







Coverage for city employees includes hormone therapy, gender-confirmation surgery.

By Lourdes Zavaleta

Despite the repeal of the Houston Equal Rights Ordinance (HERO) in 2015, City officials are doubling down on their support for transgender equality.

Communications director Alan Bernstein confirmed to OutSmart that the City is now offering comprehensive trans-inclusive health benefits to municipal employees. Bernstein said the City added the benefits to comply with nondiscrimination provisions of the Affordable Care Act (ACA).

Lou Weaver, transgender programs coordinator at Equality Texas and a former co-chair of Mayor Sylvester Turner’s LGBTQ Advisory Board, called the addition of trans healthcare benefits for City employees a “huge win in Houston and in Texas.”

“As far as City employees go, no one’s health is being excluded,” Weaver said. “This is a message that shows that the City of Houston is going to do everything that it can to take care of its trans employees. Whether these employees are current or future, they now know that the city sees them.”

Austin and Dallas are the only other Texas cities that offer comprehensive trans-inclusive health benefits to employees, according to the Human Rights Campaign (HRC).

HERO, which prohibited discrimination based on gender identity and expression, in addition to more than a dozen other characteristics, was approved by City Council in 2014. However, anti-LGBTQ groups used misleading anti-trans attack ads to convince voters to repeal the ordinance in November 2015.

Dave Welch, executive director of the Houston Area Pastor Council, which led the effort to repeal HERO, did not respond to phone messages from OutSmart about the city’s trans health benefits.

Weaver said it is likely that some of the city’s 23,000 employees are trans.

The coverage would dramatically lower out-of-pocket expenses for employees who want to transition—a process that can cost up to $50,000 for counseling sessions, hormone therapy, and gender-confirmation surgery, according to the Trans Road Map online guide. City officials will provide details about the benefits when medical providers or trans employees inquire, Bernstein said.

In 2001, San Francisco became the first city to offer health-insurance plans that covered medically necessary treatment for trans employees. The cost of covering the health needs of these employees proved to be relatively inexpensive compared to the other health needs of City workers.

According to a study conducted by UCLA’s Williams Institute, two-thirds of private employers reported no cost increases associated with adding trans-inclusive health coverage. The other one-third reported an increase of one percent or less in total costs.

“Many trans people face a struggle finding trans-inclusive health care,” said Cathryn Oakley, HRC’s state legislative director and senior counsel. “Most people get their health insurance through their employers. All of these employees deserve to access medically necessary treatments without facing discrimination.”

In 2016, under the Obama administration, the U.S. Department of Health and Human Services (HHS) adopted a rule stating that Section 1557 of the ACA prohibits anti-trans discrimination.

Eight states, led by Texas, joined religiously affiliated healthcare providers in filing a lawsuit challenging the rule. U.S. District Court judge Lee Rosenthal, of the Southern District of Texas, temporarily halted enforcement of the protections for trans patients in December 2016.

In response to Rosenthal’s ruling, the Trump administration said it planned to modify the Section 1557 rule, but had not initiated any changes as of May 2018.

“If there is ever a pushback on the anti-discrimination portion of ACA, I hope that the City of Houston doesn’t see transgender health benefits as no longer necessary because they are not recognized by law,” Oakley says. “Transgender-inclusive health benefits are absolutely medically necessary.”

For six years, HRC has compiled the Municipal Equality Index (MEI), which grades cities on LGBTQ inclusion based on their laws, policies, and services.

“The MEI is a to-do list,” Oakley says. “Cities that do not receive a perfect score can look at the index to see what they can do better.”

On the 2017 MEI, Houston received a score of 75 points out of 100. Oakley said the city lost six points because it did not provide information to HRC about trans-inclusive healthcare benefits. However, HRC hopes to revisit the trans healthcare category with the city prior to releasing its 2018 MEI, she said.

This article appears in the June 2018 edition of OutSmart magazine.