When Russell Toomey required a medically necessary double mastectomy in 2004, the recent college grad didn’t have the $8,000 to pay for it. But with the help of his father-in-law, Toomey — who was just beginning to transition from the gender he was assigned at birth — was able to get the medical care he needed.
Recently, Toomey’s doctor has recommended that he have a hysterectomy — another medically necessary, but expensive, surgery. This procedure will also require Toomey to pay out-of-pocket since Arizona’s health insurance coverage excludes transition-related surgery.
Only 29% of U.S. employers currently offer transgender inclusive healthcare benefits, according to the International Foundation of Employee Benefit Plans, an organization that offers education for the employee benefits community. Although that figure has climbed from only 12% in 2016, there is still a significant percentage of American employers who aren’t offering healthcare coverage equally among workers.
Healthcare for gender confirmation surgery has been excluded from most public and private health insurance programs because the care is incorrectly viewed as cosmetic, and in the past had been seen as experimental, says Joshua Block, an attorney with the American Civil Liberties Union’s Lesbian Gay Bisexual Transgender & HIV Projects.
“Healthcare related to gender transition has been universally recognized by every major medical organization that has spoken on the issue as medically necessary care,” Block says.
Block and the ACLU are representing Toomey, a professor of family studies and human development at the University of Arizona, in a class action lawsuit he brought against the state of Arizona and the Arizona Board of Regents — which oversees the state’s universities and is technically Toomey’s direct employer.
Toomey pressed both the University of Arizona and the Arizona Board of Regents on why the state excludes medically necessary procedures for transgender individuals. He says he was told that the issue is beyond their control to rectify, but that both the university and the board had asked the state to remove the exclusions.
The Arizona Board of Regents and the University of Arizona both declined to comment.
Toomey isn’t alone in facing such challenges. Transgender employees are fighting an ongoing battle against discrimination when it comes to healthcare benefits. The same treatments and care that doctors deem medically necessary for cisgender individuals (someone who identifies with the gender they were assigned at birth) may not be covered for transgender individuals.
“Not only do these exclusions violate the contemporary standards of care of the medical community, but they also violate federal and state anti-discrimination laws,” Block adds.
While the Arizona insurance standard is clear-cut, private employers may not realize they are failing their employees by not paying close enough attention to the fine print, or even by complying with deliberately discriminatory policies.
“For an employer, when they’re negotiating with an insurance provider on the front end when those contracts come up for renewal, that’s a good opportunity to go back and forth with the insurance company and [review what] is included,” says JoLynn Markison, a labor and employee group lawyer with the firm Dorsey & Whitney.
A theme among those who would argue against coverage for gender confirmation care is the supposedly high cost. Indeed, in 2017 President Trump tweeted about the “tremendous medical costs and disruption that transgender in the military would entail.” The Pentagon’s ban on transgender recruits joining the military went into effect in April.
The military has spent about $8 million on care for transgender troops since 2016, according to The Associated Press, as compared with the military’s annual healthcare budget of $50 billion. According to a report by the Military Times, the military has spent a total of $84.2 million on erectile dysfunction medications for active members, eligible family members and retirees.
During a state visit to the U.K. in early June, Trump appeared on “Good Morning Britain” where he stood by his ban on transgender members of the military. Trump claimed the “massive amounts of drugs” transgender people “have to take” would be a burden on the armed forces and that it would break mililtary rules for these service members to even take those medications.
It is unclear where Trump is getting his facts as the military does not prohibit soldiers from taking doctor prescribed medications.
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“The Military Health System covers all approved medically necessary treatments and prescription medications,” says Jessica Maxwell, a spokeswoman for the Department of Defense. “All service members are entitled to health care provided by Military Treatment Facilities.”
Additionally, Trump has rolled back Obama-era healthcare protections for the broader LGBTQ+ community. The proposed rule would change an Affordable Care Act regulation that prohibits healthcare discrimination based on gender and sexual orientation. The proposal also allows healthcare workers to refuse care on religious or moral grounds.
Markison maintains that the perception of higher-than-usual healthcare costs for transgender individuals is a myth. She says that a lot of the time it would be more cost effective for the company to agree to and provide coverage than it will be to deal with the issues that come up when someone suffers the mental anguish that comes with being denied necessary care.
Indeed, transgender individuals are at an increased risk for suicide relative to cisgender people, according to an article on violence and gender from the National Library of Medicine and National Institutes of Health. Forty percent of transgender adults have reported making a suicide attempt, according to a survey by the National Center for Transgender Equality, while 92% of those individuals say they made the attempt before age 25.
Greater education by employers to employees is one way to combat this health care discrimination, says Kathie Patterson, chief human resources officer with Ally Financial. The financial services company offers full health care coverage for transgender employees as well as educational seminars on a variety of topics such as broader LGBTQ+ needs and a greater understanding of what it means to be transgender.
“The most recent session I attended was a “lunch and learn” hosted by our LGBTQ+ community, and it was about being transgender,” says Patterson. “It was educational for myself and across the company.”
The session covered what it means to be a transgender individual, the stigma it entails in the workplace and how to remove it. The session also covered proper use of pronouns and the importance of using them correctly.
“It’s a [chance] for employees to come in and learn about a particular topic in a safe environment with a positive intent,” Patterson says. “It’s also an opportunity for us as employers to make clear our practices, policies and what we expect from our leaders.”
Employers have another option if an insurance company simply won’t offer coverage, Markison says. It may be within the financial power of an employer to cover the cost of care.
“There has to be a way, if an insurance company isn’t going to provide the coverage, for a company to say ‘we stand behind our transgender employees,’” Markison says.
