Sgt. Anna Lange came out as transgender in 2017 after working in the Houston County Sheriff’s Office since 2006. She has taken hormone therapy and outwardly changed her appearance over the past three years to treat gender dysphoria, the distress resulting from the mismatch between her sex assigned at birth and her gender identity.

Her next step was going to be gender-affirmation surgery, but that plan came to a halt when her insurance provider based on an exclusion specified by her employer.

Now, Lange is suing the Houston County Board of Commissioners to remove that exclusion. Early Wednesday, she and her lawyer, Noah Lewis of the Transgender Legal Defense and Education Fund, filed suit in U.S. District Court in Macon, Ga., alleging unlawful discrimination under federal and state equal protection clauses, Title VII of the Civil Rights Act and the Americans With Disabilities Act.

County officials did not return calls for comment.

Lange’s case is the latest in the U.S. to challenge the exclusion of transgender care from state and municipal employee insurance plans ― and it could create legal precedents for cases across the South.

Other transgender people have won similar fights elsewhere. The managers of Wisconsin’s state employee insurance program excluded transgender employees from coverage but later reversed that decision. Separately, two University of Wisconsin employees the state and won. Another lawsuit successfully transgender exclusions in Wisconsin’s Medicaid plan.

Earlier this year, Jesse Vroegh, a transgender employee of the Iowa Department of Corrections, won a he filed after being denied coverage by his employer’s health insurance plan.

And in Georgia, the state’s university system an insurance exclusion claim for gender-affirmation surgery filed by Skyler Jay, known for his appearance on the Netflix series “Queer Eye.” In addition to changing its employee health plan to be inclusive of transgender care, the university system paid Jay $100,000 in damages.

“The university clearly agreed that it was discrimination,” said Lewis, who also represented Jay. “That’s why they wanted to do the right thing and remove the exclusion.”

In 2011, another Georgia case, , set the legal precedent protecting transgender people from employment discrimination. However, that case did not address discrimination in employee benefits and, like Jay’s, many of the cases that deal with benefits have been settled out of court, according to Lewis.

The Affordable Care Act, which took effect in 2014, specifically prohibits discrimination by health insurance issuers on the basis of gender identity, and Title VII of the Civil Rights Act has also been interpreted to prohibit such discrimination.

Despite broad legal that transgender insurance exclusions are unlawful, state and local governments continue to pursue expensive legal fights to preserve them. The issue remains .

“Ultimately, what’s happening is that, politically, I presume they think it’s unpopular or they think they have to defend” the law or regulation, said John Knight, an attorney with the American Civil Liberties Union.

Resisting payment for such care can be more expensive than providing it. Not including the costs of state attorneys’ salaries or appeals, Wisconsin’s litigation against the employees of its university system cost the state more than $845,000, while Iowa’s cost about $125,000.

Furthermore, the cost of managing untreated gender dysphoria can the costs of providing transgender-inclusive health care, according to a 2015 study. “Given the small number of people who actually need this kind of care and the large pool of people, it will have absolutely no impact on the total cost of insurance for any state,” Knight said.

While settlements like Jay’s may be good for individuals, they do not require institutions to admit wrongdoing and do not result in a legal precedent that other, lower courts must follow.

“The court doesn’t have to look at that settlement and say, ‘Oh, this was discrimination,’” said Lewis. “Transgender workers in the South are being left behind, which is why we’re seeking a court ruling to clearly establish that this conduct is unlawful throughout the South.”

Lange’s suit argues that the county’s exclusion of transgender health care from coverage was deliberate: In documents Lewis obtained under the Freedom of Information Act, Kenneth Carter, the county’s personnel director, opted out of compliance with Section 1557 of the Affordable Care Act, which prohibits discrimination by health programs on the basis of gender identity.

“Houston County will be responsible for any penalties that result if the plan is determined to be non-compliant,” he wrote in a letter to a representative of Anthem Blue Cross and Blue Shield, which administers the plan.

Carter did not return calls for comment.

Lange’s case could end up before the 11th U.S. Circuit Court of Appeals, yielding a decision that could influence other courts in Alabama, Florida and Georgia. And, if the ruling is in Lange’s favor, Lewis said that would signal that transgender exclusions should be removed nationwide.

In its next term, the U.S. Supreme Court will hear three cases that will determine workplace protections of LGBTQ individuals, including one case involving a transgender woman.

Lange said she merely wants the same protections everyone else has. The co-workers with whom she shares a health plan might have used “something on the policy that I may never use or need, but it’s covered,” she said. “When it’s finally something that I need that one of my co-workers will probably never use or need, mine’s excluded. And that’s just not fair.”

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En Virginia, una medida promulgada en marzo requiere que la educación sexual en la escuela incluya instrucción sobre tráfico de personas.

En Colorado, una ley aprobada esta primavera requiere que cualquier educación sexual que se enseñe en las escuelas públicas del estado sea , y, en una acción inusual, se derivó .

La temporada legislativa estatal de 2019 está produciendo una gran cosecha de proyectos de ley de educación sexual en el país, con al menos 79 iniciativas presentadas en las legislaturas de 32 estados y el Distrito de Columbia, según un informe reciente del Guttmacher Institute, una organización enfocada en la investigación de la educación sexual y reproductiva y de defensa de la salud. La mayoría de los proyectos de ley se han dirigido a expandir la educación juvenil en torno a una sexualidad y relaciones saludables, y a reducir el alcance de la filosofía de “solo abstinencia” que se había convertido en parte de muchas clases de educación sexual en las últimas cuatro décadas.

Pero no fueron solo los estados socialmente liberales los que reconsideraron el enfoque de la educación sexual este año. Varios estados conservadores dieron pasos hacia una educación sexual más amplia que, aunque no es tan abarcativa como la de California, representan cambios importantes que podrían conducir a políticas más completas en el futuro.

En Tennessee, por ejemplo, en donde los republicanos controlan el Senado, la Cámara de Representantes y la gobernación, los legisladores aprobaron un proyecto de ley que alienta a las escuelas a brindar educación que hable sobre la concientización de la violencia sexual.

Y en Utah, en donde los republicanos tienen una mayoría a prueba de veto en ambas cámaras, el gobernador republicano firmó una ley que permite a los profesores en las aulas de las escuelas públicas.

Los legisladores de Mississippi, Georgia y Arkansas también intentaron avanzar con proyectos de ley, aunque éstos no fueron aprobados.

El renovado interés en el tema fue impulsado en parte por cambios legislativos durante las elecciones de medio término de noviembre pasado, que pusieron en las bancas a más demócratas, y a más legisladoras; pero también por el movimiento #MeToo, que puso sobre el tapete temas como los ataques sexuales y el consentimiento en una relación sexual.

Aunque las mujeres ocupan menos del 30% de los escaños legislativos estatales, presentaron cinco de cada siete proyectos de ley estatales que actualizan los estándares de educación sexual que se promulgaron el año pasado, según del Center for American Progress, entidad de tendencia izquierdista. Las mujeres también presentaron más de la mitad de los proyectos de ley para modernizar la educación sexual en las sesiones de este año.

“Cuando tengas gente nueva y diferente, tendrás nuevas conversaciones y nuevas ideas”, dijo Elizabeth Nash, gerente principal de asuntos estatales en Guttmacher.

Los pájaros y las abejas evolucionan

Aunque las versiones de la Cámara de Representantes y del Senado de los Estados Unidos de los nuevos estándares de educación sexual también se han reintroducido este año, es poco probable que sean aprobadas, según Jennifer Driver, directora de políticas estatales del Consejo de Educación e Información sobre Sexualidad de los Estados Unidos, una organización que aboga por una educación sexual más integral.

Las decisiones sobre estas opciones en los currículos en las escuelas públicas están en gran medida determinadas por los estados. Según Guttmacher, , y requieren que sea médicamente precisa.

Las actitudes sobre la educación sexual se han polarizado políticamente desde al menos la década de 1960, especialmente sobre si la abstinencia prematrimonial debe enseñarse como el o como una de para evitar embarazos no deseados y enfermedades de transmisión sexual (ETS).

Según el grupo de defensa SIECUS, desde la introducción de los programas de , se han gastado más de $2 mil millones en impuestos para difundir esos programas, incluso cuando se han relacionado con o, en el mejor de los casos sin cambios, en las tasas de .

Pero un aumento en las discusiones públicas sobre el peligro de las relaciones poco saludables está cambiando el juego. Primero fue una serie de episodios muy publicitados , seguidos de varios episodios de asalto sexual en los campus universitarios, y luego #MeToo, cuando . Con cada ola de indignación, los legisladores estatales comenzaron a aprobar proyectos de ley que ordenaban una educación escolar centrada en relaciones saludables, si no en una sexualidad saludable.

“Eso ha puesto más energía en torno a un tema que ha faltado durante mucho tiempo en la educación sexual, que es el consentimiento”, dijo Nash.

Las charlas sobre el consentimiento en las aulas condujeron a conversaciones sobre el control del propio cuerpo y el derecho a información precisa y sin prejuicios sobre la salud y la sexualidad. Y esto ha llevado a los debates sobre educación sexual integral. “No es exactamente un círculo, pero éste es el camino en el que se ha movido el tema”, dijo Nash.

Cuando varias legislaturas estatales se movieron hacia la izquierda con las elecciones de 2018, las ruedas comenzaron a girar rápidamente.

Cambiando la conversación en los estados rojos

Dos semanas después de esas elecciones, Jaime Winfree decidió que Georgia necesitaba un proyecto de ley sobre educación sexual.

Winfree, directora de la Coalición de Georgia para el Avance de la Educación Sexual, estaba en una conferencia sobre derechos reproductivos cuando escuchó una presentación Jennifer Chou, abogada de la filial del Norte de California de la Unión de Libertades Civiles (ACLU).

Chou detallaba la aprobación en 2015 de la Ley de Juventud Saludable de California, que exige que las escuelas brinden a los estudiantes de escuela media y secundaria una educación sexual integral que ante los diversos valores y creencias sobre la sexualidad. Chou contó en la conferencia que el proyecto de ley fue el resultado de 20 años de cambio incremental.

“Casi me caigo de la silla”, recordó Winfree.

Si el proceso tomó 20 años en California, llevará 200 años en Georgia, pensó Winfree. Pero ambos estados tuvieron que comenzar en alguna parte. Winfree decidió que el primer paso de Georgia debería ser el mismo que el de California: aprobar el requisito de que cualquier educación sexual que se enseñe en las escuelas públicas sea médicamente precisa.

Parecía una venta fácil, pero no lo fue. El proyecto de ley que Winfree y sus colegas ayudaron redactar fue patrocinado por varios legisladores demócratas y finalmente murió en comisión. Dijo que fue decepcionante, pero su pelea está lejos de terminar: Winfree ya está tramando su estrategia de presentación previa para la versión del proyecto de ley del próximo año.

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California’s Board of Education updated its statewide framework in May for teaching comprehensive sex education that prioritizes medical accuracy and sensitivity to diverse sexualities.

And in Virginia, a measure signed into law in March requires school-based sex education to include instruction on human trafficking.

The 2019 state legislative season is producing a bumper crop of sex education bills across the U.S., with at least 79 bills introduced in the legislatures of 32 states and the District of Columbia, according to a recent by the Guttmacher Institute, a sexual and reproductive health research and advocacy organization. Most of the bills have been aimed at expanding youth education around healthy sexuality and relationships — and reducing the reach of the abstinence-only ideology that had become part of many sex ed classes over the past four decades.

But it wasn’t just socially liberal states reconsidering the approach to sex education this year. Several conservative states were among those taking steps toward broader sex ed that, while not as far-reaching as California’s, represent important shifts that could lead to more comprehensive policies down the line.

In Tennessee, for example, where Republicans control the Senate, House and governor’s office, lawmakers passed a bill encouraging schools to provide education on sexual violence awareness.

And in Utah, where Republicans hold a veto-proof majority in both chambers, the state’s Republican governor signed a law allowing educators to in public school classrooms.

Mississippi, Georgia and Arkansas lawmakers attempted bills, too, although theirs did not pass.

Renewed interest in the issue was fueled in part by legislative flips during last November’s midterm elections that brought into office more Democrats — and more female lawmakers — but also by questions about sexual assault and consent raised by the #MeToo movement.

Although women hold fewer than 30% of state legislative seats, they introduced five out of every seven state bills updating sex education standards that were enacted in the past year, according to a recent by the left-leaning Center for American Progress think tank. Women also introduced more than half of the bills to modernize sex education in this year’s sessions.

“When you have different, new people, you’re going to have new conversations and new ideas,” said Elizabeth Nash, senior state issues manager at the Guttmacher Institute.

The Birds And The Bees Evolve

Although U.S. House and Senate versions of new sex education standards have been reintroduced this year, too, they are unlikely to pass, according to Jennifer Driver, state policy director at the Sexuality Information and Education Council of the United States, an organization that advocates for comprehensive sex education.

Decisions on such curriculum choices in public schools are largely determined by the states. do not require sex education, according to the , and only 13 require it to be medically accurate.

Attitudes about sex ed have been politically polarized since at least the 1960s, hinging on whether premarital abstinence should be taught as the , or as one of to avoid unwanted pregnancy and sexually transmitted diseases.

Since the in 1981, according to the SIECUS advocacy group, more than $2 billion in taxes has been spent on disseminating those programs even as they have been linked to or, at best, for unwanted pregnancies and STDs.

But an uptick in public conversations about the danger of unhealthy relationships is changing the game. First came a spate of highly publicized episodes of dating violence, followed by several episodes of on college campuses, and then #MeToo, when powerful men were called out for sexual violence and harassment. With each wave of outrage, state legislators began passing — if not healthy sexuality.

“That has meant more energy around an issue that has long been lacking in sex education, which is consent,” said Nash.

Conversations about teaching and learning consent led to conversations about control over one’s own body and the right to accurate, nonjudgmental information about health and sexuality. That has led back to conversations about comprehensive sex education. “It’s not quite a circle, but this is the path that it’s moved on,” said Nash.

When several state legislatures then shifted leftward with the 2018 elections, the wheels began turning quickly.

Changing The Conversation In Red States

It was two weeks after those elections when Jaime Winfree first decided Georgia needed a sex education bill.

Winfree, director of the Georgia Coalition for Advancing Sex Education, was at a reproductive rights conference when she heard a presentation from advocate Jennifer Chou, an attorney with the Northern California affiliate of the American Civil Liberties Union.

Chou was detailing the 2015 passage of the California Healthy Youth Act, which requires schools to provide middle and high school students with comprehensive sex education that medical accuracy and sensitivity to diverse values and beliefs on sexuality. She told the conference the bill was the result of 20 years of incremental change.

“I almost fell out of my chair,“ Winfree recalled.

If the process took 20 years in California, it’s going to take 200 years in Georgia, Winfree thought. But both states had to start somewhere. She decided Georgia’s first step should be the same as California’s: pass a requirement that any sex education taught in public schools be medically accurate.

It seemed like an easy sell, but it wasn’t. The bill that Winfree and her colleagues helped author was sponsored by several Democratic legislators and ultimately died in committee. It was disappointing, she said, but her fight is far from over — Winfree is already plotting her pre-filing strategy for next year’s version of the bill.

In Mississippi, a bill was introduced this year that would have made school sex education opt-out instead of opt-in, mandated consent education and required more frequent updates to the curriculum.

Recent high school graduate Ava Davis of Jackson helped shape the language of the bill as a member of the Mississippi Youth Council, which advocates for comprehensive sex education in the state.

“It’s important for students to be heard, because education is directly affecting us,” she said.

The bill did not pass, but to Nash, it still represented progress. “Five years ago, six years ago, there were very few legislators who would say that they were for comprehensive sex ed in Mississippi,” she said. “Now, to get to a bill? There’s a lot of building happening there.”

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .

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