There is a reason we don't allow minors to make life-changing decisions. If anything, the Left is more restrictive than the Right on many such decisions; they want to raise the age to buy any kind of firearm to 21, for example. The two real standout exceptions are in voting, where some among the far left are seeking to drop the voting age to 16.
The other is in "gender-affirming care," where minors who cannot legally buy a beer or get married are supposed to be just A-OK with making decisions regarding medical treatments, therapies, and even surgeries that are irreversible, life-altering, and in many cases, debilitating.
This brings us to Washington (the state, not the city), where a healthcare insurance company, Premera Blue Cross, is on the hot seat in a legal battle over its refusal to cover elective "gender-affirming" care for two minor girls.
Last year, a federal court in Washington State ruled that Premera Blue Cross unlawfully discriminated when it refused to cover elective double mastectomies for two young girls. The decision read like a harsh warning to every employer: exclude gender-transition procedures for children from your health plan and risk an Affordable Care Act discrimination claim. But the story doesn’t end there.
In July 2026, the United States filed a brief urging the Ninth Circuit to reject that court’s misguided reasoning.
You can view that original decision by the United States District Court for the Western District of Washington at Seattle here.
That brief by the United States Department of Justice's Civil Rights Division can be viewed here. It says in part:
Appellees in this case argue that Premera's policy constitutes sex discrimination in violation of Section 1557 of the ACA. They are wrong. Far from being discrimination on the basis of sex, this sensible policy is rooted in biological reality, developmental psychology, and medical diagnosis. As recently explained by the Supreme Court in United States v. Skrmetti, 605 U.S. 495, 514 (2025), regulating medical procedures on the basis of diagnosis does not automatically amount to discrimination on the basis of sex.
The DOJ rightly affirms the key point in this case: This is not a matter of sex discrimination. If two girls, or a hundred, or a thousand were to apply to Premera Blue Cross to cover these elective treatments, the answer would be the same, as it would be for any number of boys who applied for similar treatment. The only sane answer is "no." These are elective procedures that serve no identifiable medical purpose.
That's the gist of the matter: This is not a matter of biology, but of a social contagion. There is no discrimination based on sex. The girls in question remain girls. They each have two X chromosomes. They are female, and the surgeries they are requesting Premera to cover are elective. The insurance company is right to deny payment.
Here's what that boils down to:
At the heart of the argument sits a single contested phrase: “medically necessary.” Health plans cover what is medically necessary and decline what is not. Yet the claim that surgically transitioning a child is “medically necessary” does not rest on science but rather on an ideology and reliance on the discredited standards issued by the World Professional Association for Transgender Health (WPATH). The Federal Trade Commission and several states are now suing WPATH, alleging that it stripped age limits for mastectomy and genital surgery from its “Standards of Care” without evidentiary basis and labeled virtually every pediatric “transition” service “medically necessary.”
In other words, this was a case decided on a social issue, not a medical one; this was a court bowing to a political agenda, rather than the law.
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While this argument all boils down to the matter of payment, there are larger issues in these kinds of treatments and surgeries being carried out on minors.
First, as I've said and written many times, there is the matter of medical ethics. Primum non nocere - "first, do no harm" - is somehow thought to evaporate away when it comes down to removing healthy tissue and administering irreversible hormonal therapies, all of which can only be defined as "harm." Adults, mind you, can legally give informed consent; children cannot.
Second, the payment issue: Even for adults, who can give informed consent, the medical insurance companies can and should refuse to cover these treatments. They are purely elective; they serve no medical purpose, and like any cosmetic procedure, they should be paid for solely by the patient.
In fact, this is the real nub of this issue. The advocates for "gender-affirming" care love to cast these treatments as medically necessary. But for a person claiming gender dysphoria, a real psychological disorder, the denial of medical and biological reality is not the answer. These are not medically necessary procedures; they are cosmetic treatments, just like a tummy-tuck or a nose job. They are purely elective and purely cosmetic; the young women who are plaintiffs in this case will remain girls, no matter how many elective surgeries they have undertaken. They remain girls because you cannot change sex, not through surgery, not through hormone therapy, not at all.
Purely cosmetic, and the cost should not be shared among Premera Blue Cross's clients.
This appears to be a case that could have wide-ranging implications for the young people buying into the social contagion of "transgenderism." Gender dysphoria remains a real thing, and people diagnosed thusly have a more legitimate claim to coverage, but for therapy, not for surgery or hormonal treatments.
