Earlier this morning the Portland, Oregon City Council unanimously voted to remove the trans exclusion clause in their employee health coverage and implement a trans inclusive policy, a proposal brought by mayor Sam Adams. They are only the third municipality ever to do so. This is obviously important to any trans employees of the city, however, it is just as important that the city is recognizing the inherent discrimination involved in trans exclusion clauses, where many specific treatments are covered, until the insurer discovers you are trans.
The oppositions main arguments were "But it's not medically necessary!" and "Not with my tax dollars!" However, both of these knee-jerk reactions are uninformed to say the least. Here is a quick, four point, refutation.
- Uninformed individuals can insist again and again that trans related health care is elective, but that doesn't make it so. The AMA, APA, a number of other medical associations, and even the federal tax court have all deemed that trans related healthcare, including surgery, is medically necessary.
- Trans exclusion clauses deny much more than surgery. I was denied a doctor's visit for an allergy test because I informed and educated my doctor about my current medications in the same visit. Trans people often have medical needs that span both "male" and "female" medical needs, but are cut off from access to one or the other (such as trans men with ovarian cancer or trans women with prostate cancer). In one radical case, a Washington woman was denied coverage for her broken arm because supposedly she wouldn't have been playing for a lesbian softball league if she hadn't transitioned.
- Costs to taxpayers are minimal. In San Francisco they estimated it would cost $5 million and set aside the money for it, later to realize the utilization was low enough that existing premiums were enough to cover it with no increase. When my employer switched to trans inclusive benefits, the insurer offered hormones and therapy (but no surgery) for a $70,000 increase to premiums, but after reviewing utilization data their second offer was to include surgery and all for zero increase. The city's insurer guesses it will cost $32,000, but if other policies are any indication, the costs will ultimately be negligible.
- Covering trans healthcare saves money in the long run. There are many short and long term health problems that may arise from inadequate access to trans related healthcare: back and respiratory problems from long term binding, treatment for anxiety and depression, stress related illnesses, avoidance of preventative care, and alienation from the body resulting in self-destructive behavior. Anecdotally, I know of one person whose annual medical costs were about $30,000. The year after his insurance became trans inclusive, his medical costs were significantly lower. I think it was $3,000.
Ultimately this is a huge victory and part of a larger wave of change as employers recognize both how significant this form of discrimination is as well as how cheap it can be to fix. The city of Seattle is in the news for looking into obtaining trans inclusive health insurance for their employees, and the HRC Corporate Equality Index is going to require trans inclusive healthcare for employers to get a 100% rating starting in 2012.