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Mitch Kellaway

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Transgender Health Insurance Coverage (Part 1): Ready for Reforms

Posted: 06/17/2013 1:44 pm

Whenever I talk about health insurance -- be it with friends, coworkers, or even providers -- my wheels tend to spin in fruitless frustration or my eyes glaze over in apathy. Insurance policy is largely a labyrinth, and companies benefit from an (arguably) average person like myself not having a map. Even the most dogged can collapse in fatigue, and I know I have done so for "minor" prescriptions. You know, the ones that add up slowly to a fortune, so the burn is just slower?

When I've resigned myself to paying out-of-pocket for that inhaler or that anxiety pill, I know my insurance company, Blue Cross/Blue Shield, has benefitted by not having to cover my expenses. When I've raged, the company has also invisibly benefitted from me socially perpetuating the idea that laymen cannot possibly expect fair, timely insurance coverage. I, like most low-middle income patients, viscerally feel myself to be on the wrong side of this win-lose equation.

It's likely now common knowledge that insurance companies capitalize on offering coverage and then denying it as often as possible. "That's our messed up healthcare system!" many lament, implicitly believing impenetrable health insurance policies to be a logical endpoint of a capitalist economy.

One of the gifts I offer society is my experience as a transgender man. I am inside this economic system in the role of wage-earner, but positioned atypically within the gender system that invisibly upholds social and financial competition. Gender is one of the main shortcuts to coding an individual as worthy of benefitting from (supposedly) limited resources, or as largely expendable. Being a trans man allows me to reexamine the logic of what's accepted as "common" through the eyes of the (as of right now) socially uncommon.

As a man who desires medical affirmation for my gender transition, I've inherited a community history of insurance rejection, which has effectively functioned as yet another strand of social rejection. Decades before me, it was a "given" that gender-confirming medical intervention, in the form of hormone replacement therapy and body-shaping surgeries (chest, genitalia, and facial), were not covered by insurance at all.

Progress has been made on this front, but still relatively few companies and universities consider proactively determining how to include transgender healthcare in their insurance packages. It often isn't even a question brought to the table. When it is, companies and schools work through an economic mutual-benefit, rather than human rights, framework. Right now, this is working for the transgender community to gain incremental aggregate change, albeit a monumental individual change within the lives of an extremely small number of people with access.

Transgender health insurance coverage is granted by companies bolstering a "progressive" face, universities who no longer wish to lose the full productivity of their gender non-conforming alumni, and any institution proactive about their nondiscrimination policy. Other decision-makers are simply convinced by the humanity of a trans worker or loved one who stands before their eyes. While human rights tells us that denial of healthcare is simply not the humane thing to do, insurance remains a private company's choice based on a mixture of fiscal and emotional factors. I look forward to the day that enactment of federal policies will follow the suit of Oregon and California, and directly instruct insurance companies to be trans-inclusive.

Currently we're in a healthcare system bind from which trans people need liberation. As a staunch believer that telling our own stories forms a building block for liberation, I have a story to tell: I've had the privilege of being one of a few thousand trans people a year to whom surgical coverage has been offered.

Receiving even the chance of coverage means standing on the shoulders of the reformers that thoroughly dismantled two particularly destructive pieces of cultural misinformation: that (1) trans healthcare is merely "cosmetic" and (2) will unduly burden employers and tax payers.

The American professional associations in medicine, psychology psychiatry, endocrinology, and obstetrics have unequivocally affirmed what transgender communities have known for decades: hormonal and surgical intervention are medically necessary treatments for those trans-identified folks who express the need. This isn't just an idle desire: there are serious implications for an individual's mental and physical health when they are denied care.

Research has shown that transgender health coverage is a virtually negligible cost for employers (Jamison Green & Associates) and potentially less costly for insurance companies as a form of preventative care against serious and unnecessary future conditions: depression, anxiety, unsafe sex practices, constricted breathing (due to chest binding), self-harm, and social/domestic exposure to violence (Basic Rights Oregon, Oregon Treasurer Ted Wheeler). We know that every state can implement trans-inclusive healthcare within current legal frameworks (Attorney Sara Schnorr, Center for American Progress). We're in a historical moment where transgender and allied communities are positioned to pressure for meaningful reforms.

Until a federal reform, health insurance policies must be changed one-by-one. I stepped into the middle of the crossfire between America's current institutionally oppressive healthcare system and trans community-based resistance by being part of the right institution at the right time. Three years into my undergraduate degree, my institution opted to cover chest reconstruction (and soon followed with coverage for genital reconstruction). Now a year past this decision and post-graduation, I am nearing the end of my my blessed bubble of coverage. I have sat down to record my experience on the eve of the day I will learn whether my chest surgery has been approved. This series relates my personal experiences with desiring surgery and seeking coverage, aimed to aid my trans brothers and sister to have the healthy lives they deserve.

 

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