Sharon Coolidge

scoolidge@enquirer.com

Rachel Dovel legally changed her name from Nathan last year, came out to her co-workers and was ready for the surgery that would allow her to live what she felt was a more authentic life as a woman.

But her elation was short lived. Her employer, the Public Library of Cincinnati and Hamilton County, doesn't offer insurance for gender confirmation surgery and when she asked if they would change their policy, the library board unanimously voted against making a change.

"It’s very disconcerting to wake up every morning, see my body and know that it’s not lined up with my head," said Dovel, 33, of Clifton Heights. "That has caused me a lot of depression over the years. It’s something I'm trying very hard to fix. I cannot do it on my own."

Dovel expects the surgery to cost roughly $25,000.

The library board is set to discuss the matter again Tuesday. A library spokesman declined to comment until after the meeting.

Library board member Bob Hendon told The Enquirer: "We’re investigating it and looking at the cost. We have never exclusively said, 'No, we’re not going to provide insurance for that.' We have not made a firm decision."

To include the surgery for Dovel, the board would have to change how it covers all employees, a move that would be more expensive.

"The library is behind the times and we’re just asking them to do what’s right," said Dovel's attorney, Josh Langdon, whose Cincinnati practice champions LGBT rights.

Dovel has worked at the library for 10 years. She is an electronic line assistant, a job in which she enters data on new materials into the system.

The library's board decision comes as transgender rights are at the forefront of LGBT rights. In December 2014, transgender teen Leelah Alcorn killed herself in Warren County, leaving behind a suicide note that said she wanted her death to mean something. It garnered worldwide attention, helping shed light on discrimination.

Cincinnati City Council member Chris Seelbach, who paved the way for the city to be the first city in Ohio to cover medically necessary transgender procedures for employees, attended a past board meeting to help educate library officials on why it is important for employers to include gender confirmation surgery in its insurance plans.

"Cincinnati has been a leader on inclusion efforts for the last decade – in particular, LGBT issues," Seelbach said. "We cannot go back. The library board should do the right thing, joining the city and corporate community to offer medically necessary care to all of their employees."

Because the library has Anthem insurance – which in some cases covers the surgery – Dovel assumed she would be covered under the current insurance plan. But last year, on the day of the historic U.S. Supreme Court Obergefell v. Hodges decision that found it was a fundamental right for same-sex couples to marry, Dovel was told the library did not have the option to cover her gender confirmation surgery because of the exclusions in its contract with Anthem.

The following month, the library board, after a private discussion in executive session, voted not to change coverage for gender confirmation surgery, minutes from the meeting show. At the next Board of Trustees meeting, Dovel, along with Jonah Yokoyama from the Heartland Trans* Wellness Group, tried to explain to the board transgender issues and why coverage is essential for transgender employees.

Several Fortune 500 companies – including Procter & Gamble and U.S. Bank – offer transgender-inclusive benefits.

Nationally, large insurance companies like Anthem are being pressured under the Affordable Care Act’s non-discrimination clause. Ten states and the District of Columbia have explicitly banned transgender exclusions in most health plans. Ohio is not one of them.

But Langdon said Anthem took the matter so seriously, it applied with the Ohio Department of Insurance to offer an optional policy rider to its fully-insured groups, like the library, to cover gender transition-related health care. It was approved, which now gives the library the option of providing coverage for Dovel's surgery.

Dovel has filed an employment discrimination claim with the Equal Employment Opportunity Commission. The matter is pending.

The EEOC and LGBT rights

Dovel's EEOC complaint is part of the continuing evolution of employment law as it pertains to LGBT rights. In 2012, the EEOC held that discrimination against an individual due to that person’s gender identity is discrimination because of sex and therefore is prohibited under Title VII. The EEOC then held that discrimination against an individual because of that person's sexual orientation is discrimination because of sex and therefore prohibited under Title VII.

Dovel's EEOC complaint is based on the theory that health care is an offered incident and benefit of employment, and therefore, an employer’s refusal to offer coverage for gender confirmation surgery is employment discrimination banned under Title VII.

Source: Josh Langdon