By Erin Rook, PQ Monthly

Transgender individuals are routinely denied medically-necessary health care based solely on their gender identity. But now, denying care to a trans person that is available to other people will be treated as discrimination, according to a bulletin from the Oregon Insurance Division clarifying the state’s 2007 non-discrimination law.

The clarification was issued on Dec. 19, more than five years after the passage of the non-discrimination law and following pressure from BRO’s Trans Working Group and complaints from transgender Oregonians denied coverage of medical treatments on the basis of their gender identity. While it’s not clear how the bulletin will affect federally-managed insurance programs such as Medicare and Medicaid (Oregon Health Plan), it does apply to all private insurers transacting in Oregon.

“This is, I think, a huge victory for the transgender community in Oregon. This is really making clear what trans folks know – that we deserve equal healthcare access,” said Basic Rights Oregon‘s trans justice manager tash shatz. “It’s such an incredible thing that it’s kind of hard to describe how big a deal it is.”

Though 16 states and Washington, D.C., prohibit discrimination on the basis of gender identity and expression, only California and Oregon have protections specific to medical care. In 2006, the Transgender Law Center helped pass California’s Insurance Gender Nondiscrimination Act.

“For me, this coverage is preventive health care,” Trans Justice Working Group member Ray Crider said in a release. “As a transgender man, part of my daily routine is binding my chest to create a masculine appearance. This created health problems for me by restricting my breathing and causing inflammation in the wall of my lungs. As a result, I ended up in the emergency room several times for shortness of breath and chest pain. Doctors told me the only solution was to stop binding, but the surgery I needed ended up being the same cost as my emergency room visits. Transgender exclusions in insurance policies are a lose-lose proposition, and I’m glad they’re coming to an end.”

According to the OID bulletin, insurers are prohibited from doing any of the following: rejecting an application for insurance coverage based on gender identity; charging trans folks different rates or premiums; classifying “gender identity disorder” or “gender dysphoria” (GI/GD) as a disqualifying pre-existing condition; denying coverage for a procedure that is provided for the treatment of other conditions or illnesses (such as hormone therapy, mastectomy, or vocal training); categorically denying coverage of GI/GD; denying mental health coverage for GI/GD-related issue in adults; and denying sex-specific care (such as pap smears and prostate exams).

Antoinette Sparkles, a 30-year-old trans woman, says that while she may not benefit from the clarification directly, she is encouraged by the bulletin’s potential to influence not only healthcare access but public attitudes.

“These changes don’t directly affect me, because I am currently uninsured, and I believe many other members of the community are as well,” Sparkles said. “It is hard to imagine that the social attitude towards trans*-related health issues will not be affected by these changes, however, and that will definitely be a positive change that I will be able to enjoy.”

She has some concerns about the language in the bulletin, but figures it’s a good first step.

“There seems to be a lot of equivalence language used that may imply that any care that would be considered trans* exclusive, which is to say only procedures or medicine that a person would seek if they were trans*, may be unprotected,” Sparkles said. “Trying to equate one set of health care needs to another as a way of determining appropriate care seems a little bit ridiculous to me.”

Only time will tell how well the changes protect transgender folks and how adept insurance companies are at finding loopholes. In the meantime, trans folks are encouraged to file a complaint if they believe their insurance provider has discriminated against them.

Complaints can be filed online (cbs.state.or.us) or via a printed form. Once a complaint has been submitted, companies are required to respond to complaints within 21 days, said Ron Fredrickson of the Oregon Insurance Division’s Complaints Department.

“Once we get a response back, an advocate decides whether or not the insurer is in compliance. If they are in violation, we get good resolution for consumer,” Fredrickson says. “If we find that the company engaged in practice in violation of the law, we can investigate whether other consumers have been affected.”

Penalties for violating state law can include fines, but Fredrickson says the ultimate objective is changing behaviors and ensuring consumers are treated fairly.

“I think that any kind of clarification of law of this magnitude in terms of impact for a community is going to take some time to implement,” shatz said. “The good thing is this is coming from the insurance division.… I think it bodes really well for the implementation of it.”

The clarification bring all insurers doing business in the state in line with a number of Oregon businesses who have pushed for inclusive coverage in their company plans, including Oregon Health & Science University (OHSU), New Seasons, the National College of Natural Medicine, Portland State University, Progressive Insurance, Starbucks, IBM, and Microsoft.

“This clarification is indicative of a sea change on the issue where more and more people are understanding that transition-related care is something that shouldn’t really be excluded,” shatz said. “The tide is really turning.”

Originally published in PQ Monthly.