Wait a second, didn't I write something much like that a year ago? Let's see, there was To Peris(h) by Bicycle, Autumn Comes to 45-deg N, and what was it? Oh yes, An Exclusive Halloween Ogre Just for Us!
Halloween is in the air once more. It is again the time of witches, fairy princesses, hobos, Boo Radley, and the Hollywood fantasies of a childhood younger than mine. It is the time when I am again reminded of the transgender exclusion, that special ogre that visits transgender women, men, and children of all ages in the form of exclusionary clauses in medical insurance policies. In macabre fashion, these clauses deny coverage of medical procedures that are in any way connected with or, in the eyes of insurance providers, a consequence of gender transition.
In many cases, the services being denied to transgender persons – such as estrogen or testosterone medications, hysterectomies, or mastectomies – are regularly being provided to others who are not transgender. It is not uncommon for an insurance provider to deny coverage for claims for gender-specific care based on the person's gender marker on file with insurance. For example, insurance may deny coverage to a transgender woman who develops prostate cancer.
The transgender exclusion brings consequences that may extend years beyond transition. A provider may deny coverage for a heart condition if it decides that this condition was in any way transition-related. My own provider, the Foreign Service Benefit Plan underwritten by Coventry, now routinely questions every claim whether it is directly related to my transition or not.
Last year I wrote of the growing list of progressive public and private employers who now offer medical policies without transgender exclusions to their employees. In the Washington, DC, area, American University is just the most recent addition to this list. (See http://www.hrc.org/files/assets/resources/CorporateEqualityIndex_2013.pdf.) Almost all employers that now provide transition-related coverage report that there has been little or no increase in premiums. (See http://williamsinstitute.law.ucla.edu/wp-content/uploads/Herman-Cost-Benefit-of-Trans-Health-Benefits-Sept-2013.pdf )
"Has the U.S. Government (USG) joined this group of progressive employers over the past twelve months?" I'm glad you asked.
Alas, I regret to report that the transgender exclusion is still alive and healthily flexing his muscle in the FEHB plans offered to federal employees. Sigh. As equal employment opportunity and workforce diversity policies have progressed, health insurance has remained quaintly in the age of disco.What I wrote a year ago still applies. The answer has not changed, nor, I am given to understand, will it be any different in Federal Employee Health Benefit policies for 2014.
"Why has there been no change?" you ask.
"I don't know," your humble servant replies.
Unlike a year ago, however, I am now in a position to do something more than just wring my hands. I am president of Gays and Lesbians in Foreign Affairs Agencies (GLIFAA). We have written a white paper on the transgender exclusion in which we present all the arguments why this clause is discriminatory and must be removed. We will be presenting this white paper to highly placed officials within the agencies whose LGBT employees are represented by GLIFAA. We will be requesting that these agencies go on record with the Office of Personnel Management as favoring the exclusion's removal.
Will this work? We don't know, but we hope so.
Meanwhile, as I wrote a year ago --
Beware as you make your rounds this Halloween night. Amidst the witches, hobos, wizards, and zombies, our own exclusive hobgoblin lurks, waiting to pounce. Someday he will transform into a beautiful fairy prince or princess, ready to grant all wishes. Of this I am certain. It hasn't happened quite yet, but like any fairy tale, this one too will have a happy ending.For those of us covered by FEHB, may Halloween a year from now be ogre-free.