Transgender Rights: Legal Challenges Against French Health Insurance
Multiple legal actions are underway against the French national health insurance system over alleged discrimination in healthcare access for transgender individuals.
In late December 2023, nine individuals from five different cities, supported by five advocacy groups and represented by attorney Laura Gandonou, initiated legal proceedings against the National Health Insurance Fund (Caisse Nationale d’Assurance Maladie, Cnam) and five regional health insurance funds (Caisse Primaire d’Assurance Maladie, CPAM) in Seine-Saint-Denis, Tarn, Rhône, Haute-Vienne, and Isère.
The plaintiffs filed eight individual appeals simultaneously in the social division of the Lyon judicial court, seeking a unified hearing to address the overarching issue of non-coverage of healthcare for transgender individuals due to their gender identity.
However, on May 2, 2024, the Lyon court declared itself incompetent, citing the division of cases across multiple regions.
In response to this decision, the advocacy organizations and affected individuals decided not to appeal but to continue pursuing their cases regionally across France.
Their objectives have remained consistent over the past two years: to eliminate discrimination against transgender individuals regarding healthcare access, particularly concerning denials of coverage for surgeries and access to long-term illness benefits (ALD 31) for severe medical conditions requiring prolonged treatment.
On March 10, during the first court hearings for two plaintiffs at the Bobigny judicial court, attorney Laura Gandonou noted that the fragmentation of cases among various jurisdictions could yield jurisprudential precedents, potentially leading to common judicial positions on the matter.
Approximately fifty supporters attended the hearings, including representatives from the Pride in Struggle Collective (Collectif Fiertés en Lutte) and the Fransgenre association.
For the participants, the legal actions not only serve the plaintiffs' interests but also critique what they describe as systemic discrimination against transgender individuals in accessing healthcare.
It has been reported that many transgender individuals face refusals for services related to their transition process for various reasons.
The prior approval request, necessitated to confirm coverage from health insurance before undergoing medical procedures as part of gender transition, has also faced criticism.
During the hearings, Sophie Tassel, representing Cnam and the CPAM of Seine-Saint-Denis, clarified that a special regime was established to facilitate and protect transgender individuals, especially given the irreversible nature of gender reassignment surgeries.
She argued that Gandonou's clients did not demonstrate unfavorable treatment compared to other transgender individuals and dismissed the claim of discrimination, stating, 'Transgender individuals receive medical care, and their specific situation is not comparable to that of cisgender individuals.'
Laura Gandonou articulated concerns regarding misinformation provided by the Cnam’s newly established dedicated service for transgender individuals, which she claims led one of her clients to believe in a false prospect of regularization that did not materialize.
She further criticized the notion that recipients' strategies for seeking damages misrepresented their claims, suggesting that this perspective diminishes the gravity of the fundamental issues at stake.
Tassel asserted the obsolescence of the Health Authority's (Haut Autorité de Santé, HAS) protocol, which has been awaited since 2023. She posited that the absence of clear guidelines rendered Cnam vulnerable to the plight faced by transgender individuals, a point Gandonou countered by emphasizing the obligation of institutions to apply legal standards.
Attendees, including Éli and Léo from the CFL, expressed surprise at Tassel's focus on alleged faults of the plaintiffs instead of citing relevant legal texts.
They found the assertion that Cnam suffers due to unclear guidance to be audacious.
The CFL has highlighted Cnam's failure to uniformly organize medical oversight across France, questioning the sustainability of such an argument at future hearings.
They noted the inherent contradiction in Tassel’s claim, which appears at odds with documentation indicating a directive to cease referring to the 1989 protocol.
In concluding remarks, Tassel detailed efforts undertaken to simplify the healthcare processes for transgender individuals, acknowledging the existence of a special regime, while emphasizing that general protocols should apply.
Gandonou reminded the judge of their role in upholding fundamental freedoms and referenced multiple judgments from the European Court of Human Rights (ECHR) that establish precedents regarding transgender rights and healthcare coverage.
These included the landmark Goodwin decision from 1996 and subsequent rulings underscoring the obligation of states to support gender transition-related healthcare.
Benjamin Moron-Puech, a legal scholar specializing in gender issues, remarked that the existing disparities illustrate a lack of coherent legal framework surrounding transgender healthcare in France.
In 2010, former Minister of Health Roselyne Bachelot announced that France would recognize the non-pathological nature of transgender identity, shifting away from classifying it as a mental disorder.
However, this led to the discontinuation of 100% coverage previously provided under specific long-term illness allowances.
With hearings scheduled in Cahors and Toulouse before the summer, the upcoming decision in Bobigny is expected to be announced on June 23, which could either fully dismiss the claims or acknowledge the abusive nature of the CPAM decision while failing to address the broader implications of the healthcare treatment received by transgender individuals.
The plaintiffs filed eight individual appeals simultaneously in the social division of the Lyon judicial court, seeking a unified hearing to address the overarching issue of non-coverage of healthcare for transgender individuals due to their gender identity.
However, on May 2, 2024, the Lyon court declared itself incompetent, citing the division of cases across multiple regions.
In response to this decision, the advocacy organizations and affected individuals decided not to appeal but to continue pursuing their cases regionally across France.
Their objectives have remained consistent over the past two years: to eliminate discrimination against transgender individuals regarding healthcare access, particularly concerning denials of coverage for surgeries and access to long-term illness benefits (ALD 31) for severe medical conditions requiring prolonged treatment.
On March 10, during the first court hearings for two plaintiffs at the Bobigny judicial court, attorney Laura Gandonou noted that the fragmentation of cases among various jurisdictions could yield jurisprudential precedents, potentially leading to common judicial positions on the matter.
Approximately fifty supporters attended the hearings, including representatives from the Pride in Struggle Collective (Collectif Fiertés en Lutte) and the Fransgenre association.
For the participants, the legal actions not only serve the plaintiffs' interests but also critique what they describe as systemic discrimination against transgender individuals in accessing healthcare.
It has been reported that many transgender individuals face refusals for services related to their transition process for various reasons.
The prior approval request, necessitated to confirm coverage from health insurance before undergoing medical procedures as part of gender transition, has also faced criticism.
During the hearings, Sophie Tassel, representing Cnam and the CPAM of Seine-Saint-Denis, clarified that a special regime was established to facilitate and protect transgender individuals, especially given the irreversible nature of gender reassignment surgeries.
She argued that Gandonou's clients did not demonstrate unfavorable treatment compared to other transgender individuals and dismissed the claim of discrimination, stating, 'Transgender individuals receive medical care, and their specific situation is not comparable to that of cisgender individuals.'
Laura Gandonou articulated concerns regarding misinformation provided by the Cnam’s newly established dedicated service for transgender individuals, which she claims led one of her clients to believe in a false prospect of regularization that did not materialize.
She further criticized the notion that recipients' strategies for seeking damages misrepresented their claims, suggesting that this perspective diminishes the gravity of the fundamental issues at stake.
Tassel asserted the obsolescence of the Health Authority's (Haut Autorité de Santé, HAS) protocol, which has been awaited since 2023. She posited that the absence of clear guidelines rendered Cnam vulnerable to the plight faced by transgender individuals, a point Gandonou countered by emphasizing the obligation of institutions to apply legal standards.
Attendees, including Éli and Léo from the CFL, expressed surprise at Tassel's focus on alleged faults of the plaintiffs instead of citing relevant legal texts.
They found the assertion that Cnam suffers due to unclear guidance to be audacious.
The CFL has highlighted Cnam's failure to uniformly organize medical oversight across France, questioning the sustainability of such an argument at future hearings.
They noted the inherent contradiction in Tassel’s claim, which appears at odds with documentation indicating a directive to cease referring to the 1989 protocol.
In concluding remarks, Tassel detailed efforts undertaken to simplify the healthcare processes for transgender individuals, acknowledging the existence of a special regime, while emphasizing that general protocols should apply.
Gandonou reminded the judge of their role in upholding fundamental freedoms and referenced multiple judgments from the European Court of Human Rights (ECHR) that establish precedents regarding transgender rights and healthcare coverage.
These included the landmark Goodwin decision from 1996 and subsequent rulings underscoring the obligation of states to support gender transition-related healthcare.
Benjamin Moron-Puech, a legal scholar specializing in gender issues, remarked that the existing disparities illustrate a lack of coherent legal framework surrounding transgender healthcare in France.
In 2010, former Minister of Health Roselyne Bachelot announced that France would recognize the non-pathological nature of transgender identity, shifting away from classifying it as a mental disorder.
However, this led to the discontinuation of 100% coverage previously provided under specific long-term illness allowances.
With hearings scheduled in Cahors and Toulouse before the summer, the upcoming decision in Bobigny is expected to be announced on June 23, which could either fully dismiss the claims or acknowledge the abusive nature of the CPAM decision while failing to address the broader implications of the healthcare treatment received by transgender individuals.
