February 17, 2018

Cincinnati PL Board Votes Not To Support Coverage of Gender Confirmation Surgery

Rachel Dovel
Photo credit: Nat Kutcher

In a decision that could have reverberations for library employees across the country, the board of the Public Library of Cincinnati and Hamilton County (PLCHC) announced at its June 14 meeting that the library will not add a rider to its health plan that would cover gender confirmation surgery for Rachel Dovel, who has worked at the library for more than a decade. The seven-member board cited the rider’s additional costs, which would be passed on to the library and its employees.

In April Dovel filed a Title VII discrimination claim with the U.S. Equal Employment Opportunity Commission (EEOC), which is currently pending, and she and her attorneys are now prepared to file a gender discrimination lawsuit against the library. In the meantime, local activists and advocates have taken up her cause, calling on the library to demonstrate the support for the LGBT community that has made Cincinnati a model city for gay rights and inclusiveness.


Dovel, an electronic line assistant at PLCHC, came out as transgender to her coworkers last year, changing her name legally from Nathan in February 2015. She had been transitioning for about a year at that point and was preparing for the next step of gender confirmation surgery. Dovel assumed the surgery—estimated to cost about $25,000—would be covered under PLCHC’s insurance plan as its carrier, Anthem Blue Cross and Blue Shield, is one of a growing number of insurers that offer coverage for gender confirmation surgery.

However, on June 26, 2015, the same day that the right to same-sex marriage was signed into law by the Supreme Court, Dovel was informed that the library would not cover her surgery because it was outside of its core group benefits.

Dovel and her attorney at the time, Josh Langdon, informed Anthem that this exclusion constituted gender discrimination in violation of the Affordable Care Act. And at a PLCHC board meeting in October, Dovel requested that the library amend its insurance contract, explaining why coverage for the surgery was essential for herself and other transgender employees. Library employee Nat Kutcher also spoke in favor of providing coverage for the surgery, and Jonah Yokoyama, director of the Cincinnati-based Heartland Trans Wellness Group, provided a slide show with more information on trans issues.

In November, Anthem applied to the Ohio Department of Insurance (ODI) to offer a transgender health services policy rider to fully insured groups. The optional coverage would include hormone therapy and other transition-related services.

In mid-December, the library was notified that Anthem’s request for the policy rider was approved by ODI. The gender confirmation surgery rider, as well as four others—gastric bypass surgery, infertility medical treatment, infertility prescriptions, and sexual dysfunction drugs—would become available as of the first day of 2016, at a premium increase of 0.73 percent.

According to a press release issued by the library, this would add approximately $250,000 a year in expenses for the library and its employees. The library would renew its benefits in August, but the riders could be added at any point; however, at the February 2016 meeting, the board recommended that no changes be made to the current contract until it expires on July 31.

At the same meeting several library employees, including Dovel, addressed the board in favor of the riders being added. Dovel pointed out that a number of other large employers in the area, such as Kroger, Procter & Gamble, and Fifth Third Bank, as well as the city of Cincinnati, provide gender confirmation surgery coverage. (Ten states and the District of Columbia have banned transgender exclusions in most health plans, but Ohio has not.)

“We hoped that the library board would then say, ‘OK, we’ll get the rider and we can give her access to this medical coverage,’ ” Dovel’s current attorney, Scott Knox, told LJ.

The board was set to meet again on April 12, but as only four of the seven board members were present, the discussion was tabled by board president Elizabeth LaMacchia and moved to the board’s June meeting. A previously scheduled news conference went on as planned outside the library, however. In addition to Dovel and Langdon, advocates in attendance included Callie Wright of Heartland Trans Wellness; Maurice Eckstein of the Human Rights Campaign, a national LGBT civil rights organization; local transgender rights activist Paula Ison; Cincinnati Police Department LGBT outreach officers; and Cincinnati City Council member Chris Seelbach. Seelbach, the city’s first openly gay councilman, lobbied in 2014 for the coverage of gender confirmation procedures under the City of Cincinnati’s health insurance, leading a council majority to sign a letter in favor of the change.


The PLCHC human resources committee met privately on June 2, at which time it formulated its recommendation that the rider not be added. At the regular meeting on June 14, the board announced its unanimous vote not to add any riders to the library’s insurance plan.

It was a business decision, LaMacchia told Dovel after the board meeting. “Given the recent downward trend in state funding, the Board feels the fiscally responsible action is to exclude the addition of any riders. Excluding all riders continues our past practice, keeps management or the Board from picking and choosing from a number of riders, and helps control rising health insurance costs,” LaMacchia explained in a library press release. The estimated additional $250,000 would impact the library’s current budget of $63.69 million, and human resources had never considered adding only the single rider for the surgery, PLCHC marketing team manager Chris Rice told LJ, explaining, “If we say yes to one, how do we say no to another?”

“This isn’t just not supporting me,” a visibly unhappy Dovel told the board. “This is not supporting every single one of your employees, and you should be ashamed of yourselves.”

The next step, Knox told LJ, will be a federal lawsuit. “We’re already preparing a complaint and looking into the legal theory so we can aggressively pursue this,” he said. “We think it’s the right time to do it, and the way the law’s been recognizing discrimination against transgender employees we think that it has promise.”

“It is quite unfortunate that the library’s board has exposed the library to federal litigation by treating Rachel’s case as a business dispute rather than a civil rights issue,” noted Langdon.

“They’ve let down every single one of their employees today, and I’m ashamed of them,” Dovel said at a press conference after the library board meeting. “I hope someday they change their minds. If not, I think history will look poorly on the decision that they’ve made here today.”


Cincinnati has worked hard over the past couple of years to reverse its reputation as being unfriendly to LGBT rights. In 2004 the city’s charter was amended to repeal Article XII, which blocked job and housing protections for the LGBT community, and in the past few years the city began offering same-sex benefits to all city employees, with LGBT liaison officers established in the police and fire departments and the mayor’s office. Cincinnati has also offered domestic partner registries since June 2014 so that same-sex couples can take advantage of company benefits. The city currently scores a perfect 100 on the Human Rights Campaign’s Municipal Equality Index city scorecard.

The library board decision was “a setback for our city,” Seelbach told the Cincinnati Enquirer.

“This is not some kind of feel-good legislation,” Seelbach added to LJ. “This is affecting the health of a person, what her medical doctor says she needs in order to be a successful, healthy human being. That decision should not be made by a library board who, through their own demographics, do not reflect the county which they represent.” The board’s seven members, who are appointed to seven-year terms by the Hamilton County Court of Common Pleas and the Hamilton County Commission, are nearly all white and older.


In the wake of the board’s decision, many members of the community have been vocal about their negative feelings toward PLCHC. But at least one library employee, who wishes to remain anonymous, feels that anger toward the library itself is misplaced. “My understanding is that library administration and human resources actually recommended unanimously to the board that the rider coverage should be approved,” he told LJ. “That, for some reason, has not seeped down into everybody’s consciousness, I’m not sure why.”

PLCHC director Kimber Fender is drawing fire for a decision that wasn’t hers, he believes. “An unfortunate casualty of this whole situation is I think she’s been unfairly demonized,” he told LJ. “I think people don’t realize that she has actually tried her best to be supportive. It just hasn’t trickled down into the narrative that’s circulating among staff.” Fender did not wish to comment.

Contributing to the problem, the employee said, is a lack of clear lines of communication between library administration and employees. A recent staff engagement survey “showed in no uncertain terms that communication…was a huge issue.” He added, “That’s something that they are really making huge strides toward changing right now, trying to be more open about decision-making processes.” This situation, however, represents “a missed opportunity.”

While council member Seelbach understands that the decision lay with the library board and not its administrative policies, he told LJ, “I don’t feel comfortable visiting a library where I know that the people who are in control of it are this uneducated and this unwavering in their ability to research an issue, understand the facts, and understand that this is about the life and health of a person.”

“Jim Obergefell’s decision to move his historic book signing because of their decision is one of the many repercussions the library board will see as a result of their poor decision,” Seelbach told Cincinnati.com. After the decision was made, Obergefell, one of the lead plaintiffs in the 2015 Supreme Court marriage equality decision, elected to skip the downtown library branch on his book tour in June, instead holding the signing at local Joseph-Beth Booksellers. Love Wins: The Lovers and Lawyers Who Fought the Landmark Case for Marriage Equality (Morrow), coauthored with Debbie Cenziper, tells the story of those who fought for the legalization of same-sex marriage; Obergefell played a pivotal part in the testimony after he was not allowed to marry his partner John Arthur, who was dying of ALS, in their hometown of Cincinnati.

Knox is hoping that the library board agrees to a policy change outside of court. For now, Dovel continues her work at PLCHC. “I would like to continue working for the library as a happier, healthier, more productive person, just like any employee who gets the medical care that they need,” she told LJ. “I believe in the philosophy of libraries, and I find working here to be a fulfilling experience on that level. I just hope that after this situation is resolved, I can move forward working for the good of the library, secure in the knowledge that the library is likewise working for the good of myself and all [its] employees, including…LGBT ones.”

Lisa Peet About Lisa Peet

Lisa Peet is Associate Editor, News for Library Journal.

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  1. loren klein says:

    Where else in society are people’s private medical histories and decisions submitted for a vote like this? It is women, people of color, and trans people who have to submit to this kind of treatment to get access to medical care. I know ya’ll think we’re gross and maybe not even human, but the privileged among us will keep struggling to get the rights and services we need.