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Anna Lange, a sheriff's deputy in central Georgia, filed a lawsuit Wednesday against Houston County, whose employee insurance plan has denied coverage for her transgender-related health care. (Audra Melton for NPR)

A sheriff鈥檚 deputy in Perry, Ga., filed a lawsuit in federal court Wednesday against the county where she works over its refusal to allow her health insurance plan to cover her gender-affirmation surgery.

Sgt. Anna Lange came out as transgender in 2017 after working in the Houston County Sheriff鈥檚 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.

Houston County (Ga.) sheriff鈥檚 deputy Sgt. Anna Lange came out as transgender in 2017 after working in the department since 2006. Cards of thanks and encouragement are displayed in Lange鈥檚 kitchen in Perry, Ga., in March.(Audra Melton for NPR)

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

Other transgender people have won similar fights elsewhere. The managers of Wisconsin鈥檚 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鈥檚 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鈥檚 health insurance plan.

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

鈥淭he university clearly agreed that it was discrimination,鈥� said Lewis, who also represented Jay. 鈥淭hat鈥檚 why they wanted to do the right thing and remove the exclusion.鈥�

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鈥檚, 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 .

鈥淯ltimately, what鈥檚 happening is that, politically, I presume they think it鈥檚 unpopular or they think they have to defend鈥� 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鈥� salaries or appeals, Wisconsin鈥檚 litigation against the employees of its university system cost the state more than $845,000, while Iowa鈥檚 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. 鈥淕iven 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,鈥� Knight said.

While settlements like Jay鈥檚 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.

鈥淭he court doesn鈥檛 have to look at that settlement and say, 鈥極h, this was discrimination,鈥欌�� said Lewis. 鈥淭ransgender workers in the South are being left behind, which is why we鈥檙e seeking a court ruling to clearly establish that this conduct is unlawful throughout the South.鈥�

Lange鈥檚 suit argues that the county鈥檚 exclusion of transgender health care from coverage was deliberate: In documents Lewis obtained under the Freedom of Information Act, Kenneth Carter, the county鈥檚 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.

鈥淗ouston County will be responsible for any penalties that result if the plan is determined to be non-compliant,鈥� 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鈥檚 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鈥檚 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 鈥渟omething on the policy that I may never use or need, but it鈥檚 covered,鈥� she said. 鈥淲hen it鈥檚 finally something that I need that one of my co-workers will probably never use or need, mine鈥檚 excluded. And that鈥檚 just not fair.鈥�