In the U.S., very few public and private health insurance companies cover transgender-related surgery or other care. Most explicitly exclude it from their plans. (For more information about that, download this fact sheet on transition-related health care from www.lambdalegal.org ).
These policies persist despite medical consensus of the “efficacy, benefit and medical necessity” of transition-related surgery and other treatment, as the American Psychological Association put it in a 2008 statement. The same year, the American Medical Association affirmed the “medical necessity” of such care and that these procedures are not cosmetic or elective. (For a list of professional medical organizations calling for greater access to transition-related health care, downloadable here: http://www.lambdalegal.org/publications/fs_professional-org-statements-supporting-trans-health).
Big business is starting to catch on. See “The Costly Business of Discrimination” and “HRC’s Transgender-Inclusive Benefits for Employees and Dependents”. Studies show that it costs more to discriminate against trans people, than to cover their medically necessary health care. In the meantime, the reality is that transgender people face high poverty rates and double the rate of unemployment, leaving them without any health insurance at all and no ability to pay for it out-of-pocket.
What is the harm associated with denying this type of care?
Gender transition is an individualized process; there is no one-size-fits-all prescription for care. For some people, social transition (living in accordance with one’s gender identity – one’s deep-seated understanding of being male or female) is sufficient. For others, medical transition (hormone replacement therapy and/or gender-affirming surgeries, referred to as transition-related health care) is indicated by their medical providers and understood to be medically necessary. For more information on the guidelines governing the medical community’s support of transition-related health care, see the internationally recognized Standards of Care published by WPATH.
Transgender people often face tremendous stress when they do not have access to transition-related health care. The suicide rate is alarming. Forty-one percent of the 6,450 transgender people interviewed for the 2011 National Transgender Discrimination Survey (NTDS) reported attempting suicide. (Download the NTDS here: http://endtransdiscrimination.org/report.html)
And studies show a clear link between lack of health care coverage and the high suicide rates. In a 2006 Dutch study, for instance, suicide rates dropped from 29.3 percent to 5.1 percent when there was access to transition-related treatment, including surgery. A meta-analysis of 28 studies showed that 78 percent of transgender people had improved psychological functioning after such treatment. See De Cuypere, G. E. (2006). Sexologies, 15, 126␣133.
What makes the Jim Collins Foundation knowledgeable about these issues?
We are an organization of advocates who are actively working in the fields of transgender civil rights, health care and community support. We grapple with these issues on a daily basis, follow the medical and legal debates, and closely monitor the experiences of transgender people and their health care providers.
Why donate to the Jim Collins Foundation?
We are an all-volunteer organization. Your donation goes directly to meeting grant recipients’ surgical needs. The Jim Collins Foundation provides grants with the donations we receive – we do not have an endowment. That means, if you don’t donate, then we can’t provide this help to transgender individuals who are greatly in need.