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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

June 25, 2014 at 4:45 PM

Transgender discrimination is illegal, state reminds health insurers

In a letter Wednesday to health insurance companies, the state makes clear that it is illegal to discriminate against transgender policyholders under both state law and the federal Affordable Care Act.

Specifically, an insurance company cannot deny services for a transgender person solely on the basis of gender status. Additionally, the health insurer must pay for gender transition procedures if they are deemed medically necessary and if they’re covered for other policyholders for different reasons. Those procedures include hormone therapy, counseling services, gender-transition process, mastectomy, and breast augmentation and reconstruction.

Insurance Commissioner Mike Kreidler said he’ll carefully examine policies that have been submitted by insurance companies to be sold later this year on the state’s exchange, Washington Healthplanfinder, to be sure they do not exclude these procedures.

Kreidler’s move to clarify the rules around transgender health care follows a national trend. Medicare officials in May announced that the program would end a 33-year ban on the coverage of gender reassignment surgery. In January, Oregon officials issued a notice making clear that transgender discrimination by insurers was not allowed, and in April California officials took similar action.

Seattle-based Pride Foundation and other groups promoting the rights of transgender people celebrated Kreidler’s actions. They said that insurance plans frequently banned the coverage of procedures and care needed by transgender patients.

“As a smaller employer without the ability to self-insure, Pride Foundation found that we could not purchase an insurance plan in Washington that would provide these much-needed benefits to our employees,” said Seth Kirby, board president of Pride Foundation, in an emailed statement. “We were compelled to create a supplemental policy to cover those services so that we could treat all employees fairly and remain a competitive employer.”

The U.S. transgender population is small at roughly 0.3 percent, according to a 2011 study by the Williams Institute, a think tank at the University of California at Los Angeles School of Law. In Washington, that’s about 20,000 people.

“Transgender people are entitled to the same access to health care as everyone else,” Kreidler said in a news release. “Whether specific services are considered medically necessary should be up to the provider to decide on behalf of their patient.”

Comments | Topics: Affordable Care Act, health insurance, Mike Kreidler


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