Improving Transgender Health Care

There has been a slew of stories lately on the medical front concerning treatment of transgender people by medical professionals, emanating from Ohio, Washington, Oregon, California and Massachusetts.

To quote one of the authors of the pieces I shall link to:

There has been a long history of lack of access to basic healthcare and systematic discrimination for transgender people.

–Pat Magee, MSW, for Rage Monthly

Seven stories on the other side.

Starting next year medically necessary “transgender procedures” will be covered by the City of Cincinnati’s health care plan.

Since I’ve been here I’ve worked to make this city as competitive and inclusive as possible.  This is a another step in that direction

–Cincinnati City Councilman Chris Seelbach, the city’s first openly gay councilman

Cincinnati will become the first city in Ohio to offer transition-rlated procedures in its health benefits package.

For Cincinnati to cover their trans employees – because there are trans employees who work there – is great.  Hopefully cities elsewhere in Ohio will follow that.

–Shane Morgan, TransOhio

Interim City Manager Scott Skiles initiated the change, with encouragement from the majority of theCity Council.  

It is important that we provide necessary medical benefits to all of our employees.  This positions us well for progress and keeps the City competitive as an employer.

–Skiles

This will help the city attract more businesses, more conventions and more Downtown residents.  It’s one way the city can market itself as welcoming.

–Paula Ison, area trans woman

In Columbus the Columbus Public Health Department is attempting to decrease the disparity in care for people in the LGBT community.  

One in five transgender people in Ohio say they’ve been refused medical care due to their gender identity.

These are things we need to talk about, we need to address, and we need to fix.

–Dwayne Stewart, Columbus Public Health Depatment

There is more about the Columbus initiative here.

In Oregon an August 14 vote by the Health Evidence Review Commission will result in treatments for gender dysphoria being covered by the Oregon Health Plan (OHP) beginning in January of 2015.  OHP is Oregon’s version of Medicaid.

This new “continuum” of covered treatments, which Basic Rights Oregon policy director Danielle Askini says will “save lives and money,” will encompass therapy, hormonal treatment, puberty suppressants and reassignment surgery.  HERC predicts that 175 transgender people will utilize these treatments per year.

Askini says that coverage expansion is based on logic:  the evidence is that suicide rates in transgender people decrease drastically when we are given proper treatment and so the money spent on treatment now will be far less than what would be spent on lifelong psychological therapy or emergency room visits following suicide attempts.

The major problem in Oregon is that there is only one gender reassignment surgeon in Oregon and he doesn’t accept OHP.

A barrier for low-income folks is now removed, and that is huge because in previous years if you were financially able, you could get the care that you needed.

–Allison Cleveland, Oregon Anti-Violence Project

There are times when you just are completely tired of feeling in pain and feeling hurt and you just want to give up.  Usually you’re just struggling to survive every day.  A big part of my transition was realizing – survival isn’t enough.  You have to be able to live as well.

–Alex Paige, Portland transgender woman

By a unanimous vote the Washington Public Employees Benefits Board has ended the exclusions that most employee health plans have used to deny services to transgender people.

We’re definitely very happy with the vote.  This move brings things more in line with the decisions that more and more states are making in recognizing that these exclusions are an illegal discriminatory practice … It will have a significant impact on people’s health and well-being.

–Tobi Hill-Meyer, Gender Justice League

Coverage changes should take effect by January 2015 except for surgical needs, which would have to wait until July 1, 2015.

Then there is a story from Kaiser Health News about Devin Payne and her access of transition treatment through the Affordable Care Act.

The law and policy are on a transgender person’s side for the first time.

–Anand Kalra, Transgender Law Center

Of course, there is opposition:

We would oppose sex change operations all together.  But as a public policy issue, we would feel particularly strongly that taxpayers shouldn’t be asked to pay for it.

–Peter Sprigg, senior fellow at the Family Research Council in Washington, D.C

Devin unfortunately had to use an out-of-network surgeon for her surgery in Palo Alto.  By the date of her surgery Blue Shield had authorized her operation but had not yet determined how much it would pay an out-of-network provider.  She paid for the surgery with all her savings ($27K) and is hoping that her insurer would reimburse at least some of it.  She is also concerned about paying for the hospital stay, the anesthesiology, and the lab work.

Recently MS. Payne got a statement saying she still owed $17K.

Jenny Taylor, one of Devin’s friends, purchased an insurance policy through the Tennessee exchange.  Then she learned that her doctor wasn’t in the plan’s network and that she had to pay cash for everything with no reimbursement.

My insurance, even though I finally got it, was useless.

–Jenny Taylor, friend of Devin Payne

Taylor’s policy wouldn’t even pay for hormone therapy:  her pharmacist told her that since her ID still listed her as male and the medication was for women, she was just out of luck.

I was really frustrated.  We’re just trying to be ourselves, at the end of the day.

–Taylor

Taylor has now moved to southern California and is planning to apply for insurance through Covered California.

MSW Pat Magee shares The State of Transgender Healthcare at Edge on the Net.

Another factor that has been problematic is the hesitation of transgender people themselves to access care.  Born out of the fear of humiliation, disrespect and rejection, some transgender people may not even make an attempt to seek required care.  Sadly, important health needs such as PAP smears, prostate exams and mammograms are often avoided just because a transgender person does not believe they will be treated appropriately and with dignity.

I have personally been laughed at directly, by medical staff, while in a paper gown awaiting a pelvic exam.  Others have shared with me having been refused life-saving care, being openly called “it” by nurses, or the humiliation of having a parade of curious hospital employees lifting the gowns of a semi-conscious transgender patient to peek at their body and genitals.  These stories are horrific and justify the concern and demand for more sensitivity training and the need for stronger advocacy.

–Magee

And finally, Fenway Health has released a survey, Discrimination and Health in Massachusetts:  a statewide survey of transgender and gender nonconforming adults.

The study raises the intriguing possibility that passage of a law in Massachusetts banning discrimination against transgender people in public areas might not just lessen the likelihood of violent and discriminatory acts taking place against transgender people.  Such a law might also improve the overall physical and mental health of the state’s transgender residents.

Good point.  Unfortunately Massachusetts’ nondiscrimination law does not include public accommodations.  Too bad for us.

The survey of nearly 500 adults conducted in August-December 2013 found that 65 percent reported at least one incident of discrimination in a public setting in the previous 12 months.  Discrimination, which ranged from physical assault to verbal harassment, occurred most commonly in areas of public transportation, such as trains, busses, subways, and airports (36%).  That was followed by retail establishments (28%), dining (26%), public gathering locations (25%), and health care settings (24%).