Gender Surgery for Minors Faces a Legal Reckoning
Last year, a federal court in Washington State ruled that Premera Blue Cross unlawfully discriminated when it refused to cover elective double mastectomies for two young girls. The decision read like a harsh warning to every employer: exclude gender-transition procedures for children from your health plan and risk an Affordable Care Act discrimination claim. But the story doesn’t end there. In July 2026, the United States filed a brief urging the Ninth Circuit to reject that court’s misguided reasoning. In a 39-page brief supporting Premera’s appeal, the Justice Department’s Civil Rights Division argues that declining to fund these elective sex-denying surgeries for minors is not sex discrimination. “Far from being discrimination on the basis of sex,” the brief states, “this sensible policy is rooted in biological reality, developmental psychology, and medical diagnosis.” The brief anchors its argument in the Supreme Court’s 2025 decision in United States v. Skrmetti, arguing that “regulating medical procedures on the basis of diagnosis does not automatically amount to discrimination on the basis of sex.” Premera covers a mastectomy for a teenage boy with gynecomastia and for a girl with breast cancer but declines to cover the same surgery when it is performed on healthy adolescents—boys and girls alike. The distinction, the brief argues, is …