NEW HAVEN (LN) — U.S. District Judge Victor A. Bolden on Friday denied Aetna Life Insurance Company’s motion to stay a preliminary injunction requiring the insurer to make individualized coverage determinations for gender-affirming facial reconstruction, rejecting the company’s argument that compliance would cause irreparable harm or that it had a substantial likelihood of success on appeal.

The ruling resolves a procedural standoff in Gordon et al. v. Aetna Life Insurance Company, where transgender women Binah Gordon, Kay Mayers, Alma Avalle, Jamie Homnick, and Gennifer Herley sued the insurer under Section 1557 of the Affordable Care Act, alleging discrimination based on sex.

On March 8, 2026, Bolden granted a preliminary injunction for Dr. Homnick and Dr. Herley, ordering Aetna to stop categorically excluding their claims under Clinical Policy Bulletin 0615 and instead evaluate their requests for gender-affirming facial reconstruction based on medical necessity.

Aetna filed a notice of appeal and a motion to stay the injunction on March 31, 2026, arguing that compliance would alter its contractual responsibilities to plan sponsors and that the Supreme Court’s recent decision in United States v. Skrmetti suggested it would likely prevail on appeal.

The insurer pointed to rulings from the Fourth, Eighth, Ninth, Tenth, and Eleventh Circuits that applied Skrmetti to hold that health plans excluding treatments for gender dysphoria while covering them for other diagnoses are not facially discriminatory.

Bolden disagreed, noting that Skrmetti did not address statutory sex discrimination claims under the ACA and that the Second Circuit is bound by the Supreme Court’s Bostock precedent, which establishes that sex is a but-for cause of discrimination when treatment availability changes based on a patient’s sex assigned at birth.

Citing his prior order, Bolden wrote, “The Court already determined that because the availability of a medical necessity determination would change based on the patient’s sex assigned at birth, the ‘but-for’ test to establish sex discrimination set forth in Bostock has been satisfied.”

The judge also rejected Aetna’s claim that it would suffer irreparable harm from complying with the order, noting that the plan sponsors had delegated coverage determinations to Aetna and that the insurer could not claim harm from terminating an unlawful practice.

Bolden further ruled that the risk of mootness for Aetna’s appeal did not constitute irreparable injury, particularly because the central legal issue regarding CPB 0615 remained relevant to the remaining plaintiffs’ claims.

The plaintiffs had also filed an emergency motion to enforce the injunction and hold Aetna in contempt for alleged noncompliance.

Bolden denied the motion to enforce without prejudice to renewal, finding that while the order was clear and unambiguous, it did not set a fixed deadline for compliance, and Aetna had not yet failed to act within a specified time.

However, the judge warned that Aetna must now act with “reasonable diligence” in complying with the order, and the plaintiffs may renew their enforcement motion if the insurer fails to take reasonable steps to comply.

Aetna’s counsel had previously emailed plaintiffs’ counsel on March 30, 2026, arguing that the insurer would face irreparable harm if required to comply with the Court’s Order.

The case continues for the remaining plaintiffs, who are seeking broader relief for the putative class of similarly situated individuals.