Laura Harrington is an employee of the University of Washington. Her twelve-year-old son is transgender. In 2008 she attended a conference to learn how to better raise her son, who first expressed his maleness at the age of 5. While there, she met the man who is now her husband, who is a transman.
Because of exclusions in both her health care policy and that of her employer, many of her husband's treatments are not covered.
There have been times when we've had to decide between paying the electric bill or paying for his hormone therapy. The electric bill has necessarily won out. As a result, he suffers bouts of depression, anger, frustration, stagnation, all of the logical outcomes for someone who isn't living the life they need to live.
--Laura Harrington, to state officials this past spring
Harrington and other advocates contacted the state Public Employees Benefits Board in April about the challenges transgender Washingtonians face.
Last week the benefits board began the process of discovering just how fast such coverage can be included in private and state-run insurance plans serving government employees and retirees. The goal is to require such plans to cover transgender services by January 2016...and to remove specific exclusions to hormone treatments and other care before that date.
This will require careful, thoughtful work on our part and due diligence to develop a comprehensive, evidence-based benefit ... that assures the highest quality of care to people with gender dysphoria.
--Dan Lessler, chief medical officer for the state Health Care Authority
Oregon and California, some othr states and the District of Columbia bar exclusion of these services, and both cover or are moving to offer such coverage to all government workers in state-subsidized health plans. Seattle and King County also cover such treatment for public employees. Major employers, such as Microsoft, Nike, Best Buy, Pepsico, and Group Health Cooperative, also cover such treatments.
Last Friday Medicare announced it was lifting the automatic ban on paying for sex reassignment surgeries. In Washington Medicaid offers hormonal therapy and mental health services but not gender reassignment surgeries. That policy is under review.
Harrington and her fellow advocates say they applaud the state's intentions, but they hope action takes place before 2016.
I personally know a number of Washington state employees who need transgender health benefits. It seems that the 18-month time line ... (is) awfully long from our point of view. These people are suffering now and could use health care.
--Dr. Bobbi Dalley, associate professor of radiology at the University of Washington School of Medicine
Dr, Dalley describes herself as transgender. She testified in April that she was fortunate to have a job which afforded her the opportunity to pay for the services not covered by the state insurance. She noted that a transgender man getting a mammogram might be denied coverage.
It's not just about surgery. It's also about coverage for hormone therapy, psychotherapy which would not be covered if you put gender identity disorder in the (billing) code, as well as routine health care.
--Dr. Dalley
State officials say the three major plans offered to employees, the state's Uniform Medical Plan, Group Health Cooperative, and Kaiser Permanente, all cover mental health care related to gender issues. The last two also cover hormone therapy, but all three exclude genital surgery.
Danielle Askini of the Gender Justice League of Seattle said the lack of coverage creates a lot of strain on people and families like Harrington's that cannot afford to pay the costs out of pocket. The Associated Press has reported that costs can run higher than $25,000 for some gender reassignment surgeries, but Askini said the expense is relatively minor for larger health plans.
She cited a 2013 survey of employers by the Williams Institute, based at UCLA, and a 2012 report by the California Department of Insurance that examined the experience of Golden State government agencies with coverage. Both found slight costs and one showed less use of the new benefit than insurers expected in some jurisdictions.
I would hope that we could move this benefit (into being) as quickly as possible in a manner that maintains high quality.
--Greg Devereux, executive director of the Washington Federation of State Employees
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Gender Justice League here.