Tag Archives: Policy

Trans Healthcare Exclusions — The History

trans healthcare oregonHow would you react if it turned out that your insurance company refused to pay for surgery your doctor said you needed based on an analysis of the surgery’s effectiveness published before the dawn of the internet?

Would you be concerned if you found out that federal equal opportunity educational policies were based on a position paper written by someone who believes African-Americans are an inferior race?

Would you want someone who had gone through a bitter divorce determining whether their ex-spouse should be provided life-sustaining medical treatment?

Would you agree that public policy ought to focus on the elimination of unwed pregnancies by refusing to pay for the health care of pregnant women who are unmarried?

If any or all of those scenarios appall you, you should be advocating for transgender health care justice, because all of these questions reflect the history behind trans people’s restricted access to health care services.

Currently five states and the District of Columbia have forbidden insurance companies from refusing to pay for care of transgender people; everywhere else such exclusions are not only legal, but ubiquitous.  Such “transgender exclusions” are typically said to exist because transgender related health care is “experimental,” “cosmetic,” “elective,” and/or “too expensive.”  In truth, all such treatments are routinely covered by insurance companies when they are provided to patients who are not transgender.  Furthermore, such exclusions were never based on medical evidence, but instead can be traced to one policy paper written by a person who had had unhappy experiences dating transsexual people and who had subsequently developed a rabid anti-transgender philosophy.

You cannot find an online, original copy of “Technology on the Social and Ethical Aspects of Transsexual Surgery,” by Janice G. Raymond because it was written in 1980, before the World Wide Web existed.  Transcribed copies can be found in a variety of places, including http://auntyorthodox.tumblr.com/post/82585002623/technology-on-the-social-and-ethical-aspects

The paper was written at the request of the National Center for Health Care Technology (NCHCT), which was a government-funded body that was charged with making evidence-based judgments about the efficacy of medical technologies.  Rather than consulting medical experts, NCHCT asked Janice Raymond, an assistant professor of medical ethics and women’s studies at the University of Massachusetts, to address the issue of the medical care of transgender people.  The year before, Raymond had published The Transsexual Empire: The Making of the She-Male, arguing that not only was it impossible to change one’s sex, but that those who did so were anti-feminist.

The NCHCT paper was filled with political and even inflammatory statements.  Raymond said medical care of transgender people brought up “questions of bodily mutilation and integrity,” argued that “transsexualism is an ethical” issue, and called for “the elimination of transsexualism.”  She worried that clinics that specialized in working with transgender people “could become potential centers of sex-role control for non-transsexuals – e.g., children whose parents have strong ideas about the kind of masculine or feminine children they want their offspring to be.”  She made an analogy between medical care of transgender people and “oppressed people us[ing] heroin to make life tolerable in intolerable conditions.”  Just as the “contentment and euphoria produced by the drug [heroin] diffuses the critical consciousness of the user,” she said, “Transsexual surgery produces satisfaction and relief for the transsexual at the expense of muting his or her critical consciousness of the ways in which such surgery reinforces sex role behavior.”

When she did address legitimate medical issues, Raymond did so in a skewed and misleading way.  For example, she stated that “[t]ranssexual treatment…has been known to cause cancer,” citing two cases of breast cancer in trans women.  She suggested “that the malignance was entirely due to the hormonal imbalance created by castration plus the massive doses of estrogen received.”  Apparently she felt the fact that breast cancer is extremely common in women across the board, whether or not they have ever taken estrogen pills, had no relevance.

Despite the obvious political bias of its author, “Technology on the Social and Ethical Aspects of Transsexual Surgery” became the basis of Medicare’s exclusion of coverage for transgender related care.  Medicare’s decision, in turn, led to the exclusion of such care not only in other public programs such as Medicaid, but also by most health care insurance companies.

And that is how one woman’s personal 1980 prejudices and worldview came to shape medical care for thousands and thousands of transgender people ever since.

Trans People, Marriage, and Social Security

social security cardAfter sustained lobbying by the National Center for Transgender Equality and others and after Robina Asti’s public statement (see http://www.grayprideparade.com/2014/01/29/i-was-shocked-i-was-shamed/), the Social Security Administration has finally issued guidance telling staff to automatically assume that most marriages involving transgender people are valid.

Of course, given the mish-mash we currently have with some states refusing to recognize other states’ “same-sex” marriages and some states’ bad decisions concerning the legal gender of transgender people, the guidance is complicated.  The guidance now requires Social Security staff to determine where the marriage was performed and if the sex change took place before or after the marriage.  If the sex change took place before the marriage and the transgender person currently lives in (or died in) American Samoa, Florida, Idaho, Kansas, Ohio, Oklahoma, Puerto Rico, Tennessee, Texas, or the Virgin Islands, a legal opinion about the validity of the marriage is still required.  Otherwise, marriages involving transgender people are to be treated under existing rules for opposite-sex and same-sex marriages, bypassing the current procedure of referring all marriages involving transgender people to legal counsel.

The actual bureaucratic memo is available at https://secure.ssa.gov/apps10/public/reference.nsf/links/03252014040307PM  (Trigger warning: in discussing sample cases, the memo uses typical bureaucratizee about applicants “alleging” personal facts.)

Same-Sex Military Couples Gain Benefits

MilitaryKissAnd another one falls!

A California judge has ruled that the portion of the U.S. Code governing veterans benefits is unconstitutional and unenforceable in its definition of marriage, which excludes same-sex couples.

The ruling will enable same-sex military couples to access benefits available to other married couples.

The article is available at http://www.buzzfeed.com/chrisgeidner/federal-judge-strikes-down-law-barring-same-sex-couples-from

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

Bathroom Politics

public-restroomsEveryone needs them, which may be why they have been the site of so many pitched political battles:  bathrooms.

Interestingly, the battles usually revolve around “safety.”  When some people wanted human races kept separate, they argued that blacks and whites had different germs and/or hygiene practices, and that having them use the same facilities would lead to the spread of disease.  Now the argument for segregation seems to revolve around women’s “safety,” which apparently is assured by never, ever allowing an adult male to use the same facilities.

Any segregation, of course, involves formal and/or informal policing, and the forced assignment of people into distinctly separate categories.  That’s why the simple right of transgender people to pee in facilities built specifically for that purpose has so often been challenged or denied: if men have to be kept out of women’s bathrooms, then we have to determine who a man is.  Apparently, that cannot be decided by the person him- or herself; instead, something else — a body part, a government identity document, manner of dress or appearance — is the determinant.  Or so the lawsuits, arrests, and civilian bathroom-rules-enforcers insist.

As society battles out these issues over who is safe and who isn’t and who is allowed to “go” where, though, real casualties mount.  Actual people get hurt.  A new study recently released by The Williams Institute begins to quantify the damage: it reports that in a survey of transgender and gender non-conforming people in Washington, D.C., 70% reported having been denied access, verbally harassed, or physically assaulted in public restrooms.  The damage didn’t stop there: many of these victims reported negative ramifications of bathroom denial or abuse on their education, their employment, their health, and their participation in public life.  You can read more about it at http://williamsinstitute.law.ucla.edu/wp-content/uploads/Herman-Gendered-Restrooms-and-Minority-Stress-June-2013.pdf

 

Australia Gets Transgender Aged Care Specialist

LGBT-flag-map-of-AustraliaAs part of the Australian government’s effort to ensure its Living Longer Living Better aged care reform plan reaches everyone, funding has been provided to the Gender Centre Incorporated to hire a Transgender Aged Care Specialist Support Officer.

The new position will focus on “front line crisis management, psycho-social and community support,” training, and providing referrals.  It is part of the government’s National LGBTI Ageing and Aged Care Strategy.  You can read more at http://anthonyalbanese.com.au/better-care-for-older-lgbti-australians-in-inner-west

Married LGBT Federal Retirees Need to Act

federal-retirementDominoes continue to fall as a result of last week’s Supreme Court ruling that the Defense of Marriage Act is unconstitutional, with one of the latest being a memo from the U.S. Office of Personnel Management that has great relevance to federal retirees who have a legal marriage.

The 6/28/2013 memo, available at http://www.chcoc.gov/transmittals/TransmittalDetails.aspx?TransmittalID=5700, is entitled, “Guidance on the Extension of Benefits to Married Gay and Lesbian Federal Employees, Annuitants, and Their Families.”

Of critical importance are the following two deadlines.

Annuitants (and employees) have only until August 26, 2013, to add their spouses to their health insurance under the FEHB program.  (Other additions can be made during annual Open Seasons.)

Annuitants have until June 26, 2015 to inform the Office of Personnel Management “that they have a legal marriage that now qualifies for recognition and elect any changes to their retirement benefits based on their recognized marital status.”  OPM will be issuing further guidance to help retirees figure out if this change makes financial sense for their situation, since providing benefits to a surviving spouse “will likely result in a deduction to the monthly annuity that the retiree currently receives.”

Now What? Married LGBT Elders After DOMA

Edith WindsorToday the U.S. Supreme Court struck down the Defense of Marriage Act (DOMA), meaning that federal benefits must be made available to legally married same-sex couples.

Seems simple and straight-forward, right?  Unfortunately, it’s not.  Take two of the programs most important to LGBT elders — Social Security and Medicare.  Both of these programs base their marriage eligibility criteria on the law of the state where the person lives at the time of filing for benefits.  This means that if Jane and Kathy married in Vermont (where their marriage was legal) but they actually reside in Tennessee (where their marriage is not recognized), the federal government still won’t recognize their marriage for Social Security and Medicare purposes.

It will take some time to sort out all the implications of today’s rulings, and even more time to correct some of the injustices that will remain.  In the meantime, a coalition of LGBT groups has put out a very useful series of fact sheets that individuals and advocates should review before they seek out personal legal assistance from a qualified attorney.

Social Security Spousal and Family Protections: http://www.thetaskforce.org/downloads/release_materials/Post-DOMA_FSS_Social-Security_v2.pdf

Medicare Spousal Protections:  http://www.thetaskforce.org/downloads/release_materials/Post-DOMA_Medicare_v2.pdf

Other post-DOMA fact sheets:  http://thetaskforceblog.org/2013/06/26/heres-almost-everything-you-need-to-know-now-that-doma-is-dead/

Social Security Gender Change Changes

social security cardThe Social Security Administration (SSA) recently issued new guidelines that make it far easier for transpeople to change their gender marker.

Previously, changing the gender marker on your Social Security account generally required proof of having undergone sex reassignment surgery; no more!  Now people can update their gender marker using any of four documents:

  • A U.S. passport showing the correct gender;
  • A birth certificate showing the correct gender;
  • A court order recognizing the correct gender; or
  • A signed letter from a physician stating the person “has had appropriate clinical treatment for gender transition to (the new male or female) gender.”

The physician letter does not have to specify what clinical treatment has been done, and what is “appropriate” can remain private between the patient and their doctor.  The physician letter needs to be on the physician’s letterhead, include their medical license or certificate number and the jurisdiction that issued it, and the statement, “I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct.”

The National Center for Transgender Equality has written a plain-English fact sheet that includes additional details and links for those who are interested.  It’s available at http://www.transequality.org/Resources/SSAResource_June2013.pdf