Last month, an investigation by the California Department of Managed Health Care found that Health Net, a health insurance company in the state, discriminated against seven transgender people between 2013 and 2015. The patients were denied coverage for gender-affirming surgeries such as testosterone injections, bilateral mastectomy, facial feminization surgery, and gender reassignment surgery, according to the San Fransisco Chronicle, because the company claimed the treatments were cosmetic.
Health Net was ordered to pay $200,000 for violating state anti-discrimination laws, and to update their policies to comply with state law by September 30, according to a letter of agreement. It's a huge win for transgender rights to healthcare in California, but also highlights out how difficult it is for transgender people to access gender-affirming treatments.
California is one of only a handful of states that has anti-discrimination laws requiring health insurance companies to provide coverage for gender-affirming surgeries. As of last year, 14 states had laws explicitly banning transgender exclusions in both private health insurance and Medicaid, according to the National Center for Transgender Equality. Five more had laws offering some protection for transgender people, banning discrimination from private insurers or Medicaid but not both. The other 31 states had no protections whatsoever.
Yet, even in a state that has had a law explicitly banning discrimination from health insurers since 2012, transgender people still faced discrimination and restrictions to coverage.
That can mean that transgender people aren't able to afford hormone replacement therapy that, for example, would deepen a transgender man's voice and facilitate body hair growth. Trans people have also been denied coverage for top surgeries that would augment breasts for a transgender woman or remove them for a transgender man, and other treatments to aid in transition on the misguided idea that these treatments are not medically necessary.
Even health screenings that are considered medically necessary for everyone else, like prostate exams for transgender women and pap smears for transgender men, are more difficult to access once a person has legally changed their gender identity.
Cole Hayes, a transgender man who was seeking a hysterectomy, wrote about his experience in The Advocate in May. "Initially, my insurance said no to paying for the hysterectomy — not because I hadn’t completed the list of medical prerequisites, but because I was a man," he wrote. "It didn’t matter that I was a trans man with a uterus. The insurance company doesn’t give men hysterectomies; there was nothing else the people there could tell me other than that their policy hadn’t been updated in quite a few years."
The California law, as well as guidelines the governor of New York sent to health insurance companies in a letter on Wednesday, forbid health insurance companies for denying coverage for gendered screenings and treatments like these just because a person's legal gender doesn't match the gender of those who typically need the treatment.
But California, New York, and the 12 other states that have forbidden discrimination from health insurance companies are the standouts, and there's so much more work that needs to be done to ensure that Hayes and other transgender people have access to the care they need.
"Feeling human, healthy, and comfortable shouldn’t be considered cosmetic," Hayes wrote. "In my case, the removal of my reproductive organs is a medical necessity, not only for my transition but for my overall health."
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