It is a Necessity To Cover Transgender/Transsexual Procedures

The discrimination begins as soon as transgender individuals are required to check the ‘female’ or ‘male’ box as they apply for health insurance.  Unfortunately, it does not stop there, furthermore according to the Transgender Law Center; most transgender individuals are denied health insurance coverage not only from a group plan, but also from private health insurance companies because they are transgender.  So, even if a transgender were to need medical coverage to an issue non-transgender related (such as a broken arm), this individual would need to cover this cost themselves.  Even when transgender people are able to obtain insurance, most insurance programs do not include services related to their specific needs.  Almost every health insurance program excludes transgender related procedures in their plan, also known as the “transgender exclusion”.  Insured patients with well-paying jobs see the cost of these procedures overly expensive making the reality of these procedures slim to none.

There are many reasons why insurance companies should require to cover services related to being transsexual or transgender, I will be outlining the four reasons that are the most important.

Number One.  I want to clarity the most common misconception inflicted with this topic and one that many insurance companies use to justify their exclusion toward transgender individuals: “Transgender procedures are “Experimental” or “Cosmetic” and not a necessity”.   The only experimental procedure could be traced back to the original surgery in 1952.  According to the ‘Transgender Health Benefit’ article, for the transsexual procedure to be possible individuals must comply with the Harry Benjamin Standards of Care which, “strictly outline the diagnosis and procedure that must be followed for a true, medically necessary transition” (Transgender at Work, 2).  Transgender individuals must first be diagnosed with Gender Identity Disorder (GID); under these standards the most effective ways to treat GID is through counseling, medical, and surgical.  The World Professional Association for Transgender Health (WPATH) Standards have revised this issue and concluded that the treatment is a medical necessity.  It is time to begin to recognize that this treatment cannot be compared to a breast augmentation procedure, transgender individuals require this to live the life that they have always wanted, in the body that they should have been born in but were not.  Also, medical necessity is a term commonly used by health care coverage and insurance policies to allow Physicians to provide a patient with, “the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, disease or its symptoms” (WPATH Article, 2).  Insurance companies who deny these treatments are also prohibiting physicians to practice their job to full potential.  This also concludes that the only means behind health insurance provider’s exclusion is to discriminate against transgender individuals.  Procedures needed by transsexuals such as: Hormone Replacement Therapy (covered for post-menopausal women), Vaginoplasty or Phalloplasty, Mastectomies or Hysterectomies (for the treatment of cancer), and Gynocomastica for the treatment of a hormone imbalance are covered for non-transsexuals but NOT transsexuals individuals (Transgender at Work, 1).

Number two.  Now that we have concluded that transgender procedures are necessary and that insurance companies choose to exclude based on discrimination, we must look at the actual cost of this procedure.  Furthermost I must begin with stating the following, according to the DSM-IV, “Transexuality is very rare, it affects an estimated 1 in 30,000 people” (Transgender law center, 1).  We need to keep this number in mind because when it comes to how much these procedures are going to affect health insurance cost overall, the number of how many individuals may need it becomes crucial.  According to ‘The Cost of Transgender Health Benefits’ article, the average cost for a male-to female primary surgery can range from $4,500 to $26,000, this however does not include the extra costs for therapy ($1000), hormones ($15000), and doctor visits and lab tests ($500).  The average cost for female-to-male primary surgery can range from $4,000 to $60,000 which does not include the extra cost for the necessary therapy, hormones, or doctor visits (Horton, 2).  Without these procedures included in health care plans, patients need to pay this amount out of their own pocket; which becomes extremely difficult.

The opposition side worries that their health insurance cost will increase dramatically if there procedure were to be added to their plan, however this is a misconception.  Due to the fact that the number of individuals who will actually benefit  from this is very small, according to a surgical cost analysis, assuming that 1,166 procedures occur per year, the total cost per insured would result in an estimating 24¢ (2008) a year (Horton & Goza, 43).  This amount is a reasonable amount to contribute to help transgender individuals; it demonstrates that the total cost that would be expected to pay is very minimal, so why not contribute?  One may argue that by allowing this procedure to be available that the amount of individuals would increase therefore increasing the cost.  This may be true because many do not even begin the procedure due to lack of funds.  However, if there is a high demand for these procedures there would need to be more surgeons and specialists to be able to accommodate those needs.  This could increase the number of new specialists performing these procedures which would then increase competition and bring prices down.  (Horton, 10).  The fear of having insurance cost raise is a valid concern, but when thinking about how this could affect our economy, it can be predicted that competition will take care of that problem.

Number three.  We need to keep in mind that not all transgender individuals require or want the same treatment.  According to ‘Recommendations for Transgender Health Care’ article, “Many transgender people, to fully actualize their gender, want only hormones, or only surgery, or low doses of hormones, or no surgery and no hormones” (Transgender Law Center, 4).  Despite the fact that diversity in procedures exist for each unique individual, doctors often will require transgender people to have all the procedures or none.  By forcing individuals to require all procedures not only violates an indivuduals’ own needs and choices, but it also increases the cost of the patient which without insurance will be impossible to cover.  The assumption that all transgender individuals will want the same exact procedure is therefore

Number Four.  Finally, I believe that the consequences of not including transgender procedures in health insurance plans will in the long run cost more money.  By limiting their services health insurance companies in a way force transsexuals to obtain drugs illegally and cause more harm to their bodies.  Out of desperation transgender individuals risk their life by buying sex change hormones via online without medical supervision, this could result in fatal blood clots and liver damage (Batty, 1)

Also, according to Mary Ann Horton, “individuals suffering from untreated GID may exhibit symptoms of other conditions (such as stress, depression, substance abuse or suicide)” (Horton, 10).  Transgender individuals go through extreme measures to get their sex changed, most will resort to attempt performing their own surgeries which in most cases results in death.  All of this could easily be prevented if insurance companies would include transgender services in the first place.  If the major concern is cost, untreated GID costs more.  The solution is to target the issue from the beginning by allowing these procedures to happen otherwise more transgender individuals are going to die.  By ignoring the problem and excluding them altogether causes more mental and physical problems for the transgender individuals.  To me it seems that insurance companies would rather want transgender people to die before giving them a helpful hand.

According to clinical experience and medical research, transgender medical procedures are vital to achieve the well-being of transsexual individuals, “A recent study found significantly improved quality of life following cross-gender hormonal therapy.  Moreover, those who had also undergone chest reconstruction had significantly higher scores for general health, social functioning, as well as mental health (Transgender at Work, 3).  In conclusion, health insurance companies need to stop discriminating against transgenders, they need to require cover services related to transsexual and transgender because as studies have shown these procedures are cost effective rather than cost prohibitive.  These individuals deserve the opportunity to be allowed coverage just like everyone else; lastly, this procedure is a necessity, insurance companies therefore have no reason to continue to deny them care!

Batty , David. “Warning Over Online Trade in Sex Hormones.” Wednesday 18 February, 2004 1-2. Web. 23 Nov 2009.

http://pol285.blog.gustavus.edu/files/2009/08/Batty-Warning-Over-Online-Trade-in-Sex-Hormones.pdf

“Clarification on Medical Necessity of Treatment”. World Professional Association for Transgender Health, Inc. (June 17 2008): 1-4. Web. 30 Nov 2009.

http://pol285.blog.gustavus.edu/files/2009/08/WPATH-Clarification-on-Medical-Necessity-of-Treatment.pdf

Horton, Mary A. “The Cost of Transgender Health Benefits.” Transgender at Work 6.5. (September 2008): 1-12. Web. 23 Nov 2009.

http://pol285.blog.gustavus.edu/files/2009/08/Horton-The-Cost-of-Transgender-Health-Benefits.pdf

Horton, Mary A. “The Incidence and Prevalence of SRS among US Residents.” Transgender at Work 6.5. (September 2008): 1-11. Web. 23 Nov 2009.

http://pol285.blog.gustavus.edu/files/2009/08/Horton-Incidence-and-Prevalence-of-SRS-Among-US-Residents.pdf

Horton, Mary A., and Elizabeth Goza. “The Cost of Transgender Health Benefit.” Transgenders at Work 1-44. Web. 23 Nov 2009.

http://pol285.blog.gustavus.edu/files/2009/08/Horton-and-Goza-Cost-of-Transgender-Health-Benefits.pdf

Marsamer, Jody, and Dylan Vade. “Recommendations for Transgender Health Care.” Transgender Law Center (2002): 1-5. Web. 23 Nov 2009.

http://pol285.blog.gustavus.edu/files/2009/08/TLC-Recommendations-for-Transgender-Health-Care.pdf

“Transgender Health Benefits.” Transgenders at Work n. pag. Web. 23 Nov 2009.

http://pol285.blog.gustavus.edu/files/2009/08/TaW-Transgender-Health-Benefits.pdf

8 Responses to “It is a Necessity To Cover Transgender/Transsexual Procedures”

  1. Meghan Lee says:

    Irma makes a good argument for making transsexual and transgender benefits covered by health insurance companies. I have a few questions and responses, though, to some claims that were made. A large issue of the debate is the cost of including these benefits and how those costs affect non-transgender people. Irma points out that the cost, according to “Transgender Law Center,” is quite minimum due to the fact that trans-sexuality is very rare, affecting roughly 1 in 30,000 people. In the breakdown set up by Horton and Goza in their “Transgender Healthcare Benefits” presentations, this would accumulate in a 24 cent raise in the cost of coverage for all people insured to cover the expense of the reassignment surgeries that take place. All in all I would say that 24 cents is a fair contribution to make to the transgender “movement.”

    Section 3 was not completed in Irma’s argument, although I would like to hear more regarding the issue of “not all transgender individuals want all of the procedures.” How does this affect the issue of having the procedures covered by insurance? Is it making the argument again that the cost is quite low to cover the procedures?

    I would like to bring up, what I find an interesting twist to the debate, the fact that the United States is currently deciding on a new health care plan that would extend coverage to over 36 million people currently without insurance and create a government health insurance program. What does this do to the issue of including trans-sexual and transgender benefits in health care? It could go both ways – positive or negative. We have already seen what the Stupak amendment has done to the access for women to have abortions safely and legally. Another amendment could be right around the corner setting in stone what the position of transgenders in the health care plan would be. I think right now the focus should be on getting all U.S citizens insured before we go into making inclusions or exclusions based on circumstances of some people. But can those two issues really be separated? Immediately after writing this sentence, I think probably not!

  2. Irma Marquez says:

    Meghan!
    Thank You For Pointing That Out, It must of have not Paste Correctly I Apologize. I believe That The Last Part of This Argument Was, “The assumption that all transgender individuals will want the same exact procedure is therefore..one that should be not be considered because we cannot assume that every transgender is going to want the full package”.

    Again, Sorry About This.
    -Irma

  3. Katie Cummings says:

    Irma, I think you have done an excellent job finding the sources to back up your argument. However, you are lacking one key point. Why should insurance companies have to cover this, because transgender people would have to pay more otherwise? It is unfortunate that the costs of health care are high. However, insurance companies are for-profit companies. They are currently not owned by the state, and do not need to cover services just because someone wants a certain service. Furthermore, our country is ran by majority vote and at this point in time, I do not believe that the majority of people in this country understand transgender people, or knows that they need help. Finally, to quote the Rolling Stones “You Can’t Always Get What You Want,” my brother has special needs and I want the insurance companies to fully cover him, however, there are some things that have to be paid for out of pocket.

    The strongest part of your argument is the discrepancy you noted between needing coverage for a non-transgender issue and not receiving that coverage. A broken arm is exactly the type of coverage that insurance companies need to cover. Which are the accidental things that happen in life that you cannot prepare for. I think it would be best to fight the insurance companies for coverage on this angle.

  4. Leigh Ann Mason says:

    Irma outlines why and how transgender individuals should receive health insurance. I fully agree that transgender people should not be denied access to insurance coverage and services, but like Meghan, I am left with a few questions as well. I would like to focus on a couple issues, on Irma covered and one she did not. First, Irma begins by mentioning that if transgender people must cover costly services alone. According to the Transgender Law Center “Transgender people who develop health problems, break a leg, get an infection, etc., have nowhere to turn unless they pay for the services themselves”. How is this fair? Why should anyone be denied proper treatment because they are “different” than societal expectations? The Transgender Law Center suggests this could be remedied by creating “universal health insurance coverage”. This relates to Katie’s comment about how people cannot always get what the want. With universal health insurance coverage people can get what they need. Irma did an excellent job pointing out the unhealthy struggles and complications transgender people go through in order to acquire the traits that they were not born with because people fail to understand this is something they need, not something they want.

    Something Irma did not acknowledge is the quality of care that is available to transgender people. Even though they should have the right to medical care under insurance how certain is it that doctors would provide quality care? The Transgender Law Center highlights one example of the lack of care for transgender patients, “Transgender people have also died because emergency response teams have stopped treatment when they realized that the person they were treating did not have the genitals that they expected or have entirely refused treatment because of the gender androgyny of their patient”. “Transphobia” is cannot be made illegal. The Transgender Law Center suggests “that the medical establishment educate medical students and health care providers about transgender sensitivity, that the medical establishment support training providers on medically appropriate treatment for transgender people”. While this is a good idea in theory, I do not visualize it becoming a reality. Medical students have to seek out opportunities to learn about abortion, so chances of another “moral” issue becoming a required part of training seems unlikely. Even if transgender people were provided with health insurance, how can services be made fair and of the highest quality?

    “Recommendations for Transgender Healthcare”; Transgender Law Center.

  5. Jaime Olsen says:

    Irma makes a good argument, outlining the major points that have been used to advocate for insurance coverage for transgender individuals.

    I think that her point Number One can be elaborated on a bit more, especially when she mentions the Harry Benjamin Standards of Care. According to “Transgender Health Benefits”, under these standards, an individual must first be diagnosed with Gender Identity Disorder, which is recognized as a legitimate medical condition (2). Only then can the individual be treated as a medical patient – the physician’s job in this case is “preventing, evaluating, diagnosing, or treating an illness, injury, disease or its symptoms” (WPATH 2). Using this logic, if we recognize that Gender Identity Disorder is a medical condition, one can make the argument that insurance companies are discriminating against transsexuals by preventing them from receiving proper medical treatment. In addition, I think one can also say that by preventing these individuals from receiving medical care, the insurance companies are also interfering with a physician’s duty to treat his/her patients.

    In relation, the World Professional Association for Transgender Health article discusses the “Real Life Experience” of transgender individuals, which comprises their “social gender recognition” and their “social functioning” (2). In order for the individual to change his/her lifestyle and to be socially recognized as the opposite sex, it is not always necessary to undergo any sort of surgical procedure; moreover, sometimes (depending on the individual’s wishes) all that is needed is a psychological adjustment, which can be achieved through much less expensive venues than surgery, such as psychotherapy, counseling, and/or legal name and sex changes on identity documents (WPATH 2). Thus, as Irma argues, “we need to keep in mind that not all transgender individuals require or want the same treatment”, and realize that the “Real Life Experience” is a transition process (WPATH 2) that may not necessarily incur a high cost to insurance companies.

  6. Ashley Biermann says:

    “It is time to begin to recognize that this treatment cannot be compared to a breast augmentation procedure, transgender individuals require this to live the life that they have always wanted, in the body that they should have been born in but were not.” With this statement Irma is arguing that transgender individuals should have access to insurance because their procedure is not elective—it is something that should have happened naturally but did not. It almost sounds like a robbery. This argument seems a little shaky because it does conjure up a parallel to a person who was born with a less than desirable body (as portrayed by mainstream society: thin, muscular, curvy, white) and has always wanted the kind of body that would gain more attention, or one that would not be a subject of teasing or ridicule. Imagine a young woman who grew up being teased for her flat chest. The boys would greet her at the door with their own little jingle “flatsy, flatsy, you’re flat and that’s that.” This young woman would return home, look in the mirror, and be discouraged at the reflection she saw. She would without a doubt believe her breast augmentation fit under the same category Irma described as unique to transgender individuals: being required to live a life they did not want due to limitations with her body; she too probably believes she should have been born with a different body that better reflected how she felt inside.
    Also, later in the same paragraph Irma states “insurance companies who deny these treatments are also prohibiting physicians to practice their job to full potential.” To this I would answer that these procedures are not outlawed. Physicians are not prohibited from doing anything. If the doctor in question wished to do carry out this surgery to reach some kind of potential then the individual may do it without the patient’s insurance coverage. They could do it for free. They could do it for a discounted rate. Or they could do it after the patient saved up for the procedure and were able to pay out of pocket. The bottom line is that the doctor is in no way kept from reaching his or her potential by insurance companies refusing to cover transsexuals’ surgeries. And on the same note transgender individuals are not banned from getting the surgery either, they just must save for it like countless other procedures medical insurance will not cover.

  7. Ashley Biermann says:

    That posted all together… Sorry! I’ll repost to make it easier to read.

    “It is time to begin to recognize that this treatment cannot be compared to a breast augmentation procedure, transgender individuals require this to live the life that they have always wanted, in the body that they should have been born in but were not.” With this statement Irma is arguing that transgender individuals should have access to insurance because their procedure is not elective—it is something that should have happened naturally but did not. It almost sounds like a robbery. This argument seems a little shaky because it does conjure up a parallel to a person who was born with a less than desirable body (as portrayed by mainstream society: thin, muscular, curvy, white) and has always wanted the kind of body that would gain more attention, or one that would not be a subject of teasing or ridicule. Imagine a young woman who grew up being teased for her flat chest. The boys would greet her at the door with their own little jingle “flatsy, flatsy, you’re flat and that’s that.” This young woman would return home, look in the mirror, and be discouraged at the reflection she saw. She would without a doubt believe her breast augmentation fit under the same category Irma described as unique to transgender individuals: being required to live a life they did not want due to limitations with her body; she too probably believes she should have been born with a different body that better reflected how she felt inside.

    Also, later in the same paragraph Irma states “insurance companies who deny these treatments are also prohibiting physicians to practice their job to full potential.” To this I would answer that these procedures are not outlawed. Physicians are not prohibited from doing anything. If the doctor in question wished to do carry out this surgery to reach some kind of potential then the individual may do it without the patient’s insurance coverage. They could do it for free. They could do it for a discounted rate. Or they could do it after the patient saved up for the procedure and were able to pay out of pocket. The bottom line is that the doctor is in no way kept from reaching his or her potential by insurance companies refusing to cover transsexuals’ surgeries. And on the same note transgender individuals are not banned from getting the surgery either, they just must save for it like countless other procedures medical insurance will not cover.

  8. Kyle Rosas says:

    I think Irma makes very strong points. However, I, like Meghan and Katie, have some responses/questions:
    First, why do the insurance companies need to cover them? They clearly don’t respond to moral or ethical pressure, because neither of those pressures get them money. The argument that will convince the insurance companies, therefore, is one that is economic, and not one that attempts to draw on the ethos of the situation.
    Second, why, with the current health care debacle, do transgenders deserve a more expedient health care coverage process than the millions upon millions without health care, who are struggling to survive as a result of their lack of coverage? The answer is they don’t. They don’t deserve anything more than anyone else, any faster than anyone else. There needs to be a complete overhaul of the healthcare system before there is an inclusive or exclusive process initiated. We need to fix the wound instead of clean up the mess coming from it.
    Third, and finally, would it be better for the insurance companies to have a box than can be checked for transgenders, but still not cover them completely? In other words, is this an all or nothing situation? Or can there be a compromise?