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Back to Section One | Back to Arts & Entertainment
posted Friday, May 6, 2011 - Volume 39 Issue 18
Seattle's LGBT Commission challenges city policy of Trans health care exclusion
Section One
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Seattle's LGBT Commission challenges city policy of Trans health care exclusion

by Shaun Knittel - SGN Associate Editor

The Seattle LGBT Commission - which advises the mayor, City Council, and several departments about sexual minority issues as well as recommending policies and legislation - will meet with Council Member Bruce Harrell on May 12 to address an issue that Commission members believe needs to be resolved.

In a March 23 letter to Energy, Technology and Civil Rights Committee chair Harrell (given to the Seattle Gay News by the commission), LGBT Commission members said, 'On behalf of the LGBT Commission, Commission for People with Disabilities, Human Rights Commission, Women's Commission, and the Immigrant and Refugee Advisory Board, we are writing to inform you about current Transgender exclusions in all health care plans offered to City of Seattle employees. We urge the City to remove these exclusions, and to provide coverage of gender-affirming surgical, hormonal, psychological, and medical care for its valued Transgender employees.'

According to page 47 of the Benefit Plan prepared on behalf of the City of Seattle for its City Preventative Plan, all insurance plans currently offered to employees of the City of Seattle contain extensive exclusions regarding medical care for Transgender individuals.

'These exclusions have devastating effects on Transgender employees,' said LGBT Commission members to Harrell. 'The exclusions promote negative messaging and discrimination, and they prevent employees from accessing care that could increase their safety, comfort, and work performance.'

Specifically, on page 47 of the Benefit Plan, the policy reads that Transgender persons would not be covered for: 'Sex change: Any treatment, drug, service, or supply related to changing sex or sexual characteristics, including surgical procedures to alter the appearance or function of the body; hormones and hormone therapy; prosthetic devices; and medical or psychological counseling.'

According to LGBT Commission members, an exclusion this broad has devastating health outcomes. City of Seattle employees denied coverage through their insurance plans due to their Transgender status could develop debilitating secondary medical conditions, have substantially higher risk for suicide, and experience increased psychological distress. Typically with exclusions this broad, once an insurance company is aware of an individual's Transgender status, they will exclude other basic medical and psychological care that it erroneously assumes is related to being Transgender.

'Many of the Transgender individuals we know describe this as common practice and affirm that it has happened to them,' said the Commission. 'They describe that once the term 'Transgender' is in the chart, mental health, steroids, or procedures are universally denied. This experience is unfair, especially as non-Transgender patients do not have to prove medical necessity for any number of health care services. This exclusion should be removed.'

PRECEDENTS AND COST EFFECTIVENESS
The Seattle LGBT Commission did their homework on this. When commission members like Tiffany Nelson, who is also an employee at Group Health, learned of the injustice, they set out to change the way the City of Seattle does business with its Transgender employees. But first, she said, they needed proof that this change has worked in other places.

Nationally, San Francisco leads the way and serves as an example of the impact on costs and utilization of adding Transgender benefits. In 2001, the city set out to provide inclusion of these benefits for their 100,000 people covered (employees, retirees, and dependents).

San Francisco anticipated 35 members would file claims of approximately $50,000 each. For four years (2001-2004), $1.70 in additional premiums were added in anticipation of high utilization and high cost coverage of these additional benefits. During this time, the city collected $4.3 million and only paid out $156,000 on seven claims. This allowed the city to negotiate lower rates for the subsequent years; after 2006, the benefit was no longer a 'rider' (a separately added benefit) but part of a complete package. During the period of 2001-2006, the city increased premiums for Transgender coverage totaling $5.6 million, but only paid out $386,417 in claims.

'It is a common misperception that adding Transgender coverage will result in employees' rushing to schedule expensive procedures - San Francisco's experience demonstrates that a large city can plan and budget to include these benefits without experiencing skyrocketing utilization, and that there is no need to separately rate and price the Transgender benefit,' LGBT Commission members told Councilmember Harrell. 'The City of Seattle can negotiate with health insurance providers for a plan that treats the benefit for Transgender procedures the same as all other medical procedures and does not require an additional premium or [at most] a very minimal increase.'

The city of Berkeley, California, is currently wrestling with whether or not to remove these exclusions. Berkeley proposes to set aside $20,000 in a pool on a first-come, first-served basis since they cannot add it to their current benefit package.

Sadly, much of the local discussion of this issue illustrates the lack of understanding that these services are medically necessary and not frivolous, said the Commission. 'In a city as liberal as Berkeley, we are reminded of the need to educate the general community about Transgender issues.'

According to the LGBT Commission, the coverage is a medical necessity.

'There is a great deal of misinformation about Transgender identities and gender-affirmative medical care,' pointed out the Commission. 'First and foremost, Transgender medical treatment is not cosmetic. It is necessary medical treatment. Psychological care, hormonal treatments, and surgical procedures are all medically necessary for Transgender-identified individuals.'

This fact of medical necessity is no longer open to debate - the American Medical Association, American Psychological Association, the Diagnostic and Statistical Manual, Fourth Edition, and the World Professional Association of Transgender Professionals all clearly outline medically necessary treatment for Transgender individuals.

ACCESSIBLE AND INCLUSIVE COVERAGE FOR ALL
The LGBT Commission maintains that what they are asking for is simply that the City of Seattle provides accessible and inclusive coverage for all of its employees.

According to the Commission, a sound insurance plan should remove all Transgender-specific insurance plan exclusions, add important Transgender-specific language ('Transgender Medical Treatment: The plans cover charges for Transgender medical treatment including all medically necessary office visits, laboratory tests, prescription drugs, hormone treatments, and transitional surgeries. The plans cover these charges the same as covered medical expenses for any other sickness'), and cover all medically necessary procedures and surgeries.

The city of Seattle has the opportunity to lead the way for the state of Washington on this important issue, they say. 'The current climate of marginalization and exclusion will only change if the City requires inclusivity from their plans and carriers and then urges other organizations and vendors to do the same. Transgender benefits are not cost-prohibitive, and planned inclusion is simply the right thing to do.'

Seattle Gay News is committed to its continual coverage of this issue and will update our readers on the outcome of the scheduled meeting between Harrell and the LGBT Commission.

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