Document ID: ./input/supremecourt_opinions/opinions/19pdf/17-1618_hfci.pdf
Page Number: 87.0

50 

BOSTOCK v. CLAYTON COUNTY 

ALITO, J., dissenting 

the ministerial exception?  Provisions of Title VII provide 
exemptions for certain religious organizations and schools 
“with respect to the employment of individuals of a partic-
ular religion to perform work connected with the carrying 
on”  of  the  “activities”  of  the  organization  or  school,  42 
U. S. C. §2000e–1(a); see also §2000e–2(e)(2), but the scope 
of these provisions is disputed, and as interpreted by some 
lower courts, they provide only narrow protection.55
  Healthcare.    Healthcare  benefits  may  emerge  as  an  in-
tense battleground under the Court’s holding.  Transgender
employees  have  brought  suit  under  Title  VII  to  challenge
employer-provided health insurance plans that do not cover 
costly  sex  reassignment  surgery.56    Similar  claims  have 
been brought under the Affordable Care Act (ACA), which
broadly  prohibits  sex  discrimination  in  the  provision  of
healthcare.57 

—————— 

55 See,  e.g.,  EEOC  v. Kamehameha  Schools/Bishop  Estate,  990  F.  2d 
458, 460 (CA9 1993); EEOC v. Fremont Christian School, 781 F. 2d 1362, 
1365–1367  (CA9  1986);  Rayburn  v.  General  Conference  of  Seventh-day 
Adventists, 772 F. 2d 1164, 1166 (CA4 1985); EEOC v. Mississippi Col-
lege, 626 F. 2d 477, 484–486 (CA5 1980); see also Brief for United States
Conference of Catholic Bishops et al. as Amici Curiae in No. 18–107, at 
30,  n. 28  (discussing  disputed  scope).    In  addition,  42  U. S. C.  §2000e–
2(e)(1)  provides  that  religion  may  be  a  BFOQ,  and  allows  religious
schools  to  hire  religious  employees,  but  as  noted,  the  BFOQ  exception 
has been read narrowly.  See supra, at 48. 

56 See,  e.g.,  Amended  Complaint  in  Toomey  v.  Arizona,  No. 4:19–cv– 
00035 (D Ariz., Mar. 2, 2020).  At least one District Court has already
held that a state health insurance policy that does not provide coverage 
for sex reassignment surgery violates Title VII.  Fletcher v. Alaska, ___ 
F. Supp. 3d ___, ___, 2020 WL 2487060, *5 (D Alaska, Mar. 6, 2020). 

57 See,  e.g.,  Complaint  in  Conforti  v.  St.  Joseph’s  Healthcare  System, 
No.  2:17–cv–00050  (D  NJ,  Jan.  5,  2017)  (transgender  man  claims  dis-
crimination under the ACA because a Catholic hospital refused to allow
a surgeon to perform a hysterectomy).  And multiple District Courts have
already concluded that the ACA requires health insurance coverage for 
sex reassignment surgery and treatment.  Kadel v. Folwell, ___ F. Supp.
3d  ___,  ___,  2020  WL  1169271,  *12  (MDNC,  Mar.  11,  2020)  (allowing