BELLINGHAM, Wash. — A Bellingham mother who works for a Catholic health care organization claims her employer denied medical coverage for her transgender son.
The American Civil Liberties Union filed the lawsuit against PeaceHealth on Thursday.
Pax and his parents struggle for surgery
Pax Enstad, 17, is a transgender boy. His assigned sex at birth was female, but he has a male gender identity.
According to Pax's family, he was diagnosed with gender dysphoria. It’s a condition in which an individual experiences significant distress from incongruence between their gender identity and the one assigned at birth. Untreated, it can lead to self-harm.
Since age 11, Pax experienced significant depression and anxiety. Doctors prescribed chest reconstruction surgery, but according to the family, PeaceHealth refused to cover the surgery because its policy excludes transgender services.
“To exist in a body because it wasn’t mine was unbearable for me,” Pax said. “I was devastated when my health provider refused … My parents made great sacrifices to get me surgery, but they didn’t have to. No one should. “
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After seeing Pax’s depression and anxiety since age 11, the family was willing to do whatever it took to get medical care. After hearing from the doctor about surgery, the family was willing to do whatever it took to get Pax the care he needs.
Pax’s parents, Cheryl and Mark, paid nearly $10,000 out of pocket for the surgery. They had to take out a second mortgage and dip into Pax’s college funds.
But Cheryl, who has worked as a medical social worker for PeaceHealth for 20 years, is still stunned that coverage was denied for Pax.
“I felt betrayed,” she said. “When your child is singled out and rejected simply for being themselves, it’s heartbreaking, and it isn’t fair. We’re bringing this lawsuit to ensure no family has to go through what we did.”
Why lawyers say the employer is violating laws
According to the ACLU, PeaceHealth’s policy of refusing medical care required by transgender people is discrimination, violating federal and state law. Attorney Lisa Nowlin says the blanket exclusion of “transgender services” is not based on standards of medical care.
“Under state and federal law, no company is allowed to single out and exclude one group of individuals from medical care that is prescribed for them by their doctors and that the company routinely provides for others,” Nowlin said.
According to the Washington State Office of the Insurance Commissioner, because PeaceHealth is a smaller, self-funded plan, they are not required to pay for the surgery.
Insurance Commissioner Mike Kreider said this in 2014: "Transgender people are entitled to the same access to health care as everyone else. Whether specific services are considered medically necessary should be up to the provider to decide on behalf of their patient.”
The ACLU argues that as it’s not covered under the commissioner statement, under the Affordable Care Act and Washington law against discrimination, the surgery is covered and the employer acted with discrimination on the basis of sex.
PeaceHealth could not take KIRO 7's questions on a pending lawsuit, but they did provide this statement.
“PeaceHealth is committed to creating an inclusive healthcare environment. Throughout our 126-year heritage, we have been dedicated to embracing and celebrating the diversity of our communities, our caregivers and the individuals we are privileged to serve. We remain committed to promoting personal and community health, and treating each person in a loving and caring way.”
How Pax says the surgery changed his life
When Pax hit puberty, he suffered debilitating depression.
He stopped participating in athletics, wore several layers of clothes to hide his chest, and eventually avoided going outside. Eventually, Pax started to wear a binder to flatten his chest.
After the surgery, Pax says his whole life changed.
“I started to spend more time with my friends and outside. I hadn’t been swimming in nine years. I went swimming first time forever after this,” he said. “I went to homecoming, and wore a suit, and I was really proud of it. I spent more time out of my room, because I had been hiding, now my whole life is different.”
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Pax, a senior in high school, is currently applying to colleges. He’s now involved with Queer-Straight-Alliance (QSA).
“I feel like I have a good community, quite a few trans kids at my school,” he said. “I’ve really enjoyed finding my community and connecting with them. “
Pax and his family say that they’ve been grateful for people in Bellingham supporting their son. But Cheryl says there’s a lot of learning still – as her son’s experienced prejudice in school.
Advocating for transgender rights is part of why Pax wanted to file the lawsuit.
“I don’t want a kid without a supportive family or access [to not have care],” Pax said. “It’s really important and life-saving.”
Cox Media Group
