by Nina Roumell, Strategic Engagement Fellow, with contributions from Adison Quin Petti
The transgender community recently won a major uphill battle: the Colorado Division of Insurance (DOI) released a bulletin banning discrimination in health coverage based on sexual orientation. The bulletin is designed to protect transgender Coloradans from insurance policies excluding transition related healthcare services when those same services are covered for non-trans consumers.
The Affordable Care Act, or Obamacare, also prohibits exclusions to transgender individuals. Obamacare and DOI bulletin are crucial in ensuring all Coloradans get the care they need when they need it.
Adison Quin Petti, a queer and transgender Coloradan, is the Leadership Development Coordinator for Public Health and Human Rights at the Colorado College Collaborative for Community Engagement. Adison says opponents of the bulletin argue that transition related services such as hormone replacement therapy, transgender counseling, or chest reconstruction surgeries are either considered experimental or medically unnecessary. Consumer advocates believe that medically necessary treatment should be determined between a doctor and patient, rather than insurance agencies.
While most insurance policies have excluded trans-specific healthcare to date, Adison says some people have been fortunate to find LGBTQ friendly providers who understand the importance of coverage for transition services and utilize billing loopholes to ensure access to care. For example, a provider may choose to bill the insurance for an endocrine disorder, instead of transsexualism to ensure that hormone replacement therapy covered for non-trans people will also be covered for transgender patients.
Loopholes, though, aren’t enough with the history of discrimination trans people face. In national surveys, 19% to 27% of transgender people report being denied care by health care providers and are often reluctant to seek health care. Having health insurance does not equal care. Adison hymself (Adison prefers the pronouns hy/hys/hym instead of he/his/him) has been denied access to both primary and transition related healthcare by several Colorado physicians since first coming out as trans nearly 10 years ago. The problem was also compounded by hys experience of homelessness after being forced to leave home at the age of 15 for hys sexual orientation and gender identity—an experience all to common for Colorado’s queer and trans youth. It was not until finding a transgender counselor in Holyoke, MA that Adison was able to medically alter hys gender.
This bulletin is about more than just healthcare. As Adison notes, the reason access to transition related healthcare is so critical, is that trans people’s legal rights often hinge on being neatly categorized as women or men in the eyes of the state. By denying transgender people access to medically necessary treatment, employers and insurance agencies place trans people at disproportionate risk for poverty, unemployment, and violence, by preventing them from changing their gender marker and names on the legal documents required to rent an apartment, secure a job, enroll in school, or gain equal access to gendered spaces such as restrooms or shelter services.
So will the division of insurance’s recent bulletin resolve all of this discrimination? Activists like Adison are optimistic, but caution against relaxing the fight. “I think employers, in particular, have a real choice to make,” suggests Adison. “It isn’t enough for employers to wait and see if the bulletin affects them or not. It’s time to take a stand proactively to ensure this coverage exists. Unfortunately, the response of employers doesn’t change overnight, even with the new bulletin in place. It’s up to the community to hold them accountable, and offer the education and resources to tackle these issues collectively, because real people’s lives are at stake. It shouldn’t take another lawsuit or another six months to determine if and how the law applies to end a practice we’ve known to be discriminatory for so many years. We’re really at a historical crossroads, and Coloradoans are in an excellent position to distinguish themselves as truly emergent leaders in transgender rights. Our actions, or inactions, will have a ripple effect as we watch this unfold nationwide. People are watching us, and that’s exciting to see because it means we have to act rapidly to preserve our reputation as an inclusive community.”
Adison’s statements echo those of Vice President Joe Biden in Florida last year– “transgender rights are the civil rights issue of our time.”
The recent emergence of civil rights claims filed against health insurance companies for excluding transition related health care shouldn’t be necessary for people to access care. However, Colorado is moving in the right direction to prevent these practices. The Division of Insurance, Kaiser Permanente, and the Colorado Civil Rights Commission are planning meetings to discuss the health needs of transgender individuals. Consumer advocates are fighting to ensure the provisions in the DOI bulletin and health reform are followed so trans Coloradans can see their doctor without fear of discrimination or unpredictable costs.
If you or someone you know believes they have been discriminated against in healthcare based on your sexual orientation or gender identity, make your voice heard and share your story! You can also contact OneColorado, Colorado’s statewide LGBT advocacy group regarding health access issues or questions for help.