A federal lawsuit recently filed by two people alleges that the state of Tennessee and its insurance committee are discriminatory against transgender people through the state’s employee benefits program.

The plaintiffs are Gerda Zinner, a 30-year-old transgender woman and an academic advisor at the University of Tennessee at Chattanooga, and Story VanNess, a 38-year-old transgender woman and a former special education teacher at Knox County Board of Education (VanNess has since left her job). Both plaintiffs suffer from gender dysphoria, which is psychological distress as a result of a disconnect between a person’s assigned sex at birth and the person’s gender identity. 

Zinner and VanNess’ physicians deemed it medically-necessary for them to receive transgender-related surgeries to treat their gender dysphoria. However, Zinner is currently enrolled and VanNess was previously enrolled in the State of Tennessee Comprehensive Medical and Hospitalization Program, which denies coverage of “surgery or treatment for, or related to, sex transformations.” This only bars coverage for transgender people, according to the complaint. 

Zinner and VanNess contend they have asked the state to remove this exclusion from the benefits program, but the “defendants have steadfastly refused and/or ignored plaintiffs’ requests.”

By denying coverage to Zinner and VanNess, the defendants are in violation of the Equal Protection Clause of the Fourteenth Amendment, Title IX of the Education Amendments of 1972 and Title VII of the Civil Rights Act of 1964, the plaintiffs allege. They are asking the court for a trial by jury.

Zinner has received hormone replacement therapy, which has helped her gender dysphoria, but it hasn’t done enough. As a result, her providers considered it medically-necessary for her to receive a gender-affirming vaginoplasty. But coverage for the surgery was denied, and Zinner cannot afford to pay for the surgery herself.

“Because of her inability to access her medically-necessary vaginoplasty, Ms. Zinner feels that her life is on hold. Her unmet healthcare needs continue to weigh on her, leading her to feel stressed, anxious, depressed, and preoccupied,” the lawsuit said.

VanNess has also received hormone replacement therapy. While it improved her wellbeing, it did not “change the underlying bone structure of her facial features and did not change Ms. VanNess’s chest in a way that addressed her gender dysphoria.”

“Ms. VanNess fears for her life because of her masculine facial features and the increased scrutiny on and violence towards people who are visibly transgender, especially trans women. Ms. VanNess feels extremely unsafe in public,” the lawsuit stated. “Every time she leaves the house, she braces herself for a violent attack.”

Because of this, VanNess’ providers decided it was medically necessary for her to receive facial gender-affirming surgery and breast augmentation. After coverage for the surgeries was denied, VanNess paid out of pocket for the breast augmentation, but cannot afford to do the same for facial gender-affirming surgery. This led to her decision to leave her job.

“Ms. VanNess continues to experience severe gender dysphoria from her facial features,” the plaintiffs said in the complaint. “Her face is the first thing that she sees when she looks in the mirror, and the first thing that others see when they look at her.”

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