--Federal law currently requires employers such as Gaston County to offer insurance coverage for employees who might seek out gender reassignment and hormone therapy.

But Gaston County's top administrator is recommending defying that mandate, despite the fact that it could invite a lawsuit or jeopardize the county's access to federal funds. County Manager Earl Mathers sees it as the more fiscally responsible approach, given the cost of gender reassignment treatments, and also believes the federal government ultimately will never call the county's bluff.

"I think it is a concern," Mathers said of the potential loss of federal funding due to the violation. "But I believe too that these rules were enacted during the Obama administration, and some of these kinds of things (in the Affordable Care Act) may be rolled back, in which case this becomes a moot point."

Mathers acknowledged he doesn't have a crystal ball.

"It's all about measuring risk, I guess," he said. "But I don't feel there's a great deal of risk associated with (not providing the coverage)."

Others believe that would be a misguided approach. Ginger Feimster is president of PFLAG Gaston, a nonprofit that advocates for the local gay, lesbian and transgender communities. She said not providing the coverage would be misguided on multiple fronts.

"I believe the county should go with the law, not against the law," she said. "Even more than being the law, (providing coverage) is the right thing to do."

Gaston County is preparing to renew its contract with Blue Cross Blue Shield of North Carolina, and is having to make decisions about what types of coverage it wants to provide. In an email to Mathers and county commissioners Friday morning, Human Resources Director Pam Overcash laid out their options regarding coverage of gender reassignment surgery and hormone therapy.

Overcash clarified that the Affordable Care Act requires the coverage for employees. But because Gaston County is a self-funded insurance provider, Blue Cross Blue Shield will allow the county to sign a waiver to opt out of that coverage.

But there's a potential catch, Overcash said.

"The liability with the waiver is two-fold," she said in her email. "One, an individual who was denied coverage could bring a lawsuit. And two, non-compliance with federal law puts all of our federal funding in jeopardy."

Overcash said the county's insurance consultant recommended providing the coverage.

"However, we were also told that several of their other self-funded groups have opted out of the coverage and signed the waiver," she said.

More to discuss

Mathers responded with a follow-up email to commissioners advising against extending the coverage, adding that other counties have also chosen to sign the waiver. He also said he knows commissioners are free to go against his advice.

Mathers said his recommendation is based in part on how members of the all-Republican board have demonstrated that they stand on social issues. But more than that, it's based on his knowledge of how they feel about finances and conservative spending.

"Gender reassignment surgery and various things associated with that are extraordinarily expensive," he said. "We are trying to contain the cost of our health care coverage as much as we can."

Gaston County already spends about $20 million per year to insure its hundreds of employees. Because the county is self-insured, catastrophic health issues that require costly treatment for employees results in the county spending "a tremendous amount of money," Mathers said.

"We've gone to great lengths to introduce wellness programs to provide direct assistance to employees who need help with chronic issues," he said. "So anything that that is highly impactful in terms of cost certainly undermines that."

Commission Chairman Chad Brown could not be reached for comment Friday, and none of his colleagues have formally weighed in on the issue yet. But when reached by phone Friday, a couple of them said they have some initial concerns about Mathers' recommendation.

"Whatever my personal feelings may be about it, I want to make sure we're protected legally," said Commissioner Ronnie Worley.

Commissioner Tom Keigher said he wants to talk more with Mathers, the county attorney and the community as a whole about what's at stake.

"If it turns out it's a law and we have to, then we have to," he said. "If we have an option and aren't in jeopardy of losing money to the feds, I'd be OK. But if it's a law, we need to follow it."

Feimster said the county should respect the federal law, and demonstrate compassion for employees who might need help with gender reassignment coverage.

"As far as gender reassignment surgery goes, people who are asking for that are not doing it for cosmetic reasons," she said. "It's not a frivolous thing. It's something that's very important and ingrained in the person who is feeling or knowing that they need the surgery.

"It's something to complete them and make them whole, to be who they are supposed to be."

You can reach Michael Barrett at 704-869-1826 or on Twitter @GazetteMike.

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