The open enrollment period ends next week for 720,000 North Carolina employees and teachers, and for the second year in a row, the State Health Plan coverage excludes gender dysphoria treatment for transgender and non-binary employees.

The State Health Plan that was in place for 2017 included gender confirmation surgery and other treatments, in accordance with the federal Affordable Care Act. But Dale Folwell, a Republican, ended coverage after he became Treasurer, citing cost-saving measures.

“I pledged to the people of North Carolina that we would reduce the state health plan’s 32 billion dollar debt, provide a more affordable family premium especially for our lowest paid employees and provide transparency to the taxpayers,” Folwell told the News and Observer of Raleigh in an email in December, 2016. “The provision to pay for sex change operations does none of those three things.”

Folwell’s decision came on the heels of the Republican led General Assembly approving a so-called "bathroom bill" which restricted use of public toilets for transgender people.

“This is not the first time that transgender people in North Carolina have had to face some action by the state government trying to act as if we are not here or we are not important or we don't exist," said Ames Simmons, who directs policy for the LGBTQ advocacy group Equality NC. “Our resilience as a community is as strong as it's ever been and we will not accept these things without fighting back.”

Simmons said the State Health Plan should reverse course, or it could face a lawsuit from transgender employees. Wisconsin recently lost a lawsuit for similar exclusions.

The State Health Plan covers hormone treatment for cisgender menopausal women or men with low testosterone.

“It's important because it's discriminatory for the state to say that they're going to provide coverage to some people but not others based on their assumptions about what a person's sex assigned a birth tells them about what their gender identity should be,” Simmons said.

CORRECTION: An earlier version of this story incorrectly stated that “State Treasurer Dale Folwell included gender confirmation surgery and other treatments in 2017.” The 2017 State Health Plan was approved in 2016, when former State Treasurer Janet Cowell, a Democrat, was still in office.