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Is the administration moving to include transgender care in federal health insurance coverage?

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The short answer? Maybe.

Dive into the longer but far more satisfying answer below…

While some company and local government health plans cover care for transgender policy-holders, the Federal government does not and specifically excludes transition-related care from coverage.

Transition-related care may include hormone replacement therapy, mental health services, and sexual reassignment surgery (SRS).  The costs of this care can easily reach into the tens of thousands of dollars, putting it beyond the reach of many who need it.

But some recent and almost unnoticeable steps by federal agencies could mean transgender care coverage federal employees and many others.

Many people believe the inner workings of the government are needlessly complex or hopelessly laborious. And in many cases they are.

So follow me into the workings of the government so I can show you.

On Dec. 2 the departmental appeals board at the Health and Human Services Department decided that the “National Coverage Determination” (basically what is covered under Medicare and Medicaid and other programs) excluding sexual reassignment surgery specifically from Medicare coverage needed to be revisited.

The coverage decision has been in place since May 6, 1981 and  the original determination stated:

“Transsexual surgery for sex reassignment of transsexuals is controversial. Because of the lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental;. Moreover there is a high rate of serious complications for these surgical procedures. For these reasons, transsexual surgery is not covered.”

The complaint that sparked this action noted that the language was terribly out of date and had no real bearing on modern day medicine. It seems HHS is inclined to agree.

But what does this have to do with Federal employees?  In addition to administering Medicare, HHS is also responsible for enforcement of section 1557 of the Affordable Care Act, which covers “any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title [of the ACA].”

If you read that and thought the scope of the inquiry was extensive you are right. It covers a wide range of programs, including at least Medicare, Medicaid and the Federal Employee Health Benefits Program.

On an HHS Q and A on Section 1557 of the Affordable Care Act – which prohibits discrimination on the bases of “race, color, national origin, sex, age, or disability in certain health programs and activities” the agency answered a list of self-imposed questions, including:

“Does this mean that transition related surgery is required to be covered by health insurers?”

The answer was a simple “no.”

But the Q and A has since vanished from the site. (Update: I want to make clear the Q and A I link to is a web archive version.)

At the same time the agency issued a request for information on the same section (1557) seekinginformation on a variety of issues to better understand individuals’ experiences with discrimination in health programs or activities and covered entities’ experiences in complying with Federal civil rights laws.”

The agency specifically requested examples of covered discrimination on the basis of sex, ‘including discrimination on the basis of gender identity, sex stereotyping, or pregnancy.”

While the rulemaking is far from complete these are signs the administration is open to changing how it treats its transgender employees.

This could be a huge step in getting transgender care covered under the health plans available to millions of people across the country.

I have reached out to the Office of Personnel Management and to HHS for comment. I will update if I hear anything.

Comments

  1. Zoe Brain Says:
    December 10th, 2013 at 8:39 pm

    Reading between the lines – there were 8 reports in favour of treatment in the original ruling, one against. The one against was on ideological, not medical grounds. The others were dismissed because they did not meet “the *ideal* criteria of a valid scientific evaluation of a clinical procedure.

    They met the criteria – but not the *ideal* criteria, an unattainable standard not used in any other decision that I’ve found.

    Then the continuing record that is supposed to be updated as new evidence comes in, in order to support the decision (or otherwise) has been neglected for 32 years.

    It’s pretty scandalous, and I’m sure there are a lot of red faces there at the moment.

  2. Scott Fieker Says:
    December 11th, 2013 at 4:46 pm

    Transsexual care should be a covered medical benefit including medication, hormones, SRS, therapy and reconstructive surgery. Discrimination against a medical condition is wrong.

  3. Jeanne Says:
    December 12th, 2013 at 12:22 pm

    This needs to be reported on more. This information is worthy of professional journalism and needs to be seen widely in the transgender community and beyond. I applaud those who have addressed this issue that is so important now with the new laws regarding quickly changing health insurance mandates. I hope someone(s) will develop press releases including contact information of the movers and shakers that might bring this issue mass attention and useful momentum.

  4. zahria Says:
    December 24th, 2013 at 4:55 pm

    You mean to tell me they are considering offering healthcare insurance for transgender treatments, which is strictly voluntary. However, I am unable to get infertility treatments because they are considered an optional medical expense. Really people?

  5. Chutney Says:
    January 5th, 2014 at 9:17 pm

    @ zahria
    I am glad to see that HHS is beginning to crawl out of the dark ages. Gender Dysphoria (being trans) is a painful medical condition to live with, both physical and emotional pain. I can appreciate the weight of the need to give birth; it has to be right there with the need to be who we really are. But, there’s NOTHING voluntary about being Trans.

    We are born like this. Most of us get treated like dirt by our family’s, government, police, employers, schools, doctors and landlords. Many of us have good educations that do us no good at all. I have multiple college degrees and I spent years looking for an employer that would hire me, because I’m trans.

    We as a community need this to happen. We need medical coverage. We need jobs. We need people to see us as human.

  6. Chutney Says:
    January 5th, 2014 at 9:18 pm

    I am glad to see that HHS is beginning to crawl out of the dark ages. Gender Dysphoria (being trans) is a painful medical condition to live with, both physical and emotional pain. I can appreciate the weight of the need to give birth; it has to be right there with the need to be who we really are. But, there’s NOTHING voluntary about being Trans.

    We are born like this. Most of us get treated like dirt by our family’s, government, police, employers, schools, doctors and landlords. Many of us have good educations that do us no good at all. I have multiple college degrees and I spent years looking for an employer that would hire me, because I’m trans.

    We as a community need this to happen. We need medical coverage. We need jobs. We need people to see us as human.