A Georgia county asked a federal appeals court on Tuesday to overturn a ruling that it illegally discriminated against a sheriff’s deputy by failing to pay for her gender-affirmation surgery.

But lawyers for Houston County Sgt. Anna Lange urged a three-judge panel of the 11th U.S. Circuit Court of Appeals to reject the appeal. They said during a hearing in Atlanta that the U.S. Supreme Court has made it clear that denying Lange insurance coverage for the procedure is illegal sex discrimination.

Lange, an investigator for the Houston County sheriff’s office, sued Sheriff Cullen Talton and the county in 2019 after she was denied coverage.

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Anna Lange, a sheriff’s sergeant in Houston County, Ga., poses for a picture Nov. 14, 2023, after a federal appeals court hearing in Atlanta. Houston County is asking the 11th U.S. Circuit Court of Appeals to overturn a lower court ruling that it illegally discriminated against Lange by refusing to pay for her gender-confirmation surgery. (AP Photo/Jeff Amy)

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U.S. District Court Judge Marc Treadwell ruled in 2022 that the county’s refusal to cover Lange’s prescribed gender-affirmation surgery amounted to illegal sex discrimination under the Civil Rights Act of 1964. Treadwell’s order cited the U.S. Supreme Court’s 2020 decision finding that a Michigan funeral home couldn’t fire an employee for being transgender.

The judge ordered the county’s insurance plan to pay for the surgery, and Lange eventually underwent the procedure. A jury awarded Lange $60,000 in damages in 2022.

The county wants to undo Treadwell’s order and the damage award, seeking to argue its case before a jury.

Lange expressed confidence after the hearing that the order and the damage award would stand, saying, “The law is on our side, clearly.”

Houston County argues that the U.S. Supreme Court ruling that prohibits firing people because they are transgender doesn’t apply to health insurance.

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The county also argues that its exclusion of gender-affirmation surgery isn’t discriminatory because the plan pays for some other treatments. A lawyer for the county likens the county’s refusal to pay for Lange’s surgery to its refusal to pay for hearing aids or lap band surgery for weight reduction. The county said it paid for some care for Lange, such as hormone therapy and endocrinologist visits, but was trying to avoid the cost of surgery.

“We have one plan that Sgt. Lange got, just like every other county employee and sheriff’s employee,” lawyer Patrick Lail told the judges on Tuesday.

But lawyers for Lange and the U.S. Department of Justice told judges that Houston County’s arguments should be rejected, pointing to six other court rulings elsewhere that agreed with Treadwell’s decision. The federal government intervened on Lange’s behalf, saying it needed to protect the rights of transgender people and uphold Title VII of the 1964 civil rights law.

“This is a simple case,” argued David Brown, a lawyer for Lange. “The Supreme Court has established that an employer who offers unequal benefits because of sex violates Title VII.”

Attorneys for Lange argued that the court should disregard arguments about other benefits provided to the sergeant or other procedures not covered. Instead, they said, the judges should focus on whether this particular rule excluding gender-affirming surgery was discriminatory.

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“What it creates is an obligation not to treat people differently because of sex,” Justice Department attorney Anna Baldwin said. “You can’t have an exclusion that says we don’t cover lap band surgery because you’re transgender.”

Lange told the sheriff and other officials in 2018 that she wanted to begin dressing as a woman at work, according to court documents, and asked if Houston County’s health plan would pay for gender-affirmation surgery.

Talton, first elected sheriff in 1972, told Lange he doesn’t “believe in sex changes” before ultimately granting her permission to dress as a woman, the documents state.

The county health plan had excluded gender-affirmation surgery and drugs since 1998, and court documents showed Houston County officials kept the exclusion even after the company that administers the plan advised in 2016 that the rule was discriminatory under the federal Affordable Care Act.