“United Healthcare should deny their request because United Healthcare would be violating the Affordable Care Act,” Branch said Tuesday in a telephone interview.

In addition, Branch said the county was probably discriminating against an employee by not providing the coverage.

“I bet there is someone harmed,” she said. “The employee hasn’t come forward because they are afraid of being discriminated against.”

Commissioner Pat South said gender reassigment surgery should be considered an elective procedure.

Last year, Warren County retained its own lawyer to join litigation fighting the health care act's charges to the county and other governments to fund a transitional reinsurance program for people shifting or signing up for coverage under the federal program.

Warren County claims its self-funded health insurance program should not have to pay the transitional reinsurance fee required under, the federal health care law, commonly referred to as Obamacare.

The state of Ohio and a handful of universities joined in the lawsuit still pending in federal court.

In August, a group of religious organizations and states, not including Ohio, filed a lawsuit challenging new Obamacare provisions requiring care to transgender patients.

And in September, Rachel Dovel, a transgender woman and long-time employee of the Hamilton County library system, filed a lawsuit after being denied coverage for procedures following diagnosis for gender dysphoria.

“In May 2014, Ms. Dovel was diagnosed with gender dysphoria and began her medical transition, a process through which she has brought her life and outer appearance into closer alignment with her gender identity,” according to the lawsuit filed in U.S. District Court in Cincinnati.

Dovel’s lawsuit claims sexual discrimination and seeks an injunction covering Dovel’s surgery, scheduled for November, as well as damages, attorney fees and a ruling requiring the library to cover other employees undergoing treatment for gender dysphoria.

Before voting with Young and Commissioner Pat South not to provide the coverage, Commissioner Tom Grossmann questioned the step.

“If the government says it has to be covered, it has to be covered,” Grossmann, an assistant prosecutor in Hamilton County, said, “I think we need to follow what the law is.”

South said gender reassignment surgery should be treated as an elective procedure.

Young likened the issue to the one brought by Hobby Lobby over Obamacare requiring family businesses to provide employees birth control. The Supreme Court ruled 5-4 in favor of Hobby Lobby.

“Sometimes you have to take a principled stand,” Young said, while also noting reports Tuesday that rates on plans purchased from state exchanges under Obamacare would go up as much as 25 percent next year.

Young, who is up for reelection on Nov. 8, predicted the changes were another step toward nationalized health care “which doesn’t work.”

Charles Sanders, the Democratic challenger, supports Obamacare.

"I do not think taxpayers' money should be used in frivolous exploratory legal challenges to remove a plan that is working for at least 20 million people," he said in a response to the Dayton Daily News Voters Guide.