For LGBTQ+ Americans, the landscape of civil rights remains a patchwork quilt—sometimes stitched with progress, sometimes frayed by setbacks. In a week marked by two major court decisions, the future of marriage equality appears secure for now, but transgender rights in healthcare have hit a significant legal roadblock.
On September 9, 2025, the 11th U.S. Court of Appeals handed down a ruling that reverberated through the LGBTQ+ community and beyond. The court reversed its own earlier decision, declaring that Houston County, Georgia, and Sheriff Cullen Talton had not discriminated against Anna Lange, a transgender deputy, when the county’s health insurance plan denied coverage for her gender-affirming surgery. This reversal followed a year of legal wrangling and a previous finding that such denial violated Title VII of the Civil Rights Act of 1964. The appellate court’s majority—seven judges in favor, five against—concluded that the insurance policy did not discriminate, as it excluded sex change surgeries for all employees, regardless of their biological sex.
“Although the plan does not cover sex change surgeries, it does not treat anyone differently based on a protected characteristic,” court documents stated, according to court records cited in the reporting. The decision vacated a 2022 ruling by Judge Marc Treadwell, which had previously found Houston County and Sheriff Talton liable for sex discrimination and ordered the county’s insurer, Anthem Blue Cross Blue Shield, to provide coverage for gender-affirming surgery.
The saga began when Anna Lange, who had served as a patrol officer since 2006, came out as transgender in 2017. After hormone therapy and feminizing breast surgery, Lange sought insurance coverage for bottom surgery in 2018. Initially told by her insurer that the surgery would be covered, she was denied once the procedure was pre-authorized. Appeals to the insurer and the county were unsuccessful, prompting Lange to file suit in April 2020. In a jury trial, she was awarded $60,000 in damages—an award now nullified by the appellate reversal.
The appellate judges’ reasoning drew heavily on recent Supreme Court precedent. Last year, Judge Charles Wilson had cited the landmark Bostock v. Clayton County decision, which established that discrimination against transgender employees violated Title VII. However, the landscape shifted in the wake of United States v. Skrmetti, a Supreme Court ruling that limited access to gender dysphoria treatments for children, while allowing such treatments for those with qualifying diagnoses. The appellate court concluded that the Houston County policy, though excluding coverage for gender-affirming surgery, did so uniformly and was thus not discriminatory under Title VII.
Lange’s supporters argue that the policy, while facially neutral, disproportionately harms transgender individuals seeking medically necessary care. The appellate court, however, was unconvinced by this argument, writing, “The fact that the plan excludes coverage for one treatment for gender dysphoria is not a penalty in any sense of the word. The plan does not, for example, impose a surcharge on employees who have undergone a sex change. Instead, the plan declines to extend a benefit—namely, coverage for a sex change operation. And that benefit is declined to everyone.”
This setback for transgender rights comes at a time when marriage equality, another pillar of LGBTQ+ civil rights, faces renewed scrutiny—though legal experts say its foundation remains firm. The latest challenge arose from Kim Davis, the former Kentucky county clerk who gained national attention for refusing to issue marriage licenses to same-sex couples following the Supreme Court’s 2015 Obergefell v. Hodges decision. Davis, who spent six days in jail and paid hundreds of thousands in fines, recently appealed to the Supreme Court in a bid to overturn marriage equality.
Despite the alarms raised by Davis’s appeal, legal experts and advocates are quick to tamp down fears. According to Lambda Legal’s interim legal director of litigation, Karen Loewy, “queer couples should feel secure in the future of marriage equality.” Lambda Legal, which played a key role in securing marriage rights a decade ago, points to the Supreme Court’s previous refusal to take up Davis’s case. “Even then, Justice [Samuel] Alito, who we all know would love nothing more than to reverse Obergefell, was like, ‘This is not a vehicle for that,’” Loewy told reporters.
Ezra Ishmael Young, a constitutional law professor in New York, echoed this sentiment, noting, “It is highly unlikely they will want to touch her case for lots of reasons. The vast majority of cases brought to the Supreme Court are long shots.” Young emphasized that there have been no recent court rulings signaling a willingness to overturn Obergefell, and that courts are not enforcing bathroom bans or denying law licenses to LGBTQ+ individuals.
Still, the climate of anti-LGBTQ+ rhetoric and policy, especially within the Republican Party, has left many feeling anxious. Hillary Clinton herself weighed in, warning that the Supreme Court could overturn marriage equality just as it did with the federal right to abortion. Loewy acknowledged these fears, saying, “Everything feels like an existential threat at the moment.” However, she added, “It’s not Kim Davis’ case that has gotten better.”
Even in the unlikely event the Supreme Court were to overturn Obergefell, the practical effects would be limited by the 2022 Respect for Marriage Act. While the Act does not enshrine same-sex marriage nationwide, it requires states to recognize marriages performed elsewhere and protects those already performed. As Young explained, “Marriage is kind of like an on/off switch. You either have it or you don’t.” Existing marriages would remain intact, and couples could still marry in the 15 states (and Washington, D.C.) without same-sex marriage bans.
The Respect for Marriage Act also contains a unique safeguard: it prohibits polygamy nationwide. Young described it as a “poison pill,” making it unlikely the Supreme Court would strike down the Act without opening the door to polygamous marriages—something most justices would be loath to do. Furthermore, federal rights for LGBTQ+ couples were secured in the 2013 United States v. Windsor decision, independent of Obergefell, ensuring continued federal recognition of same-sex marriages.
For many advocates, the focus must now expand beyond marriage and healthcare to other pressing civil rights issues. Young warned that the current climate of increased immigration enforcement poses an existential threat to vulnerable communities, urging the LGBTQ+ movement to remain vigilant: “The White, non-immigrant, LGBT community, need to understand this government is in the process of dehumanizing others, and we need to be vigilant about that. Because if they get away with it, then we could be on the chopping block next.”
As the dust settles on these latest rulings, LGBTQ+ Americans find themselves navigating a legal landscape that is both reassuring and precarious. The right to marry remains largely secure, while access to gender-affirming healthcare faces new barriers. The courts have spoken for now, but the debate—and the fight for equality—continues.