Last week, the student newspaper the Brown Daily Herald reported that Brown University would be eliminating a discriminatory rider in its student health insurance plan that banned transgender-specific health care coverage. The plan will now cover up to $50,000 worth of treatment, including sex reassignment surgery, hormone therapies and other treatments.
Genny Beemyn, the director of the Stonewall Center at the University of Massachusetts, Amherst, praised Brown’s decision this week in an interview with Raw Story. “It’s interesting because this is very much a new trend, a very new trend.”
“It’s been less than 10 years since any college had coverage under their student health insurance policy for students who are transitioning,” Beemyn continued. “So the fact that we now have about three dozen colleges that will cover surgeries, will cover hormones for students who are transitioning is all very new, and most of them are in the past couple of years. It’s a trend that I see really accelerating.”
College can be the perfect time to transition, and many have noticed a trend of trans people coming out at a younger and younger ages. In Beemyn’s experience, individuals used to typically transition closer to middle age, but now, people are coming to college who have identified as transgender for years. Indeed, thousands of young people have posted videos, including one particularly heartbreaking video by Josey Julien (posted below) coming out as transgender on YouTube.
Shane Snowdon, director of the Human Rights Campaign’s health and aging program, agreed that the timing can be important for college students. “Each year that you cannot transition when you need and want a gender identity that’s truly yours is a year that is at best difficult and at worst real pain and suffering. Having access during college years just spares you from going on for that many more years without being able to transition to your true gender identity.”
“You can change your college records, your diploma, you can be a different name or gender,” Snowdon explained to Raw Story. “You can present yourself after college into the work world with your actual gender identity.”
Snowdon, who formerly was the founding director of the Center for LGBT Health and Equity at the University of California San Francisco, worked on efforts to expand coverage for transgender individuals at the University of California system. There, she found that one effective way to talk about this was to have students talk about how it would personally impact them, but also to highlight how little this would change health care costs.
“This is not something that’s going to jack up costs for other students to any significant degree,” Snowdon said. “It’s a low cost, high need kind of coverage. Very, very, very few people access it, but those who do, it will have tremendous meaning for.”
It’s not just colleges that are eliminating these discriminatory riders. As a recent analysis of Fortune 500 companies by the Human Rights Campaign (HRC) found, about a quarter of them include health insurance benefits for transgender individuals.
“The prevailing misconception is that this is a choice, that this is cosmetic in nature,” said Deena Fidas, the deputy director of the workplace project at HRC. She points out to Raw Story that many companies have signed on because they want to remain competitive and don’t want to lose valuable employees who might require such care.
One big help to trans activists fighting for this coverage is that the American Medical Association has said since 2008 that it “supports public and private health insurance coverage for treatment for gender identity disorder treatment as recommended by the patient’s physician.” Additionally, the World Professional Association for Transgender Health had produced standards for care for transgender individuals. These standards, the first of their kind, can be used as a guideline for what health practitioners find medically necessary.
“Why it’s happening so frequently now is pretty simple. The medical community now gets this and understands this, that this kind of a decision should really really be between a doctor and a patient,” Mara Keisling, the founding executive director for the National Center for Transgender Equality, told Raw Story. “They’re tired of their health care decisions being made by insurance companies and legislators and college deans. They want medical decisions to be made by doctors and patients, and the medical community now gets this. They understand when a doctor says its medically necessary, it’s medically necessary.”
“Trans people people tend to be caught in this catch-22 where the medical profession and their individual doctor says there’s a treatment will work for you and you should get it, but the insurance company won’t pay for it,” Keisling added.
Many activists are hopeful that it’s only a matter of time before transgender people have full access to treatment, no matter which health insurance plan they have — and with some cities and states banning discriminatory riders, it may not be long.
California passed a law in 2006 that prohibits heath insurance companies from discriminating based on gender identity and regulations issued last November clarified that any treatment prescribed to a cisgender person, or a person whose gender representation matches his or her sex, must be covered when a doctor prescribes it to a trans person. For example, many women receive hormone therapies for menopause, so insurance companies cannot block coverage of hormone therapies for trans people. Portland, Oregon and Seattle have passed similar regulations banning such discriminatory exclusions.
“This is an area that is often overlooked — or has been overlooked in the past,” said Ilona Turner, the legal director for the Transgender Law Center, in an interview. “There’s a real crisis around transgender people in this country lacking access to inclusive, non-discriminatory, medically necessary health care. That is often a barrier for people that stands in the way of people being able to access identity documents that reflect who they are, being able to participate in the workplace, participate in society in every way as they are.”
And the legal framework for ensuring non-discriminatory access is starting to fall into place, Turner points out. The Department of Health and Human Services proposed regulations in November that insurance sold following the implementation of the Affordable Care Act mandates that insurers can’t “discriminate on the basis of race, color, national origin, disability, age, sex, gender identity or sexual orientation.” The final regulation should be issued in the coming weeks.
Still, as Beemyn of the Stonewall Center said, “We’re a long ways away. ”
Kay Steiger is the managing editor of Raw Story. Her contributions have appeared in The American Prospect, The Atlantic, Campus Progress, The Guardian, In These Times, Jezebel, Religion Dispatches, RH Reality Check, and others. You can follow her on Twitter @kaysteiger.
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