Keith BieryGolick

kbierygolick@enquirer.com

In the same county Leelah Alcorn once called home, Warren County commissioners took steps to make sure gender reassignment surgery is not covered for county employees.

This seems to conflict -- if not directly violate -- the Affordable Care Act, which encourages carriers to cover gender reassignment surgery and other necessary medical procedures often sought by transgender people.

"I'm not making a moral judgment here," said County Commissioner David Young. "If someone wants to do that (gender reassignment surgery), that is between them and God. It's just not something I think taxpayers should be paying for."

Young and the other two Republican commissioners signed a letter on Tuesday directing UnitedHealthcare to remove gender dysphoria coverage from its plan. Young believes gender reassignment surgery is a choice and should be considered an elective procedure.

He remembers Alcorn, and calls her story a "tragic situation." It doesn't change his mind about what he thinks is another example of federal overreach.

Alcorn was born male. In 2014, the 17-year-old from Kings Mills killed herself by stepping in front of a truck on the highway near South Lebanon. Anguished words about gender identity and parental rejection filled the teenager's suicide note.

In the note, Alcorn pleaded for her death to mean something.

Her last line: "Fix society. Please."

That's what angers Jennifer Branch the most. Branch is a civil rights attorney who represents Rachel Dovel, who sued the Public Library of Cincinnati and Hamilton County earlier this year because they would not cover Dovel's transition surgery. That case, filed in U.S. District Court, is still pending.

"Warren County shouldn't be in the business of determining what is medically necessary for their employees," said Branch. "They're wrong. It's not a choice."

Forget the Affordable Care Act, she said, public employers can't treat some employees differently than others because of the Equal Protection Act in the 14th Amendment.

"It's too bad the Warren County commissioners aren’t honoring Leelah Alcorn’s request that we fix society," Branch said. "And instead are promoting discrimination."

Allison Hoffman is a professor at the UCLA Law School, where she researches health insurance regulations.

She agrees with Young that nowhere in the Affordable Care Act does it explicitly spell out what health benefits a county needs to cover.

"The law is not clear," said Hoffman. "That ground is still being sorted out."

But she said the law is clearly moving toward a broader definition of discrimination that includes gender identity. The professor struggled to understand the language of Warren County's letter to its insurance provider, which only mentions "coverage for gender dysphoria."

Hoffman said this left it unclear whether the county would cover costs of medication for anxiety, depression or a slew of other issues potentially caused by someone's gender identity.

"This feels like grandstanding," she said. "It feels like they are trying to start controversy."

UnitedHealthcare responded to a request for comment from The Enquirer with a short statement:

“UnitedHealthcare complies with all federal and state regulations.”

A spokesman declined to answer questions.

This is not the first time Warren County officials have picked a fight with aspects of the Affordable Care Act. Last year, the county joined a lawsuit with other Ohio universities to fight the health care act’s method of funding a transition program for people signing up for coverage. That case is still pending.

Young said he is not looking for the spotlight. Instead, he is making a principled stand.

"If not us, then who?" he asked, citing the county's financial stability. "I'm willing to fight that fight."