Jones Gilbert D
Cleveland State University College of Law.
J Law Health. 2025;38(3):402-421.
This Note critically examines the evolving legal landscape surrounding transgender individuals' access to gender-affirming care in the United States, focusing on two pivotal cases before the Fourth Circuit: Kadel v. Folwell (North Carolina) and Fain v. Crouch (West Virginia). These cases present a constitutional and statutory challenge to the exclusion of medically necessary gender-affirming care from state health plans, under Title VII of the Civil Rights Act of 1964 and the Equal Protection Clause of the Fourteenth Amendment. The Note contextualizes these lawsuits within a broader historical trajectory of transgender rights, highlighting legal and cultural milestones that have shaped access to care and recognition. Drawing on precedent, including Grimm v. Gloucester County School Board and Bostock v. Clayton County, the analysis explores how gender identity is legally understood through the lens of sex discrimination. It further considers the persuasive value of medical consensus on the necessity of gender-affirming care, as endorsed by major health organizations. The paper identifies the legal inconsistencies and discriminatory rationales employed by states to deny this care and critiques the sociopolitical underpinnings of such exclusions. By comparing the different factual and legal circumstances of Kadel and Fain, the Note argues that the Fourth Circuit has an opportunity to affirm constitutional protections for transgender persons. It proposes a legally and politically viable middle ground: requiring states to provide coverage for non-surgical interventions such as medication and psychotherapy, thereby upholding basic standards of care while navigating judicial restraint. Ultimately, the Note underscores that the outcome of these joined en banc proceedings will significantly influence future litigation, legislative efforts, and the lived realities of transgender individuals. In doing so, it advocates for a legal framework rooted in equality, medical necessity, and the dignity of all persons under the law.
本笔记批判性地审视了美国围绕跨性别者获得性别肯定性医疗护理的不断演变的法律格局，重点关注第四巡回上诉法院的两个关键案件：卡德尔诉福尔韦尔案（北卡罗来纳州）和费恩诉克劳奇案（西弗吉尼亚州）。这些案件对根据1964年《民权法案》第七章和第十四修正案的平等保护条款将必要的性别肯定性医疗护理排除在州健康计划之外提出了宪法和法规挑战。本笔记将这些诉讼置于跨性别者权利更广泛的历史轨迹中，突出了塑造医疗护理获得和认可的法律和文化里程碑。借鉴包括格林诉格洛斯特县学校董事会案和博斯托克诉克莱顿县案在内的先例，分析探讨了如何通过性别歧视的视角从法律上理解性别认同。它还考虑了主要健康组织认可的关于性别肯定性医疗护理必要性的医学共识的说服力。本文指出了各州拒绝提供这种护理所采用的法律不一致性和歧视性理由，并批评了这种排除的社会政治基础。通过比较卡德尔案和费恩案不同的事实和法律情况，本笔记认为第四巡回上诉法院有机会确认对跨性别者的宪法保护。它提出了一个在法律和政治上可行的中间立场：要求各州为药物治疗和心理治疗等非手术干预提供保险，从而在遵循司法克制的同时维护基本的护理标准。最终，本笔记强调这些全院庭审程序的结果将对未来的诉讼、立法努力以及跨性别者的生活现实产生重大影响。在此过程中，它倡导建立一个基于平等、医疗必要性和法律面前所有人尊严的法律框架。
