Washington, DC mayor Vincent Gray is taking steps to protect transgender residents of his city from discrimination in health care.
Mayor Gray's office reports that transgender residents are sometimes denied medically necessary treatment...or coverage for that treatment...because their gender identity differs from the sex they were assigned at birth.
Mayor Gray is set to announce today (Thursday, as I begin writing this) details of how his administration will attempt to prevent such discrimination.
Transgender individuals have historically been denied [health insurance] coverage for certain medically necessary health-care procedures. This has resulted in a denial of benefits for some individuals because their gender identity or expression is different from their assigned sex at birth. The mayor and other District officials will clarify the District’s position regarding this issue.
--Mayor Gray's office
And here's the news:
Mayor Gray announced today that the DC Department of Insurance, Securities and Banking will issue a bulletin to all health insurance companies operating in the district about the application of discrimination provisions passed by the District...in particular that the District recognizes "gender dysphoria" as a legitimate medical condition.
Today's announcement is intended to clarify the District's position as it was enunciated in a March, 2013 bulletin that instructed health insurers to remove language that discriminates on the basis of gender identity and expression from their policies and grant those people with gender dysphoria access to medically necessary treatment covered by health insurance.
Last March, the District began the process of removing exclusions in health insurance on the basis of gender identity or expression. Through the hard work of my Office of GLBT Affairs and a multi-agency working group headed by my Chief of Staff, Chris Murphy, we have today taken the necessary steps to completely eliminate these exclusions.
Today, the District takes a major step towards leveling the playing field for individuals diagnosed with gender dysphoria. These residents should not have to pay exorbitant out-of-pocket expenses for medically necessary treatment when those without gender dysphoria do not. Today's actions take us closer to being One City that values and protects the health of all our residents.
-Mayor Vincent Gray
The ruling states that the determination of medical necessity of services and procedures should be made in reference to the World Professional Association for Transgender Health Standards of Care (WPATH SOC) in order to be in compliance with the District's Human Rights Act, which prohibits discrimination on the basis of gender identity or expression. Any treatment or service that is available to a cisgender (non-transgender) person (such as a mastectomy or hormone therapy) must also be provided to a transgender person.
This action places the District at the forefront of advancing the rights of transgender individuals. It also fully implements the District's Human Rights Act by incorporating gender identity and expression as protected classes in the District's health insurance laws.
--Mayor Gray
The District's Department of Health Care Finance and it's Department of Human Resources also clarified their policies to come under compliance with the DISB bulletin. All private plans offered in the district as well as government employee health care plans and DC Medicaid must cover any medically necessary health services for transgender people. Plans which currently require riders or supplements with additional charges must eliminate those by the next renewal date.
What we've seen from other places that have instituted these reforms is that it is of minimal cost to insurers. There's no need for a premium increase.
--Andy Bowen, DC transgender activist
Bowen is referring to reforms instituted in California and Connecticut (though similar policies have also been adopted in Oregon, Vermont, and Colorado). A study released last year by the California Department of Insurance concluded:
the adoption of the proposed regulation would have an insignificant and immaterial economic impact on the creation or elimination of jobs, the creation or elimination of new businesses, and the expansion of businesses in the State of California.
Furthermore:
[T]he Department's evidence suggests that benefits will accrue to insurance carriers and employers as costs decline for the treatment of complications arising from denial of coverage for treatments. The evidence suggests that there may be potential cost savings resulting from the adoption of the proposed regulation in the medium to long term, such as lower costs associated with the high cost of suicide and attempts at suicide, overall improvements in mental health and lower rates of substance abuse.
--California Department of Insurance
This is a win for the public. It's, frankly, a win for insurers. It's a smart government decision, and it's good for human beings.
Critically important is that as more states follow the District’s lead, we’ll be better able to educate the medical community about respectfully and comprehensively meeting our healthcare needs. And that sets us up for more wins like this in other states.
--Bowen
Ensuring the health of transgender people is a key component of achieving LGBT equality, and fair insurance coverage is a priority for advocates across the country. We thank Mayor Gray and his administration for working with the transgender community to secure access to the health care that transgender people need to live full, healthy lives.
--Laura Durso, Director of the Center for American Progress's LGBT Research and Communications Project
The Associated Press, seeking as always to inflame rather than illuminate, use this headline about the event:
DC orders insurers to cover sex-change surgery.