By Daniel Wiessner
2026年3月10日 美国东部时间下午6:20 更新于2小时前
- 摘要
- 法院称，禁止特定手术不构成歧视
- 此案是跨性别者权利更广泛斗争的一部分
- 裁决是在美国最高法院维持田纳西州法律之后做出的
3月10日（路透社）- 美国上诉法院周二维持了西弗吉尼亚州禁止医保覆盖性别确认手术的规定，这是共和党领导的各州在全国持续进行的跨性别者权利争议中取得的又一次胜利。
在一项一致通过的裁决中，弗吉尼亚州里士满的美国第四巡回上诉法院的三名法官组成的合议庭推翻了一名法官的裁决，该法官认为2004年的法律违反了两项联邦法律的反歧视保护条款以及美国宪法规定的法律平等保护原则。
（此处为图片占位符，原文中该位置有一张图片）
该法律适用于特定手术而非特定个人，因此并不构成对跨性别者的非法歧视。
共和党总统唐纳德·特朗普领导的政府已加入共和党主导的各州行列，试图限制性别确认治疗及更广泛的跨性别者权利。
美国已有超过十几个州禁止或限制医保对性别确认治疗的覆盖。Medicaid（医疗补助计划）是为低收入人群提供的联邦与州联合健康保险项目。
第四巡回上诉法院成为首个支持此类法律的联邦上诉法院，此前美国最高法院去年驳回了对田纳西州一项禁止对未成年人实施性别确认治疗的法律的质疑。
2024年，第四巡回上诉法院全体法官以8:6的投票结果判定西弗吉尼亚州的法律具有歧视性并予以推翻，但最高法院去年鉴于田纳西州案件的判决，指示该法院重新审理此案及另一宗涉及北卡罗来纳州的案件。
周二做出裁决的三名法官均由共和党总统任命，其中两名由特朗普任命，一名由乔治·H·W·布什任命。他们在2024年第四巡回上诉法院全体法官以8:6裁决西弗吉尼亚州法律无效时均投了反对票。周二，他们在35页的裁决中引用了最高法院70次判决，提出了类似的推理。
“立法机构拒绝资助可能产生相反效果的实验性程序，以鼓励公民珍视自身性别而非蔑视性别，这并非不合理，”特朗普任命的法官朱利叶斯·理查森写道。
西弗吉尼亚州法律中涉及的手术类型通常会改变身体特征以符合个人性别认同，包括胸部重建、生殖器改造和面部手术。
西弗吉尼亚州总检察长约翰·麦卡斯基（共和党人）表示，该州不应补贴”未经证实的非必要医疗程序”。
“每花在这些未经证实的程序上的一美元，就意味着减少了本可用于治疗癌症、心脏病和糖尿病的资金，”麦卡斯基说。
代表原告肖恩泰·安德森的LGBT权利组织Lambda Legal尚未立即回应置评请求。
美国地区法官罗伯特·钱伯斯（民主党前总统比尔·克林顿任命）2022年曾做出有利于安德森的裁决。
第四巡回上诉法院去年将北卡罗来纳州类似法律的案件发回下级法院重审。至少还有佛罗里达、佐治亚和亚利桑那等七个州因禁止或限制性别确认治疗的医保覆盖而面临诉讼。
特朗普已发布一系列关于跨性别者权利的行政命令，包括宣布只有男性和女性两种性别，且人的性别无法改变。他还禁止跨性别者加入美国军队。
特朗普政府提议，如果医疗服务提供者向未成年人提供性别确认治疗，将禁止其获得联邦医疗保险和医疗补助项目的资金，这一举措引发了正在审理的诉讼。
负责执行消费者保护法的联邦贸易委员会正在调查医疗团体对性别确认治疗的支持情况，医疗团体称此举是对宪法保护言论的非法报复。
（注：原文中部分链接和代码块内容因格式问题无法完全展示，此处为完整译文）
报道：Daniel Wiessner 来自纽约州奥尔巴尼；编辑：Will Dunham 和 Alexia Garamfalvi
我们的标准：路透社信托原则.
West Virginia can ban Medicaid coverage for gender-affirming surgery, US court rules
By Daniel Wiessner
March 10, 2026 6:20 PM UTC Updated 2 hours ago
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A person holds a flag as the Capitol is seen in the background during a Transgender Day of Visibility rally on the National Mall in Washington, D.C., U.S., March 31, 2025. REUTERS/Evelyn Hockstein/File Photo Purchase Licensing Rights, opens new tab
- Summary
- Ban on specific surgeries not discriminatory, court says
- Case is part of broader battle over transgender rights
- Ruling follows US Supreme Court upholding Tennessee law
March 10 (Reuters) – A U.S. appeals court on Tuesday upheld West Virginia’s ban on Medicaid coverage for gender-affirming surgeries, the latest victory for Republican-led states seeking to curb the procedures amid an ongoing national battle over transgender rights.
In a unanimous ruling, opens new tab, a three-judge panel of the 4th U.S. Circuit Court of Appeals in Richmond, Virginia, overturned a judge’s decision that the 2004 statute violated anti-discrimination protections under two federal laws as well as the U.S. Constitution’s promise of equal protection under the law.
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The 4th Circuit panel wrote that the law applies to specific procedures and not to specific individuals, and so it does not unlawfully discriminate against transgender people.
Republican President Donald Trump’s administration has joined Republican-led states in seeking to curb gender-affirming treatment and transgender rights more broadly.
More than a dozen U.S. states prohibit or limit Medicaid coverage for gender-affirming care. Medicaid is the joint federal-state health insurance program for low-income people.
The 4th Circuit became the first federal appeals court to uphold such a law, and did so after the U.S. Supreme Court last year rejected a challenge to a Tennessee law that bans gender-affirming treatment for minors.
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The full 4th Circuit in 2024 had struck down West Virginia’s law as discriminatory, but the Supreme Court last year directed it to reconsider this case and a separate one involving North Carolina, in light of its decision in the Tennessee case.
The three judges on the panel that ruled on Tuesday were appointed by Republican presidents, two by Trump and one by George H.W. Bush. All three had dissented in 2024 when the full 4th Circuit in an 8-6 ruling declared West Virginia’s law invalid. They laid out similar reasoning on Tuesday while citing the Supreme Court ruling 70 times over 35 pages.
“It is not irrational for a legislature to encourage citizens to appreciate their sex and not become disdainful of their sex by refusing to fund experimental procedures that may have the opposite effect,” Judge Julius Richardson, a Trump appointee, wrote for the court.
The type of surgeries at issue in the West Virginia law generally alter physical characteristics to align with a person’s gender identity, including chest reconstruction, genital alteration and facial procedures.
West Virginia Attorney General John McCuskey, a Republican, said the state should not be subsidizing “unproven, non-essential medical procedures.”
“Every dollar spent on these unproven procedures takes away funding that could be used to treat cancer, heart disease and diabetes,” McCuskey said.
Lambda Legal, an LGBT rights group that represents plaintiff Shauntae Anderson, did not immediately respond to a request for comment.
U.S. District Judge Robert Chambers, an appointee of Democratic former President Bill Clinton, had ruled in favor of Anderson in 2022.
The 4th Circuit last year sent the case involving a similar North Carolina law back to a lower court for further proceedings. At least seven other states including Florida, Georgia and Arizona have faced lawsuits for banning or limiting insurance coverage for gender-affirming care.
Trump has issued a series of executive orders on transgender rights including a proclamation that there are only two sexes, male and female, and a person’s sex cannot change. Trump also banned transgender people from the U.S. military.
The Trump administration has proposed barring providers from receiving funds under the Medicare and Medicaid government insurance programs if they provide gender-affirming treatment to minors, prompting lawsuits that are pending.
The Federal Trade Commission, which enforces consumer protection laws, is investigating medical groups over their support for gender-affirming treatments, an action the groups call unlawful retaliation for constitutionally protected speech.
Reporting by Daniel Wiessner in Albany, New York; Editing by Will Dunham and Alexia Garamfalvi
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