Rapid increase of health care coverage for gender transition in USA

Posted on April 27, 2017 by Ellen Defrancq

A rapidly growing number of health insurance plans in the United States now cover transition-related care for transgender people. A recent article in the New England Journal of Medicine is optimistic about the future coverage of medical care related to gender transition.

US health coverage transgenderIt’s an important shift of which everyone benefits, according to the authoritative journal. A cost-utility analysis determined that covering this care is cost-effective, given the high financial and human costs associated with gender dysphoria that is left untreated.

An economic-impact analysis noted that removing transgender exclusions in health care plans had several “immaterial” benefits. It has shown to reduce suicide risk, lower rates of drug use and increase adherence to HIV treatment among transgender people.

Coverage of gender dysphoria is still new

Every major medical association in the US recognizes the medical need of care related to gender transition and has called for insurance coverage for treatment of gender dysphoria. However, until recently most insurance companies refused to pay for any service or procedure related to such treatments.

This started to change in 2012. The California Department of Insurance then declared a rule which bans exclusions of coverage for gender transition-related care if this care is covered for other conditions. For example, many plans already included hormone therapy or breast reconstruction for non-transgender people for indications such as endocrine disorders or cancer treatment.

This regulation, as well as a rule of an independent appeals board within the Health Department and a nationwide injunction issued by a federal judge, made insurance companies change direction. According to the New England Journal of Medicine, Medicare (social insurance program), many state-regulated private plans, some state Medicaid programs and an increasing number of employer-sponsored plans now cover care related to gender transition.

Employers acknowlegde importance of care

Despite continuing court battles over federal nondiscrimination protections for transgender people and president Trump’s plan to roll back or change Obamacare, the medical journal expects the trend is likely to continue. Many employers now acknowledge the importance of such care. For example, in 2002, no Fortune 500 company offered employee coverage for gender transition, but by the end 2016, half of them did, the journal writes.

Recent statistics estimate there are about 1.4 million transgender adults in the United States (0.6% of the population) and 150,000 transgender teens between 13-17 years. They often face discrimination by health care providers and employers, and harassment in public places. Depression, anxiety, exposure to violence and HIV infection are common among transgender people. Problems are particularly acute for those with low income and transgender people of colour.

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