“Confirmed Judges, Confirmed Fears” is a blog series documenting the harmful impact of President Trump’s judges on Americans’ rights and liberties. It includes judges nominated in both his first and second terms.
The other five Trump Eleventh Circuit judges (Newsom, Branch, Grant, Luck, and Lagoa) joined an 8-5 opinion for the full court by Trump judge Andrew Brasher reversing a lower court opinion that ruled that a county’s insurance policy violated Title VII’s prohibition on sex discrimination by excluding transgender surgery. The September 2025 decision was in Lange v Houston County.
What happened in this case?
Anna Lange is a transgender woman who works as a deputy in the sheriff’s office in Houston County, Georgia. She requested that the county’s health insurance policy pay for transgender surgery and related medical care. The company denied the request. Under the Supreme Court’s Bostock ruling, Title VII prohibits employment discrimination against transgender people, because it is a type of sex discrimination. So Lange sued the county for disparate treatment because of sex under Title VII.
The district court ruled in Lange’s favor, holding that the plan’s exclusion discriminates because of sex as a matter of law. The county appealed the decision to the Eleventh Circuit, which determined that the full court would hear the case.
How did the six Trump judges and the Eleventh Circuit majority rule and why is the result harmful?
Trump judge Brasher’s 8-5 full court ruling reversed the decision below. The majority maintained that the insurance policy simply does not cover the particular procedure of sex change surgery but “does not treat anyone differently based on a protected characteristic” like gender or transgender status and thus “is not facially discriminatory” under Title VII.
Obama nominee Judge Jill Pryor led four other judges in strongly dissenting. The type of analysis used by the majority stating that there is no legal violation by simply excluding a medical procedure that has a significant impact based on sex or transgender status, she explained, is permissible when it comes to determining whether there has been an equal protection violation under the Constitution. “But the Supreme Court definitively held more than four decades ago,” Pryor went on, that “such line drawing is impermissible in Title VII cases when the dividing line is a medical condition that impacts employees differently based on sex.” Because the majority “improperly imports equal protection reasoning into a Title VII case,” she concluded, the majority was wrong and should have upheld the lower court. This is because, as Judge Pryor wrote, “Supreme Court precedent dictates that excluding coverage” for “healthcare that only transgender individuals can require constitutes sex-based discrimination in violation of Title VII.”
Biden nominee Judge Nancy Abudu also wrote a dissent. She noted that the increased debate on transgender rights is “shining a necessary light on areas of society still rife with discrimination.” She described the role courts have played in the past in rolling back entrenched systems of sex discrimination.
As society’s concepts around gender, sex, sexual orientation, and bodily autonomy evolve through time, our Court is expected to help dismantle de jure and de facto forms of discrimination based on these characteristics. In the area of sex and gender discrimination, social movements have focused on lifting cisgender women out of second- and third-class citizenship. However, instead of extending this progress to all sex- and gender-based classifications, our Court instead is imposing that lower-class citizenship to a new category — transgender people.
Trump judge Brasher’s ruling clearly harms Anna Lange’s efforts to obtain justice and adequate health care coverage. It will similarly harm other transgender individuals, particularly in the Eleventh Circuit, which includes Florida, Georgia and Alabama. In addition, the decision illustrates the importance of our federal courts to health, welfare and justice and the significance of having fair-minded judges on the federal bench.