The right to transgender health care

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Nearly every insurance plan has outdated exclusions that bar transgender people from receiving medically necessary health care.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.