- The Obama administration on Tuesday told federal employees' health insurers that after 2015 they can no longer contain blanket exclusions for transgender-inclusive health care, such as hormone therapy and other transition-related care for people who identify with a gender different from the one assigned to them at birth.
- The decision from the US Office of Personnel Management came a year after the government lifted its ban on transition-related care. The lift allowed health insurers to offer such care, but it didn't require them to do so.
- Now all federal employees should have access to transition-related care starting on January 2016. But trans advocates say they expect some resistance from insurers before they provide a full scope of services.
LGBTQ advocates cheered the move — but remained cautious
Mara Keisling, executive director of the National Center for Transgender Equality, said in a statement:
The Office of Personnel Management's action eliminating blanket trans exclusions represents a huge step toward ending one of the last remaining ways the federal government itself discriminates against transgender people. Until now, the federal government has been providing discriminatory healthcare plans to its trans employees. Transgender workers have been required to pay out of pocket to cover care deemed necessary by their doctor — often for services that are covered for non-transgender people. This is completely out of step with the medical consensus on this issue and it is discrimination, plain and simple.
With today's announcement, transgender federal employees can now access health care that is so fundamental to their well-being and, in the long-term, will make transgender employees happier and more productive workers. We know that plans will still try to exclude some necessary services, and we will keep pushing to eliminate all insurance discrimination against trans people.
Trans-inclusive medical care can help treat gender dysphoria, a state of emotional distress caused by how the gender someone was designated at birth conflicts with their gender identity. Major health groups, including the American Medical Association and American Psychiatric Association, agree that hormone therapy and other forms of care can treat severe gender dysphoria, which can afflict some but not all trans people.
Providing trans-inclusive care isn't very expensive
The cost of health plans doesn't increase much, if at all, if they include trans-inclusive health benefits.
The Human Rights Campaign, an LGBTQ advocacy group, estimates that trans-specific treatments can cost between $25,000 and $75,000, which is minimal compared to other health-care needs. And very few patients require these treatments, since trans people make up less than 1 percent of the population, making the cost relatively small for major health providers.
These treatments can also save health insurers money in other areas, since some trans people may be less likely to struggle with gender dysphoria, depression, and other mental health issues after medically transitioning.
When San Francisco began to offer trans-inclusive health coverage to its employees in 2001, the city applied a small surcharge to all employers enrolled in its health plan. But the city ended up using just $386,000 of the $5.6 million raised by the surcharge — a cost so low that it eventually dropped the additional charge altogether.
"[D]espite actuarial fears of over-utilization and a potentially expensive benefit," San Francisco's Human Rights Commission noted, "the Transgender Health Benefit Program has proven to be appropriately accessed and undeniably more affordable than other, often routinely covered, procedures."