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The City of Baltimore’s health insurance plan will soon cover sex reassignment surgery and other transgender services for municipal employees, bringing the city in line with surrounding jurisdictions that offer the same benefits.

The city’s five-member spending board, led by Mayor Catherine Pugh, approved the change this morning. A Board of Estimates agenda item stipulated that with their approval, Baltimore’s health care plan would now cover counseling, hormone replacement therapy and “gender conforming surgery.”

According to a table in the agenda, Baltimore County government and Public Schools, the District of Columbia, Howard County Public Schools, Montgomery and Prince George’s County government and the State of Maryland all cover “gender reassignment surgery.” Anne Arundel County’s government does not, but the county’s school system does, the table says.

The change is meant to address a federal rule laid out in the Affordable Care Act that “prohibits discrimination on the basis of sex,” the agenda says. The document cites a “commitment to inclusion and non-discrimination,” and says offering the benefit “reaffirms the City’s commitment to equal employment opportunity for all employees.”

As for the effect on health care costs for employees on the city’s plan, the agenda says they will likely increase—the exact amount “cannot be stated”—but for “similar employers,” the increase has not exceeded 0.1 percent of all medical claims in the plan.

“The claims for this benefit are often few and fewer [p]articipants will elect the major, and more costly, services provided under the benefit,” it explains, referring to the gap in estimated costs for counseling ($2,000-$7,000) and hormone replacement therapy ($3,000-$13,000) versus those for surgery ($25,000-$100,000).

Government agencies around the country have faced lawsuits for not covering transgender services in their health care plans. In Ohio, the Public Library of Cincinnati and Hamilton County in spring of 2017 settled a lawsuit brought an employee and agreed to cover surgery and other services. At the federal level, transgender veterans and others have sued the Trump administration over the U.S. Department of Veterans Affairs’ exclusion of transgender-friendly options in its coverage. The VA is reportedly considering changing the rule.

The board’s agenda suggested that if it had declined to approve the change, the city would face “an immeasurable cost element” with defending against potential lawsuits, “negative public relations” and “negative employee perception of the City as an employer.”