The right to transgender health care

Labor takes the lead


OPINION When I first came out as a transgender man in the mid 1990s, I quickly realized that I would have to pay out-of-pocket for the health care I needed.

Nearly every insurance plan has outdated exclusions that bar transgender people from receiving medically necessary health care. Everything from cancer screenings to the care related to gender transition is commonly excluded, despite being provided without exclusion to non-transgender health insurance customers.

For working people everywhere, including members of the LGBT community, accessible, affordable, quality healthcare is critical. And for union members like myself, healthcare equity is part of a basic and broader vision for equality for all people.

In recognition of this vision, Pride at Work, the SEIU National Lavender Caucus, National Center for Transgender Equality, the Transgender Law Center, and Basic Rights Oregon have partnered for the very first Transgender Month of Action, aimed at lifting the healthcare inequities that face our community.

I began to gender transition in 1996, starting with hormone therapy, a process that required walking through countless hoops. I will forever be thankful to the Tom Wadell Clinic and Lyon Martin Clinic for making hormone therapy accessible to low-income and uninsured trans people like myself, but I know I was one of the lucky ones. A few years later, when I was insured, I began to feel as if insurance companies were the gatekeepers of my body.

I knew that I needed to get chest surgery and that it wouldn't be covered by my insurance, so I held a rent party and told my friends and loved ones that I needed help. It took a lot of vulnerability to do that. Like everyone else, transgender people need acute care when they are sick and preventative care to keep us from becoming ill, including services that are traditionally considered to be gender specific — such as Pap smears, prostate exams, and mammograms.

But insurers frequently expand discriminatory exclusions in a way that denies transgender people coverage for basic services. Take the outrageous example of a transgender woman in New Jersey who was denied coverage for a mammogram on the basis that it fell under her plan's sweeping exclusion for all treatments "related to changing sex."

Sometimes, trans people are denied care completely. In the late 1990s, I went to a gynecologist, but the doctor refused to treat me. Over the next 10 years, likes so many other trans people, I did not get an exam, too embarrassed and outraged to seek treatment.

In 2001, I worked with the a group of transgender healthcare activists to remove discriminatory exclusions for trans employees. When the Board of Supervisors voted to remove these exclusions, it was a huge and historic victory. Since that decision over a decade ago, San Francisco has proudly provided inclusive health care to city employees — and there's been no cost increase to the overall plan.

Pride at Work, the organization that brings together LGBT union members and their allies, has a sign in the office that states: An injury to one is an injury to all. That's the premise that underscores the labor movement's commitment to LGBT equality, including trans-inclusive healthcare.

And it's why Pride at Work is organizing local and national efforts to educate LGBT people and labor unions about the importance of ensuring access to basic healthcare for transgender people and providing coverage of medically-necessary transition-related care in health insurance. This first-of-its-kind effort is inspired by the belief that all workers deserve to have all medically-necessary care covered by health insurance, including transgender people whose healthcare needs are not being met.

Gabriel Haaland is co-vice president of Pride at Work.


But you cannot reasonably expect other people to underwrite elective and cosmetic sugery.

So yes, you are entitled to EQUAL healthcare. You are not entitled to unequal and special healthcare.

Posted by anon on Mar. 12, 2013 @ 5:42 pm

And by "elective and cosmetic", what might you be referring to?

Posted by beneficii on Mar. 12, 2013 @ 9:29 pm

procedure whose purpose is to improve appearance rather than to improve health.

Posted by Guest on Mar. 15, 2013 @ 2:18 pm

The term elective applies to any non-emergency surgery that is scheduled, so that point is totally irrelevant to medical necessity. Additionally, if you'd read the commonly accepted medical standards of care now you'd know transsexual surgery is not cosmetic. Depending on the individual the need can absolutely be determined to be medically necessary by doctors, and even life saving.

Posted by Alena Neumann on Mar. 12, 2013 @ 9:40 pm

different appearance is not the same type of medical "necessity" than, say, if you need a bypass operation.

The community may be willing to subsidize the cost of the latter, but not the former. That's the key issue here.

Posted by anon on Mar. 14, 2013 @ 10:01 am

I disagree. You are "entitled" to whatever healthcare you purchase. You are not entitled to the contents of my wallet

Posted by Guest on Mar. 14, 2013 @ 8:05 am

Oh yes we are entitled to the contents of your wallet, at least half of it.

Posted by marcos on Mar. 14, 2013 @ 8:20 am

How does it feel to be a leech?

Posted by Guest on Mar. 14, 2013 @ 8:40 am

Gender Dysphoria is a recognized medical condition where HRT, breast removal, and GRS are often required for the health of the patient. They are no more elective than receiving HRT after menopause, breast reductions for women with back pain, or the hysterectomy surgeries that are covered for a number of reasons.

Posted by Nika on Mar. 14, 2013 @ 8:18 am

Lots of conditions can be coined for any state where a person is dissatisfied with themselves, whether that is the shape of their nose or the existence of a body part they do not easily relate to.

You are welcome to fix such things but not on my dime.

Posted by anon on Mar. 14, 2013 @ 10:02 am

Dysphoria (from Greek: δύσφορος (dysphoros), from δυσ-, difficult, and φέρειν, to bear) is a state of feeling unhappy; a feeling of emotional and mental discomfort as a symptom of discontentment, restlessness, dissatisfaction, malaise, depression, anxiety or indifference.

Don't see how this makes Gender change anything but an elective, cosmetic surgery to make a person feel better.

Posted by Richmondman on Apr. 19, 2013 @ 10:28 am


The argument from the authority of being a person in SEIU leadership mixed with the written to coerce a child style.

The English language and the torture done to it.

Posted by matlock on Mar. 12, 2013 @ 11:13 pm

I hope the irony of the poor grammatical structure in this comment isn't lost on you.

Posted by Guest on Mar. 13, 2013 @ 11:26 am

and yes, I'm sure the irony is lost on him (time and again)

Posted by Guest on Mar. 13, 2013 @ 11:51 am

I'm not trying to coerce people through correct newspeak syntax.

I hope someone as smart as you can figure the difference.

Posted by matlock on Mar. 13, 2013 @ 7:56 pm

The last time I checked, we referred to it as English, not "newspeak"

Or do you contend that we should all go back to speaking ancient German?

Posted by Guest on Aug. 24, 2013 @ 9:21 am

As a trans woman who has been forced to pay out of pocket to overseas pharmacy companies for hormones, I applaud your efforts. Thank you.

Posted by Nika on Mar. 14, 2013 @ 8:02 am

As a trans woman who has been forced to pay out of pocket to overseas pharmacy companies for hormones, I applaud your efforts. Thank you.

Posted by Nika on Mar. 14, 2013 @ 8:19 am

surgeries? Why? On what basis?

I do believe that insurance policies should be available for purchase by those who disclose a transgendered tendency. It should be available but, economically, it would have to be at a higher cost.

Posted by anon on Mar. 14, 2013 @ 10:04 am

Anon, you don't seem very informed about transgender people and gender dysphoria. It isn't a "tendency" or "choice"; at least, no more than yours was to be born the gender you were.

That said, why do you feel that trans people should have to pay more? Is it just because the surgical procedures are , in your opinion, more expensive? Do a little research, and you'll find they are on par with many procedures you already subsidize for other people, less in some cases.

Would you feel it was fair to ask you to pay more because of your gender? It doesn't seem you like you are coming from an entirely neutral place here, but perhaps I'm reading between the lines.

Posted by Guest on Mar. 17, 2013 @ 4:32 am

The health care of transgender people is really a serious issue. There is no specific health care system for them and most of them remain uninsured. They are sometimes denied care completely and thus face a lot of problem. But employers and government must think about these kind of people because all individuals have the right to access health care services without considering gender. Because an injury is injury for all and they must be provided with good services.

Posted by Pamela on May. 26, 2013 @ 9:32 pm

I agree with this rights, the most important here is that we prioritize health.

Posted by karel on Jun. 12, 2013 @ 10:58 pm

It should be available but, economically, it would have to be at a higher cost.

Posted by Precyzyjny on Jun. 13, 2013 @ 2:03 am

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