Op-ed: Victories for Trans Health Care Are Closer Than We Dreamed

By Mara Keisling

Originally published on Advocate.com June 24 2014 6:00 AM ET

Unlike any month in memory, this June already has been especially significant for LGBT people. With clearly shifting views of transgender people, Laverne Cox on the cover of Time, and the enactment of real protections for LGBT workers with the imminent signing of the federal contractors nondiscrimination order — this Pride month has really delivered for all of us.

Although less visible, other recent changes at the federal and state levels also have been extraordinarily important for transgender health care rights. Two actions by the federal government — combined with state and local victories banning insurance exclusions and the growing number of inclusive insurance plans in the private sector — signal an impending end to discriminatory health care exclusions.

And as I was writing this, I learned that Massachusetts governor Deval Patrick did what Washington, D.C., mayor Vincent Gray did earlier this year — ban insurance exclusions in public and private health care plans across the state. I can barely keep up.

Without a doubt, we’ll soon live in a country where every transgender person’s health care needs will be covered under all insurance plans without caveats in the fine print, and decisions can be made by doctors and patients based on modern medicine.

Early this month, an independent board that adjudicates disputes for Medicare beneficiaries ruled that blanket exclusions against transition-related care are contrary to today’s medical science. The ruling takes government out of doctors’ offices and makes surgical treatments and hormone therapy an option for many Medicare patients and their doctors.

Exactly one week later, the Office of Personnel Management, which conducts the “human resources” functions of the federal government, told insurance companies that it could no longer justify the ban on transition-related care for federal employees. With this decision, insurance companies who run federal employee health benefits plans can begin considering transgender health care needs just like other types of medical care.

These recent back-to-back wins are small markers in the forward change we’ve seen on health care rights among private employers, state insurance regulators, and in the courts.

Americans are tired of health care decisions being made by legislatures, employers, and especially insurance carriers. They want health care decisions to be made by doctors and patients based on modern medical standards. We are seeing decisions that do just that.

The Human Rights Campaign’s Corporate Equality Index also has been an important catalyst for private employers to include transition-related care in their health care plans. According to the CEI, in 2009 only 50 corporate workplaces provided baseline trans-inclusive coverage in line with the clinical guidelines provided by the World Professional Association for Transgender Health. These baseline treatments include hormones, mental health coverage, and sex reassignment surgeries. That number today is 340 employers.

As more private sector employers begin to understand transgender health care needs, I’m sure that the upward trend of employers proactively creating trans-inclusive health care plans will solidify and the discriminatory and unnecessary insurance exclusions will all disappear.

While the federal government and private employers evolve on our health care rights, state-level changes remain vital as well. And we expect to see more and more support from states that have stood against transgender discrimination. Today, in addition to Massachusetts, five other states (California, Colorado, Connecticut, Oregon, and Vermont) and the District of Columbia have determined that the insurance carriers they regulate that denying transition-related care under these exclusions is unlawful. Notably, these victories were all won within the last 18 months with more states to follow.

An important part of our advocacy at the National Center for Transgender Equality is ensuring that any transgender person who needs treatment for gender dysphoria is able to access it. And we are winning.

That’s the landscape we see today. On every front, we’re chipping away at and — in some cases — breaking down the barriers that have kept transgender people away from their right to transition-related care.

But we’ve got more work to do, and the National Center for Transgender Equality is laying the foundation for that work. We’ve got to make sure that more providers accept Medicare so Medicare patients can access their health care benefits. We’ve got to work with 50+ state Medicaid programs so they get out from between doctors and patients and let these legitimate medical treatment be prescribed. We’ve got to make sure that this time next year, the Office of Personnel Management outright declares an end to exclusions in their next federal employee insurance review process. We’ve got to get more state insurance regulators on board with disallowing these exclusions. We have work to do with transgender health care benefits for veterans. And we need to make sure that transgender people — employed or not, in prison or not, and undocumented or not — have access to health care insurance to begin with.

So as I take stock in these victories, I’m more optimistic than ever that we’re going to win and eliminate all of these discriminatory exclusions much sooner than anyone of us would have dreamed only a few years ago.

MARA KEISLING is the executive director of the National Center for Transgender Equality, a transgender social justice organization. Follow NCTE and Mara on Twitter.