UA professor sues state over denial of health-care coverage to transgender employees

Russell Toomey and Danielle Flink [Photo from video by Ashley Carter/Cronkite News]

By Lurissa Carbajal

TUCSON – A transgender University of Arizona professor has sued the state over financial access to surgery his doctor said is medically necessary.

Russell Toomey last month filed a class action lawsuit in U.S. District Court in Tucson on behalf of state employees and their dependents. The suit, backed by the American Civil Liberties Union Foundation of Arizona, says the state’s exclusion violates transgender employees’ constitutional and civil rights.

Toomey, an associate professor of family studies and human development at UA, said it’s also a matter of finances and fairness.

“Knowing that my state discriminates based on my gender is never a good feeling,” said Toomey, whose doctor told him he needs a hysterectomy to treat his gender dysphoria. “Mentally, it’s just anxiety producing knowing that I have this part of my body that doesn’t feel authentic to me.”

Arizona is one of several states that refuse insurance coverage to transgender state employees for transitional surgeries, but according to a national insurance-reform group, at least 15 other states prohibit such exclusions.

Toomey said he knows of at least 20 families and employees affiliated with the University of Arizona who are harmed by what he called the state’s anti-trans health-insurance policy.

“Arizona provides the same discriminatory health plan to nearly all state employees and their dependents. That means hundreds, if not thousands, of transgender state employees or transgender dependents of state employees cannot receive medically necessary care,” he wrote on the ACLU blog Speak Freely.

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The Arizona Board of Regents, which oversees the state’s three public universities, declined to comment on pending litigation.

Toomey doesn’t know what the latest surgery would cost without insurance, but, in 2004, he had a double mastectomy that cost him $8,000. He said paying for the surgery out-of-pocket isn’t feasible because he and his wife have two young children and are caring for an aging parent.

Steve Kilar, ACLU of Arizona spokesman, said employee health-care plans are a valuable part of compensation, and the exclusion means transgender employees are receiving inferior care.

Public and private health insurance companies in the U.S. historically excluded transition-related care and surgeries on the assumption the treatments were either cosmetic or experimental, according to the Yale Journal of Health Policy, Law, and Ethics.

In May 2014, the federal government halted its practice of excluding Medicare coverage of sex reassignment surgery, according to the National Center for Transgender Equality. Many private insurers and state plans updated their health-care guidelines, but not all.

Russell Toomey, left, an associate professor at the University of Arizona, is suing the state for discrimination over its exclusion of health-care coverage for transition surgery and related medical treatment for transgender state employees. His wife, Danielle Flink, supports his efforts. (Photo courtesy of Russell Toomey).

The national ACLU challenged a Wisconsin law and won the case last year before turning its attention to other states.

State-funded health-insurance in Arizona generally covers medically necessary care but has a specific exclusion for gender reassignment surgery or related medical treatment, even if doctors say it’s medically necessary, according to the suit by the ACLU Foundation of Arizona.

“The Plan provides coverage for the same hysterectomies when prescribed as medically necessary treatment for other medical conditions,” the suit says. “But, the Plan categorically excludes coverage for hysterectomies when they are medically necessary for purposes of ‘gender reassignment.’”

The American Psychiatric Association defines gender dysphoria as the emotional distress experienced by people whose gender identity doesn’t align with their assigned sex. U.S. health professionals rely on standards outlined in the Diagnostic and Statistical Manual of Mental Disorders to diagnose gender dysphoria.

According to the World Professional Association of Transgender Health, transition-related treatment may include hormone therapy, surgery – sometimes called “sex reassignment surgery” or “gender confirmation surgery” – and other medical services that align peoples’ bodies with their gender identities.

Toomey’s lawsuit says that under the state health plan, employees denied coverage for most medical procedures can appeal those decisions, but there is no such review process for gender dysphoria.

“The ultimate goal is to have the exclusion removed from the policy so that all transgender employees of the state as well as dependents of employees who are transgender can have their medical claims reviewed just like any other claim,” Toomey said.

-Video by Ashley Carter/Cronkite News


  1. If you are born with a penis you are male, with a vagina female. No mistakes there, impossible to be the wrong gender scientifically. Amazing how progressive cite science even though it can not be proven. Psychologically it is another matter.

  2. Many things happen as a fetus grows inside the mother’s womb. Some die, some are born with Down’s Syndrome, some are born attached twins, some are born with webbed fingers, or a missing toe, or a hare lip or cleft palate or some other oddity that can be repaired. And some are born apparently healthy but later there are mental or physical issues that go back to when they were in the womb. Why? Who knows.

    And some are born with the body parts of the opposite gender. The transgender person I am friends with suffered a lot with being considered a male all of his life when she knew she was really a girl. Just a few years ago, as recognition grew that transgender people should be treated as brother or sister human beings and not as freaks or deviants, she came out, let her hair grow, wore dresses, took hormones to grow her breasts, and is saving to fix the problem down below. In all this she has the support of her wife, her church, and her community. She, for really the first time in her life, is happy. It’s not about wanting to feel different — it’s about fixing the mistake that Mother Nature made and letting Jean, formerly Gene, to — as the preamble to the US Constitution says, “secure the blessings of Liberty….” And, she’s cute!

    • It’s called “gender dysphoria” Al. Society may accept it, even promote it but still…it’s a mental illness that, until very recently, was correctly identified and treated as such. Mutilating someone’s body and injecting them with hormones does not change their gender. Their DNA and their actual identity remains the same. Instead of enabling and even encouraging those afflicted with this malady, shouldn’t we be trying to help them make peace with how and what they are?

  3. If a doctor prescribes a cosmetic surgery because I was in a fire, covered.
    If a doctor prescribes a cosmetic surgery because I feel not right without it, not covered. Covered by case law. You will get a lot of attention and then lose at the supreme court.

    The collective, ultimately must pay for allowed(forced) procedures. The collective should not have to pay because you want to feel different and hate your body part.

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