After being denied health coverage for hormone treatments to support her identity as a transgender woman, a former Lincoln Library manager says she is happy to work for a Chicago-area library where her employer’s plan pays for gender-affirming care.
“I’m celebrated and accepted where I am now,” Katherine Holt told Illinois Times on May 30.
But Holt continues to seek justice for what she and lawyers from the American Civil Liberties Union of Illinois believe was the city of Springfield’s violation of state civil rights laws.
“Nothing gets done if someone doesn’t step up,” she said. “We have to fight for our existence as a matter of course.”
Though Illinois has favorable laws and policies toward the LGBTQ+ community at the state level, Holt said many other states and their elected officials have enacted legislation targeting transgender individuals and used “hateful rhetoric” amid an increase in violence toward trans people nationwide.
Holt, 35, a Bloomington native who managed Lincoln Library’s circulation department from Feb. 17, 2020, to Nov. 5, 2020, received a favorable initial ruling from the Illinois Human Rights Commission in February 2022 in response to her complaint of discrimination by city officials based on gender identity.
The commission ruled that there was “substantial evidence” of such discrimination that justified further proceedings. The ruling said hormones such as spironolactone, progesterone and estradiol – the same hormone treatments for which Holt requested coverage in 2020 – “were covered elsewhere in the health plan for uses outside of transition-related care.”
The commission’s unanimous ruling “is believed to be the first to expressly confirm that excluding gender-affirming care from employee insurance plans violates Illinois’ civil rights laws, including protections for gender identity,” according to an ACLU statement. The ACLU is representing Holt at no charge.
Unless the two sides reach a settlement, written and oral presentations of evidence and arguments in front of an administrative law judge are expected in coming weeks and months, as well as a recommendation from the administrative judge and a final ruling from the commission.
The commission could award an unspecified amount of monetary damages. Either side could contest the decision in Circuit Court.
Haley Wilson, a spokesperson for Springfield Mayor Misty Buscher, didn’t respond to a request for comment on Holt’s case. Buscher took office May 5 after defeating incumbent Mayor Jim Langfelder in the April municipal election.
The federal law governing self-funded health plans doesn’t require gender-affirming care to be covered, but Illinois laws that ban discrimination against transgender people govern both self-funded and state-regulated health plans, according to Michelle Garcia, ACLU’s deputy legal director.
An Illinois law requiring state-regulated health plans – but not self-funded plans – to cover hormone therapy medication for gender dysphoria will become effective Jan. 1, 2024, according to Caron Brookens, spokesperson for the Illinois Department of Insurance.
When Holt, who holds a master’s degree in library science, was hired by the city of Springfield, she said she disclosed her transgender status to the library director, Rochelle Hartman, and later to many of her coworkers.
Holt said she felt accepted by the staff and good about her job until she approached her employer about a month after being hired and was told the health benefit plan explicitly excluded coverage for sex transformation and related hormones.
Holt said she was devastated. “It wasn’t right,” she said. “It wasn’t legal. It wasn’t moral.”
She appealed the coverage exclusion to the city’s benefits manager. But according to the commission’s ruling, Holt was informed in March 2020 that the city’s Joint Labor Health Care Management Committee – which considers and recommends any changes in the health plan’s design, coverage and premiums to the City Council – discussed her appeal and opted not to suggest any changes.
Holt was told by former Human Resources Director James Kuizin in June 2020 that her appeal was rejected “because the law did not require coverage for transition-related care,” according to the commission.
Holt, whose annual base pay was $49,500, said she resigned her job in November 2020, mainly because of the insurance conflict.
“I miss a lot of the people I worked with,” she said. “I don’t miss having the case sort of loom over my head as I had to work.”
Michael Alwood, a City Water, Light and Power employee and one of six labor union representatives on the 12-member health care management committee, said the panel’s decision to initially not recommend changes in the plan stemmed from two factors: a lack of perspective on how other health plans were covering treatments related to gender dysphoria, and statements from city legal staff that such treatments were considered “elective.”
The Human Rights Commission said in its ruling that gender dysphoria “is understood to be discomfort or distress related to an incongruence between an individual’s gender identity and the gender assigned at birth.”
After researching the issue further, Alwood said the city committee voted in 2021 to recommend the health plan cover many medications and surgical procedures to treat gender dysphoria. The City Council later accepted the changes, which took effect March 1, 2023.
Alwood said the delay in changes to cover transgender care “did a disservice” to Holt that he regretted. “The committee really is socially aware,” he said.
Lockdowns and other disruptions to the committee’s meetings and deliberations at the onset of the COVID-19 pandemic in spring 2020 were the main reasons for the delay in changes to the health plan, he said.
Dean Olsen is a senior staff writer at Illinois Times. He can be reached at dolsen@illinoistimes.com, 217-679-7810 or twitter.com/DeanOlsenIT.
This article appears in The Pet Issue 2023.
