A transgender sheriff’s deputy seeking gender-affirming medical care through a county-operated health plan in central Georgia was handed a loss by a federal court Tuesday.

The 11th U.S. Circuit Court of Appeals struck down a trial court’s decision in favor of Houston County Sheriff’s Office Sgt. Anna Lange and sent the case back to the lower court.

“After everything I’ve been through, it’s crushing to know I will have to continue to fight to get what a jury already said I was entitled to,” Lange said in a statement. “This should never have happened to me, and it shouldn’t happen to anyone else.”

Lange has served with the Houston County Sheriff’s Department since 2006. She came out as transgender and began to medically transition in 2017, according to court documents. She sued the county in 2019 after seeking gender-affirming surgery and being denied because the county’s insurance policy excludes “drugs for sex change surgery” and “services and supplies for a sex change and/or the reversal of a sex change.”

In 2022, a federal judge in Georgia ruled in Lange’s favor that an employer cannot exclude or deny coverage for transition-related medical treatments from its employee health insurance plan. Judge Marc T. Treadwell, chief judge of the U.S. District Court in Macon, cited Bostock v. Clayton County, a U.S. Supreme Court case out of Georgia affirming that transgender people are protected from discrimination under Title VII of the Civil Rights Act of 1964.

Houston County appealed the decision to the 11th Circuit Court of Appeals, where last May a three-judge panel initially upheld the lower court’s ruling. But in August, the appeals court vacated that ruling and granted a rehearing in front of the full court.

In Tuesday’s ruling, the full court cited United States v. Skrmetti, a 2025 U.S. Supreme Court case in which justices upheld a Tennessee ban on gender-affirming care for minors. Justices found that the ban was not discriminatory because they said it was based on a patient’s age and medical need rather than their sex or transgender status.

“The Supreme Court’s reasoning in Skrmetti applies equally here,” reads the 11th Circuit’s opinion. “The County’s policy does not pay for a sex change operation for anyone regardless of their biological sex. … Lange is a natal man. If Lange were instead a natal woman who wanted a female-to-male sex change, the insurance policy would not pay for it. Or if Lange were a natal woman who sought coverage for the same male-to-female sex change that Lange received (perhaps for a male dependent), the County’s policy would operate in the same way—it would deny coverage. Nothing about the policy exclusion turns on whether the County’s employee is a man or woman.”

In a dissenting opinion, Judge Nancy Abudu wrote that the majority’s opinion echoed arguments opposing past laws banning interracial marriage and “serve as fodder for those who oppose legal rights for transgender people.”

“Lange was denied coverage, and thus access, to medically necessary treatment by a healthcare coverage exclusion that limits an adult’s control over their own body,” Abudu wrote. “The importance of bodily autonomy crosses political and religious lines and has been illustrated by, for example, the recent challenges to mandatory COVID-19 vaccines. … Our Constitution does not permit courts to pick and choose which people warrant protection under the law based on the personal views of a subset of the population.”

In a statement, Lange’s lawyers expressed confidence that she will prevail at trial.

“While we are deeply disappointed in the court’s decision, we remain focused on vigorously fighting for Anna’s right to medically necessary healthcare and will continue to do so as the case proceeds,” said attorney Jill Grant of Willkie Farr & Gallagher LLP.

Georgia Recorder is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity.

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