Denied medical coverage

Transgender-based exclusions allow insurance companies to deny healthcare coverage to transgender individuals

Pride Foundation has long believed that words matter, but actions reveal truth.

In that spirit, we are excited to announce that our Board of Directors recently passed a Supplemental Transgender Health Benefit Policy, ensuring that all members of our staff have equitable access to the healthcare services they need and deserve.

Our policy marks an important step in Pride Foundation’s history—providing an opportunity for us to live up to our values as an organization, while creating innovative solutions that help further equality for the LGBTQ community.

The supplemental policy was needed for several reasons. Regrettably, Pride Foundation’s insurance carrier currently excludes coverage for transgender related healthcare. In fact, in the state of Washington, small organizations and businesses (that are not self-insured) are unable to purchase insurance coverage for medically-necessary, gender-related healthcare. We know this because we tried.

Gender Dysphoria (formerly known as Gender Identity Disorder) is a well-recognized medical condition in which a person’s gender at birth does not match the gender they know themselves to be. In 2008, the American Medical Association (AMA) adopted a resolution that recognizes Gender Dysphoria as a “serious medical condition” that can result in severe psychological impacts if untreated—including increased risk of suicide and death. AMA resolved that all public and private health insurances should cover treatment and opposed the exclusion of treatment for Gender Dysphoria when prescribed by a physician.

AMA also confirmed the effectiveness and medical necessity of mental healthcare, hormone treatment, and for some people, Sex Reassignment Surgery (SRS), as treatments for Gender Dysphoria.

Yet despite clear medical necessity, the majority of U.S. health insurance policies specifically exclude important healthcare for transgender people. Transgender-based exclusions are often written broadly and apply to both transition-related care, such as hormones, surgery, and mental-health care, as well as gender-specific care such as cancer screenings and reproductive healthcare.[1]

These services—mental healthcare, cancer screenings, hormone therapy, surgical procedures—are covered for cisgender (non-transgender) people. In addition, claims for basic care such as a cold or a broken bone can often be denied when carriers learn that a patient is transgender.[2]

Discrimination and harassment are also large barriers to care for transgender and gender non-conforming individuals. According to the National Transgender Discrimination Survey:

  • 19 percent of respondents reported being refused medical care due to their transgender or gender non-conforming status, with even higher numbers among people of color in the survey;
  • 50 percent of survey participants reported having to teach their medical providers about transgender care, and;
  • 28 percent postponed medical care when they were sick or injured due to discrimination.

Transgender people also face great economic insecurity—respondents to the survey were over four times more likely to have a household income of less than $10,000 per year compared to the general population, and faced double the rate of unemployment. As a result, healthcare remains out of reach for many transgender individuals. Forty-eight percent of survey respondents were unable to afford medical care when they needed it.

All these factors have dire consequences on the health and well-being of transgender individuals, and have led to wide disparities in health outcomes. Survey respondents reported over four times the national average of HIV infection, and over a quarter of respondents’ misused drugs or alcohol specifically to cope with discrimination they face due to their gender identity or expression. Healthcare access and outcomes are dramatically worse for transgender people of color, who are facing a combination of anti-transgender bias and racial bias.

Transgender medical care can literally be lifesaving medical care. An alarming 41 percent of transgender people have attempted suicide in their lives, and another 72 percent of people have contemplated suicide.

These realities are what led Pride Foundation and our Board of Directors to create a supplemental transgender health benefit policy. Until we are able to purchase a policy that covers healthcare for transgender employees, Pride Foundation will provide supplemental transgender health benefits to attract and retain qualified employees.

One of the common arguments against covering transgender individuals is cost. Yet no jurisdiction, employer, or insurance company that covers transgender healthcare has found the cost to be prohibitive.[3] Portland, Oregon experienced a mere 0.08 percent increase in costs after removing exclusions on transgender healthcare coverage. The County and City of San Francisco have been providing healthcare coverage to transgender people since 2001, and research has shown no discernible cost.[4]

We are at a unique moment in history, to be sure. The Affordable Care Act provides an opportunity for many individuals to purchase health coverage for the first time. But we must be vigilant to guarantee that insurance companies are not able to continue carving out exclusions for transgender people under the new law.

Pride Foundation is proud to support healthcare coverage for the transgender community. Our policy is consistent with best practices, and we are hopeful it can serve as a model for other organizations that do not have the ability to self-insure.

We recognize that this is not a long-term solution. Ultimately, we need federal and state policy changes that will support transgender healthcare equity. In the last two years, Insurance Commissioners in California, Oregon, Colorado, Vermont, Connecticut, and the District of Columbia have all taken action to prohibit discrimination against transgender people in healthcare plans. It is our hope that all the states in our region and throughout the country will take similar action.

Until then, Pride Foundation will continue to work towards this goal, bringing us closer to our vision of a world that honors diversity, fosters mutual respect, and celebrates complete equality. Together, we can increase healthcare access for transgender people, strengthening the health and well-being of all our communities.

Kris Hermanns is Pride Foundation’s executive director. Email Kris.


[1] Basic Rights Education Fund, “The Benefits of Equality: A Blueprint for Inclusive Healthcare for Transgender Workers,” http://www.basicrights.org/wp-content/uploads/2013/05/BREFTransHealthToolkit2ndEditionweb.pdf.

[2] Ibid.

[3] Ibid.

[4] Ibid.

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