Tag Archives: discrimination

The Costs and Benefits of Eliminating Trans Health Care Exclusions

Transitioning to better health careMany public and private health care insurance programs have “transgender exclusions” that refuse to pay for transition-related care for transgender people.  One common argument against ending such exclusions is that covering the cost of transgender people’s surgeries and/or hormones would raise the cost of health care insurance premiums for everyone.

The State of California’s Department of Insurance found that not only was that a false assumption, but covering such care could even “lower costs.”

How is it possible that an expansion of health care availability could actually lower health care costs?  The answer lies in accounting for the costs of discrimination:  “The Department [of Insurance] has determined that the benefits of eliminating discrimination far exceed the insignificant costs associated with implementation of the proposed regulation [requiring insurance companies to cover transgender-related care]. …Further, the Department’s evidence suggests that benefits will accrue to insurance carriers and employers as costs decline for the treatment of complications arising from denial of coverage for treatments.” (p. 9)

First, let’s talk about the costs.  The Department looked at the costs incurred and projected to be incurred by several employers who decided to cover such care, including the University of California, the City of Berkeley, the City of Portland, the City of Seattle, and the City of San Francisco.  Projected cost estimates were much higher than actual costs turned out to be, in one case 15 times higher.  Once there was actual utilization data available, the various plans’ premiums increased, at most, by 0.19%.  In several cases, insurers determined no premium increase at all was needed to cover the transgender-specific healthcare. (pp. 6-7)

So how are actual savings possible?  The report addresses four specific ways in which overall health care costs for transgender “insureds” might decline:

1. A decrease in suicide attempts and completions.  Transgender people have an extremely high rate of suicide attempts, with one large national study showing that 41% of trans respondents had attempted suicide at least once.  The Centers for Disease Control and Prevention estimate the average acute medical costs of a single suicide attempt in the U.S. is $7,234.  This figure does not include post-attempt mental health care or ongoing medical costs.  The California Department of Insurance found multiple studies showing that the rate of suicide attempts by trans people drops dramatically among those who are able to access transition-related medical care.  The Department concluded, “These studies provide overwhelming evidence that removing discriminatory barriers to treatment results in significantly lower suicide rates.  These lower rates, taken together with the estimated costs of a suicide attempt and completion, demonstrate that the proposed regulation [banning trans-related health care discrimination] will not only save insurers from the costs associated with suicide, but prevent significant numbers of transgender insureds from losing their lives.”  (pp. 10-11)

2. The Department referenced multiple studies that found mental health improvements among transgender people who were able to access transition-related medical care, including decreases in the rates of depression and anxiety.  “This overall improvement in mental health and reduction in utilization of mental health services could be a source of cost savings for employers, insurers, and insureds,” the Department of Insurance concluded. (p. 11)

3.  Substance use and abuse is one of the ways in which transgender people try to cope when they cannot access transition-related medical care.  “There are numerous studies that provide evidence that substance abuse rates decline” when transgender people can access the care they need, the Department reported.  (p. 11)

4.  Transgender people – particularly transgender women – have much higher HIV rates than the general population (28% in a meta-analysis compared to a general population rate of 0.6%).  Studies have shown “high rates of adherence to HIV care for trans people when combined with hormonal treatment,” the Department said, which is “particularly relevant to insurers because it provides evidence that offering treatment may reduce the long-term costs of treatment for HIV/AIDS.”  Furthermore, this benefit extends to the general public:  “[w]hen compliant with care, HIV-positive people stay healthier longer and are far less likely to transmit the virus to others.”  (p. 11)

In addition to these ways in which health care costs might decline as a direct result of trans people being able to access transition-related care, the Department pointed out two additional types of benefits:

5.  One of the ways some transgender individuals cope with being denied surgical assistance in modifying their body so they feel safer or more comfortable is by using silicone injections.  These are often administered by laypeople without medical training, often using construction-grade rather than medical-grade silicone.  This practice is extremely dangerous and can result in many adverse health consequences and even death. (p. 12)

6.  Finally, the California Department of Insurance noted that multiple studies have found that transgender people have higher employment rates and improvements in socioeconomic status after they have had access to transition-related care. (p. 12)

You can access the whole California Department of Insurance report at http://transgenderlawcenter.org/wp-content/uploads/2013/04/Economic-Impact-Assessment-Gender-Nondiscrimination-In-Health-Insurance.pdf

The Shape of Housing Discrimination Against Same-Sex Elders

lgbt-senior-livingJust when some people suggest that discrimination against lesbian and gay people is a thing of the past, along comes a report that proves otherwise.

“Opening Doors: An Investigation of Barriers to Senior Housing for Same Sex Couples,” (available at http://www.equalrightscenter.org/site/DocServer/Senior_Housing_Report.pdf?docID=2361) is a 2014 report by The Equal Rights Center.  They conducted 200 tests across 10 states in order to see if same-sex couples seeking housing in independent living facilities (as well as some continuing care and assisted living facilities that include independent living units) were treated the same as opposite-sex couples seeking housing.

They found that in 60% of the calls they made between April and November 2013, the “family member” seeking housing for an older relative and their same-sex spouse received adverse, disparate treatment from the “family member” seeking housing for an older relative and their opposite-sex spouse.  Many times, it was the exact same rental agent giving the two callers different information.

How did the discrimination play out?

10% of the time, same-sex couples were told about fewer available units than opposite-sex couples.  This included telling same-sex couples there were no units available while opposite-sex couples were offered units, and offering only 2-bedroom units to same-sex couples requesting 1-bedroom units.

10% the rent quotes to the same-sex couple were at least $100 more than that quoted to the opposite-sex couple.  In six of those cases, the “heterosexual” prospective renter was offered a rental option that was $200 to $500 less.

21% of the time same-sex couples were asked for higher fees or deposits.

4.5% of the time the same-sex tester received significantly less information regarding available amenities than did the opposite-sex tester that spoke to that same agent.

5.5% of the time, the heterosexual tester was offered a special incentive to rent at the facility that was not offered the same-sex tester.

11% of the time, same-sex couples were told of additional application requirements — background checks, credit checks, proof of income, or a wait list — that were not discussed with heterosexual applicants.

It’s important to note, as the study report makes clear, “Housing discrimination does not just harm the targeted individual or couple, but hurts all of society.  Residents of senior housing facilities are denied the opportunity to live and learn in a diverse community; relatives and loved ones are more limited in the options available when assisted care is needed for their aging relatives; and non-seniors observe the stigma that may confront them in their retirement planning, dimming their prospects for a healthy, productive, optimistic retirement.”

Although the report makes various recommendations, it is interesting to note that whether or not the state explicitly outlawed housing discrimination against same-sex couples appeared to have little effect on how much disparate treatment couples in that state encountered:

State State prohibits LGB housing   discrimination % same-sex older couples treated less well % same-sex older couples treated less well in two or more ways
























New Jersey



















Friendship and Workplace Discrimination

OLD-HANDS-001Yesterday we posted reasons why passage of the Employment Non-Discrimination Act, ENDA — which would make it illegal to discrimination against LGBT in employment — is particularly important to LGBT older workers.

A completely unrelated article on friendship and older LGBT people inadvertently touched on the same topic from a different angle.  Asked “What has changed in your work with regard to how people understand the role of friends for LGBT older people?”, Jesus Ramirez-Valles, director of Community Health Sciences at the University of Illinois-Chicago School of Public Health, answered:

One aspect that has changed is that friendships have increased in the workplace, since we are more open there and can create those friendships.

You can read the whole article, “Friendship a Pillar of Survival for LGBT Elders,” at http://www.asaging.org/blog/friendship-pillar-survival-lgbt-elders

Why ENDA is Important to LGBT Elders

ENDASummerFinal-228x300In July the Employment Non-Discrimination Act — ENDA — which would outlaw employment discrimination against LGBT workers — finally made it past the Senate Health, Education, Labor and Pensions Committee.

The Center for American Progress’s Andrew Cray published a blog post focusing on three reasons why ENDA is particularly important for older LGBT Americans.  One reason is that older LGBT Americans face double discrimination in the workplace, being subject to both age and anti-LGBT discrimination.  Another reason is that employment discrimination adds up over the lifespan, with on-the-job discrimination multiplying into significant later-life income disparities.

These two reasons are fairly self-evident.  The third, however, surprised me:

Data on LGBT workers overall show that while only 5 percent of LGBT employees ages 18 to 24 are open about their LGBT identity at work, more than 20 percent in the older age cohorts are out.

Since data also shows that out LGBT employees experience more discrimination than non-out employees, “older LGBT workers are more likely to face discriminatory treatment.”  And while that fact may make it seem like older LGBT workers should be closeted at work, Cray points out the negative ramifications of that choice:

And for those who are not able to be open in the workplace, a lack of trust and feelings of isolation continue to take a toll on comfort and productivity on the job and can even result in negative health outcomes.  Passing ENDA would provide relief for older LGBT workers, whether or not they decide to come out at work.

The complete blog post is available at http://www.americanprogress.org/issues/lgbt/news/2013/08/06/71553/enda-provides-protections-for-older-lgbt-americans/

An Ally’s Guide to LGBT Issues

Ally's GuideTomorrow the U.S. Senate Committee on Health, Education, Labor and Pensions is scheduled to take up — and expected to send on to the full Senate — the Employment Non-Discrimination Act (ENDA), a long-pending bill that would outlaw employment discrimination against LGBT people.

In honor of this new ENDA push, we dusted off our copy of “An Ally’s Guide to Issues Facing LGBT Americans,” a guide that was collaboratively produced by a number of LGBT organizations.  It addresses what some would call “The Gay Agenda,” giving data and background on the following LGBT wish list: Continue reading

LGBT Cancer Survivors

rainbow ribbon“Cancer doesn’t discriminate, but the healthcare system often does….”

So starts the conclusion of a new report, “LGBT Patient-Centered Outcomes:
Cancer Survivors Teach Us How to Improve Care for All,” issued by the National LGBT Cancer Network and the Network for LGBT Health Equity. Continue reading

2012 Genny Awards Announced

Stu Maddux, the producer of the acclaimed LGBT aging documentary, Gen Silent, has issued his 2012 Genny Awards to recognize the year’s most important changes towards a greater quality of life for LGBT older people.

From his website (http://stumaddux.com/gen_silent_Gennys_Ballot.html?utm_source=CONTACT+FORMS+AS+OF+120412&utm_campaign=b1d0c2bfa3-Gennys_Announcement_12_26_2012&utm_medium=email) Continue reading

American Psychiatric Association Issues Transgender Statement

The place of transgender and gender variant people in American society is rapidly changing.  Another marker of this change was issued this summer by the American Psychiatric Association (APA).  The APA formed a task force on the treatment of gender identity disorder (GID) – the psychiatric label the APA assigned to transgender people in 1980 – to “perform a critical review of the literature on the treatment of GID at different ages, to assess the quality of evidence pertaining to treatment, and to prepare a report that included an opinion as to whether or not sufficient credible literature exists for development of treatment recommendations by the APA.” Continue reading

A Story of Transgender Medical Care

What happens when you’re transgender and living in the middle of rural America and need specialized medical care?

The patient at the center of this story is only 20 years old, but his story, written up in The Daily Iowan on April 4, 2012, is instructive.  Like many transgender people — one study says the figure is 50% — he had to educate his health care providers about transgender health care.  Luckily, it worked.  Not only did he eventually get the health care he needed, but activism by him and his colleagues is beginning to change the climate in Iowa City.  For a more recent story that indicates there are still problems — but also that even more efforts are underway to correct them — see the Iowa City Patch article here.

680 Pages of Documented Discrimination

Need data to back up your advocacy for employment non-discrimination legislation for LGBT workers?  Six hundred and eighty pages of it has been compiled into a new docuemnt available at http://www.americanprogress.org/issues/2012/05/pdf/lgbt_eo_research.pdf

The compilation, put together by the Williams Institute, the Human Rights Campaign, and Center for American Progress, groups the documents into six categories:  employment discrimination and the LGBT workforce; the business case for LGBT workplace protections; public opinion and political support for equal opportunity; impact and legal issues regarding an LGBT nondiscrimination executive order; and miscellaneous.  The first category contains only one document, a policy memo (inexplicably still labeled “Confidential — not for circulation”) making the case for why President Obama should issue an Executive Order banning federal contractors from discriminating against LGBT workers.

Although none of the documents’ titles indicate they cover how employment discrimination leads to income dispararities and physical, social, and emotional problems in old age, there is obviously a clear link that can (and should) be made.  Please let us at GrayPrideParade know if you know of documents that discuss the linkages.