Cuba has approved free sex change operations for transgender citizens. What a stark contrast to the reality here in the United States.
June is LGBT Pride Month and, along with the festivals and parades, we have an opportunity to learn about the diversity within our community and the issues that impact the lives of LGBT people. For many transgender people, the process of transitioning is a long and expensive journey delayed due to the lack of health insurance coverage for medically necessary procedures.
First, a quick primer. "Transgender" describes the state of a person's gender identity, which may match their assigned at birth. Other words transgender people may use are female to male (FTM), male to female (MTF), and genderqueer. After coming out, transgender people may undergo psychological counseling for diagnosis, hormone replacement therapy (HRT) to adjust their body to their new gender, medical visits to support that therapy, and sex reassignment surgery (SRS) to change their genitals to match their new gender role. Through sex reassignment surgery, transgender women may undergo a penectomy and vaginaplasty. Transgender men may undergo bilateral mastectomy and hysterectomy and, in some cases, they may also elect phalloplasty (construction of a penis).
These procedures cost thousands of dollars and they are not optional for many transgender people. Most states require medical procedures before personal documentation, like drivers licenses and birth certificates, can be updated to reflect a person's new gender. But, despite those requirements, many insurance policies do not cover sex reassignment surgery, which is often considered cosmetic or not medically necessary. Thus transgender people must pay thousands of dollars out of pocket even if they have health insurance coverage that would cover the surgical procedure for a medically recognized condition.
Transgender people may also consider cosmetic surgery in order to adjust their appearance to their new sex role. Cosmetic surgery procedures may include breast augmentation or facial or torso surgery, and transgender women may require electrolysis to remove hair. Many insurance companies do not cover these procedures for any participant in their plan because they are considered elective or not medically required.
Why would a health insurance plan not cover a surgical procedure for a transgender person? The American Psychological Association's current classification of gender identity disorder (the diagnosis given some transgender people that may allow them to qualify for sex reassignment surgery) as a psychological disorder does not clearly support medical treatment through sex reassignment surgery. As a result of the current lack of clarity, many insurance companies discriminate against transgender people seeking coverage for the cost of surgery even if the company through which they are insured approves coverage.
Transgender activists have been working to get an official
diagnosis and classification for Gender Identity Disorder from the American
Psychological Association to address the need for medical care and appropriate
mental health care for transgender people. In 2005, the American Psychological Association formed a task force
to study gender identity and they have been reviewing the scientific
research and American Psychological Association's policies with the
goal of developing recommendations for education, training, practice
and additional research. The completed report is scheduled for
presentation to the American Psychological Association's governing
Council of Representatives in August 2008.
Transgender activists
are divided over
whether the classification of gender identity disorder from the American
Psychological Association as a mental disorder is positive or negative,
with some feeling that the classification stigmatizes transgender people
and others arguing that the classification is necessary to secure appropriate
health care and treatment. What is not in dispute is the need
to address lack of access to treatment options and the discrimination
many transgender people face within society and the medical community.
In 2007, the American Medical Association amended their nondiscrimination policies to include transgender people. As reported by the Windy City Times, the policy change "affects all aspects of the functioning of the AMA, including relations with patients, employment issues and insurance coverage." The report also noted that transgender people face discrimination within the health care system and barriers that prevent access to health care. In one section of the new policy the American Medical Association clearly states its opposition to "the denial of health insurance on the basis of sexual orientation or gender identity."
As companies, health care insurers and municipalities examine and revise their policies to ensure that transgender people are not discriminated against or denied access to medically necessary treatment, the cost of sex reassignment surgery remains an obstacle for many transgender people seeking transition into the sex role that better reflects their identity. As our community celebrates LGBT Pride Month this June, we can celebrate the progress made within the medical and psychological communities. But we must also note the progress yet to be made and the impact of that lack of progress on the lives of transgender people.
