Oregon Insurance Board: Private Insurers Must Cover Transition for Transgender Patients
After years of discussions with the advocacy group Basic Rights Oregon, the Oregon Insurance Division of the state's Department of Consumer and Business Services issued a policy last month that bars private healthcare insures from discriminating against transgender patients.
Transgender patients in Oregon can now file complaints with the state if an insurance company treats them differently on the basis of their gender identity, including if a company: drops a patient's coverage, requires different rates, disqualifies people with gender dysphoria under a pre-existing condition clause, denies coverage of gender dysphoria, or refuses to cover sex-specific care. This last point is important because many transgender people may have a sex marker that doesn't fully encompass their health needs, such as trans men who need pap smears or trans women who need prostate exams.
The biggest change ushered in by the transgender equality law applies to transition coverage. The department decided that failure to cover certain transition-related procedures is “prohibited discrimination,” and like the rest of the examples, is illegal under a 2007 Oregon law that bans discrimination based on gender identity and presentation.
Though the World Professional Association for Transgender Health's standards of care stress the need for medical transition accessibility for most transgender people, the vast majority of insurance policies deny coverage for transition-related procedures. Policies will, however, frequently cover the same procedures for non-transgender people. Hormone replacement therapy, for example, is covered for non-trans people who can't produce enough testosterone or estrogen, but trans people in the same situation have to pay for expenses out of pocket.
The Oregon Insurance Division highlighted this discrepancy in its bulletin. It lists “denying coverage for a procedure that is provided for the treatment of other conditions or illness (such as hormone therapy, mastectomy, or vocal training)” as an example of discrimination. While not all transition procedures have a non-transgender equivalent—genital surgery comes to mind—many do, and these interventions can drastically improve trans people's lives.
The cost for transition can be astronomical. Up to 64 percent of transgender people report earning less than $25,000 per year, but as a transgender support website estimates “full transition” for trans women costs between $40,000 and $50,000. For trans people in Oregon with access to insurance—especially students, whose health insurance policies often explicitly exclude transition coverage—the new policy can place transition within reach.
The Oregon decision follows numerous federal government entities's rulings in the last year that barred discrimination in healthcare settings and employment against transgender individuals, citing federal protections against sex discrimination. Seventeen states prohibit discrimination based on gender identity. Oregon, so far, is the only one to extend that prohibition to health insurance coverage.
Shay O'Reilly is a reporter with Campus Progress. Follow him on Twitter @shaygabriel.