Federal judge rules for transgender librarian



A state legislative librarian who has undergone sex-change operations must be compensated by the State of Alaska’s health insurance plan, a district court judge ruled today in Juneau.

U.S. District Court Judge H. Russel Holland said that a surgery such as vaginoplasty would be covered for some health care plan members, if medically necessary, so it must be covered for men who wish to surgically transform their bodies to appear like women.

The AlaskaCare plan currently does not cover transgender surgery.

Jennifer Fletcher, the librarian, went overseas for the surgery and paid for it from Fletcher’s personal funds. Fletcher had been diagnosed with gender dysphoria in 2014 and began living as a woman shortly thereafter.

Holland said to refuse the surgery is discriminatory based on gender.

“That is discrimination because of sex and makes defendant’s formal policy, as expressed in the provisions of AlaskaCare, facially discriminatory,” he wrote.

“Contrary to defendant’s [State of Alaska’s] contention, such a conclusion does not result in preferential treatment for transgender individuals. Rather, it results in all AlaskaCare participants being treated equally regardless of their sex. Also contrary to defendant’s contention, the court is not comparing how transgender women are treated under AlaskaCare to how non-transgender women are treated. Rather, the court is comparing how natal females are treated under AlaskaCare to how natal males are treated. Such a comparison shows that natal males are treated differently than natal females when it comes to providing coverage for certain medically necessary surgeries. As the Seventh Circuit has explained, “the tried-and-true comparative method” for determining sex discrimination is “to isolate the significance of the plaintiff’s sex to the employer’s decision: has she described a situation in which, holding all other things constant and changing only her sex, she would have been treated the same way?” Hively v. Ivy Tech Community College of Indiana, 853 F.3d 339, 345 (7th Cir. 2017). Here, plaintiff would not have been treated the same way if her natal sex were female, rather than male.”

“In sum, defendant’s policy of excluding coverage for medically necessary surgery such as vaginoplasty and mammoplasty for employees, such a plaintiff, whose natal sex is male while providing coverage for such medically necessary surgery for employees whose natal sex is female is discriminatory on its face and is direct evidence of sex discrimination. Such “[d]isparate treatment is permissible under Title VII only if justified as a bona fide occupational qualification (‘BFOQ’). A BFOQ is a qualification that is reasonably necessary to the normal operation or essence of an employer’s business.” Frank v. United Airlines, Inc., 216 F.3d 845, 853 (9th Cir. 2000). Defendant has not argued, nor could it, that there is any BFOQ for the disparate treatment at issue here. As such, plaintiff is entitled to summary judgment that defendant violated her rights under Title VII.”

In the logic used in Holland’s ruling, men who simply want breast implants for any reason, including sex altering procedures, are entitled to that coverage in the AlaskaCare plan. Likewise, women who simply want to add a penis must also be covered, since these are gender attributes and gender is protected against discrimination.


  1. I want two extra arms with hands. It would make being a mechanic and equipment operator much easier. Why should my gender be discriminated against. I just know I’ll feel much more mentally stable with 4 arms. The state should have to pay for it because my gender has 4 arms but evolution took 2 away.

  2. This one needs to go to the U.S. Supreme Court, and, no, the AK Department of Law cannot be trusted to take the case up.

  3. The state can’t pay my mandated, statutory PFD in full, but it can pay for a sex change procedure for someone who has a job? What the hell is gender dysphoria? Ten or twelve years ago that would be classified as mental illness. We, as a society, have slimed ourselves. Mental illness is seemingly everywhere, and it grows faster than a transmissioned virus.

  4. So, all you need is a made-up medical condition (gender dysphoria) “diagnosis” and you get your voluntary medical procedures paid for. We need to make up a condition so real women can get new breasts too. We could call it breast dysphoria where the woman believes that her small breasts affects her life in a negative way.

  5. This judge’s name (HOLLAND) needs to be plastered everywhere WITH his recent squandering of State funds (our money) for a State employee who CHOSE to fly to Thailand for some elective surgery.
    Apparently, Judge Holland has now decided it best to write Fletcher a check using OUR MONEY for his now missing penis and brand new breasts.
    Fine. He is being “true” to himself/herself. But to judicially rule that ALL OF US will pay for him to be “true” to himself?
    And it is justified as avoiding gender discrimination, as I understand it. If his diagnosis of dysphoria should be dealt with, give him counseling on our dime. But the line is crossed when Fletcher turns in receipts on a voluntary trip to Thailand. Check those receipts, he may have a snuck a tatoo in there too!

  6. “Rather, the court is comparing how natal females are treated under AlaskaCare to how natal males are treated. Such a comparison shows that natal males are treated differently than natal females when it comes to providing coverage for certain medically necessary surgeries.” I guess I wasn’t aware that “natal males” are being treated differently than “natal females” unless the good judge means that for a male to become a female a certain appendage need be removed with the “natal male” where as with the “natal female” the aforementioned appended needs installation? Then yeah they obviously are treated differently. If the state provides for installation but not removal then that is wrong, clearly they shouldn’t provide either elective surgery.

  7. Judge Holland is on senior status and pushing his way to 90 years old.. This is an example of why Alaska state judges as well as the vast majority of judges in other states have mandatory retirement age restrictions. In Alaska it is age 70.
    Senior status in Alaska federal Court is a policy that allows judges who have maxed out their retirement benefit to keep being assigned cases by the chief judge of the 9 th circuit Court of Appeals. No matter what their age or abilities are.
    A Lawyer appearing before these octogenarian judges is like a patient going to a neurosurgeon who has not done a serious surgery for 15 years. They are both out of touch.
    Time for Judge Holland to recognize that it is time to really retire.

    • Mental illness has affected this judge’s reasoning. And we the people are being punished for this disease called mental illness. This judge is WAY beyond his time.

  8. Does this mean I can have my facelift paid for by insurance? I identify as a much younger person.
    Great comments above. ?

  9. I remember when Liberace was outed as being gay. Someone asked him on camera how he felt about being outed? Liberace replied that “he felt terrible, all the way to the bank.”

    An openly homosexual person actually ran for president of the US?

    “I met her in a club down in old Soho
    Where you drink champagne and it tastes just like
    Cherry Cola
    C-O-L-A Cola
    She walked up to me and she asked me to dance
    I asked her her name and in a dark brown voice she said, “Lola”
    L-O-L-A Lola, lo lo lo lo Lola”

    Can’t wait to see what else is legalized and becomes socially acceptable.

    We’re doomed!

  10. Seems like this will be setting a policy for all of us to appeal insurance denials. Too often Aetna denies a procedure a doctor states is necessary. Now we should be able to just get what we want. This winter has been long, dark and cold. I need 2 weeks at a spa in the sun. Aetna should pay for this if they are paying for her procedure. The world gets crazier every day.

  11. Medically necessary vs want! I don’t care if a biological he or she decides they want to be the opposite sex and have elective surgery to achieve that goal. Just don’t expect the State of Alaska taxpayers to fund it. Just wrong!!!

  12. So we caved to this why??? I’m sick of this disgusting issue. These people are sick in the head, and somehow get money for these surgeries.. Then expect all this protection from the violent LGBTQ. Give me a break.. Now the great state of Alaska is no better than Seattle, California and the other liberal run states.. I’m a fifty year resident.. One who is tired of this behavior being propelled on our Tvs, our schools where are children and Grandchildren attend.. And our public bathrooms. At no time should a state PAY for this baloney… They wanna turn themselves into ITS that’s on them.. Shame on the state of Alaska…. Stop paying for Abortion and STOP encouraging the mentally retarded gender confused by paying for their surgery!!

  13. I feel like I’m 25 years old on the inside, but when I look in the mirror, I see the reflection of a 60 year-old woman. I think the state should pay for my facelift and collagen implants. No? Why, that’s discrimination due to age!

  14. What a disaster. Alaska has a rich history of terrible decisions from the bench. This one ranks right up there with “looks like you get a pass”.

  15. Questions are whether elective gender-reassignment surgery is a basic human right and whether one federal judge has the authority to force taxpayers in every jurisdiction of the United States government to subsidize elective gender-reassignment surgery.
    While certain insurance companies and federal programs do not provide gender reassignment surgery for private individuals, and are not required to cover the surgery for everyone, it seems reasonable to expect states should not be required to subsidize the surgery for the exclusive benefit of state employees
    Otherwise, it seems reasonable to expect anyone must therefore be entitled to automatic employment with any U.S. federal, state, or local government in order to become eligible for taxpayer-subsidized elective gender-reassignment surgery.
    A potentially far reaching, unavoidable conclusion is that nothing prevents Judge Holland’s ruling from being used to force all private sector employers, regardless of size or financial resources, to subsidize elective gender-reassignment surgery.
    Fletcher’s choice to obtain surgery in Thailand raises additional questions: (a) must insurance companies and U.S. taxpayers be forced to subsidize medical procedures performed anywhere in the world, and (b) did Fletcher knowingly choose to undergo surgery in Thailand to avoid the exhaustive psychological evaluation firewalls established in the U.S. as prerequisites to gender reassignment surgery, in part to protect providers from financial consequences of buyers’ remorse.
    Whether Fletcher’s choice was driven by opportunism instead of medical necessity would be irrelevant if taxpayers were not forced to subsidize the process.
    It is noted that Fletcher began working for the State of Alaska in 2012, obtained a diagnosis of “gender dysphoria” in 2014 and that “[w]ith the assistance of that treating professional, [she] began the process of social, legal, and medical transition to live . . . as the woman that [she has] always been.”, and obtained “gender-confirming surgery” in 2017.
    The “Diagnostic and Statistical Manual of Mental Disorders”, the bible of America’s mental-health industry, underwent a fundamental revision in 2013, changing from DSM-4 to DSM-5, changing in functionality from diagnostic to prescriptive, responsive to changing social and cultural influences.
    The diagnostic label gender identity disorder (GID) was used until 2013 when the DSM-5 was released. The condition was renamed to remove the stigma associated with the term “disorder” , i.e. changing social and cultural influences. Sexual reassignment surgery was introduced as a treatment option.
    In other words, the new diagnosis and the new treatment option can be presented as deciding criteria for a necessary medical procedure instead of cosmetic surgery which insurance will not cover.
    Therefore one might reasonably ask whether Fletcher’s decision to postpone surgery to resolve an allegedly lifelong, medically necessary affliction was predicated on taking advantage of the introduction of the DSM-5 and its prescriptive recommendation for sexual reassignment surgery and therefore should taxpayers be forced to bear the cost of Fletcher’s decision.

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