DOJ Sides With Insurer That Won’t Cover “Transition” Surgery for Minor
On July 13, 2026, the Department of Justice urged the Ninth Circuit to reverse a ruling that had ordered Premera Blue Cross to cover chest surgery for a young girl. The Justice Department’s brief argues the exclusion is not sex discrimination but a “sensible policy … rooted in biological reality, developmental psychology, and medical diagnosis.” Premera covers a mastectomy for a boy with gynecomastia and for a girl with breast cancer, but declines the same surgery when it is performed on a healthy adolescent, boys and girls alike. The line, the brief says, is the diagnosis, not the patient’s sex, and it reads the Supreme Court’s 2025 decision in Skrmetti to say exactly that. Every federal appeals court to weigh the question since, the brief notes, has rejected the lower court’s reasoning. The whole dispute turns on one phrase, “medically necessary.” That label rests heavily on the standards of the World Professional Association for Transgender Health, the same WPATH the FTC and multiple states are now suing for stripping surgical age limits without evidentiary basis and calling virtually every pediatric “transition” service “medically necessary.” The brief itself cites England’s Cass Review and a 2025 HHS review that found the evidence …