There was confusion and neglect and resistance and now that’s starting to change.

This month, major health care insurer Kaiser Permanente announced it would no longer exclude transgender Coloradans from treatment.

Gay-rights groups here are celebrating the news as a major civil rights and health service advance. Indeed, for years gay- bisexual- and transgender-rights advocacy organization One Colorado spearheaded the years-long effort to persuade Kaiser to re-examine its approach to transgender patients.

“It’s absolutely exciting,” said Jace Woodrum, who was employed by One Colorado during his transition and ran up against Kaiser’s then-exclusionary services. “Now transgender Coloradans have access to the health care they need. This is part of our healthcare system getting better for everyone.”

The news comes as the rollout of the national Affordable Care Act or Obamacare begins to protect transgender clients who have been denied insurance in the past because they have been tagged as afflicted by “gender dysphoria” — one of the many dreaded “pre-existing conditions” that allowed insurance companies to turn away Americans in droves.

One Colorado began battling transgender discrimination in health care in 2010 after conducting a general survey asking LGBTQ Coloradans what kinds of institutional changes might improve their everyday lives.

“One of the big takeaways from the survey was that transgender folks were being discriminated against in many ways, from the care they received in the system, to getting care in the first place,” said Ashley Wheeland, the group’s health policy director.

She says the problem was and still is urgent.

Forty-one percent of transgender people nationwide attempt suicide, compared to just 1.6 percent of the general population. Wheeland says these drastically elevated rates are tied to transgender people not having access to the medical and mental health care they need.

One Colorado built a coalition of several dozen small employers who were disturbed to find they couldn’t purchase health care policies that would treat all of their employees equally. The group also found many transgender individuals willing to share their stories.

“Some of the stories were heartbreaking,” says Woodrum. “Someone’s arm is broken, for example, but their claim is denied because they’re on hormone therapy.”

After months of targeted advocacy, the Colorado Division of Insurance issued a bulletin last March prohibiting discrimination in coverage based on sexual orientation that included transgender clients.

Kaiser meantime had been investigating its own practices and had begun to offer a special set of services that would cover transgender employees at large companies.

Small businesses and many nonprofits remained unaffected.

After a few months of evaluating the Insurance Division bulletin, Kaiser announced that, as of September 10, it would offer its transgender clients not just the same services it provided to non-transgender clients — treatments like hormone therapy — but that it would also cover specific services, like transition-related surgeries, that transgender people may need in particular.

Wheeland says One Colorado is thrilled Kaiser has joined with Colorado HealthOp, a nonprofit insurance cooperative funded by the Affordable Care Act, in providing plans that cover transgender Coloradans.

But she says two insurers is simply not enough.

“We believe all insurers should have options for transgender Coloradans to get the care they need,” she said. “We’re looking forward to working with companies and communities to make this happen.”

Meanwhile, Woodrum said the rollout of Obamacare, in addition to funding providers like HealthOp, also provides another, broader level of protection to transgender Americans.

“Starting in January, an insurance company will no longer be able to deny me coverage because I’m transgender,” he said.

Woodrum recently moved back to South Carolina, where he grew up. He was self-employed at the time and turned to the private market to buy health insurance. He said he was met with a classic bureaucratic Catch 22.

“The letter of denial clearly stated ‘You are being denied coverage because of a pre-existing condition of gender dysphoria.’ You need that diagnosis in order for an insurer to cover hormone therapy and surgery, but it’s the same diagnosis they can then use to deny you coverage.”

Now that Obamacare prohibits coverage denials based on pre-existing conditions, many transgender Americans will have access to health care again, or for the first time. Woodrum feels it’s just the beginning.

“We’re going to continue to see momentous change as the [Colorado Division of Insurance] guidelines are understood and implemented and as the [Affordable Care Act] takes effect.”

“It’s one step at a time but this is nothing short of a major victory,” Woodrum said of the expanded coverage in Colorado. “It came about because transgender Coloradans were courageous enough to share their stories … and folks on other side listened, were moved, and took action.”

[ Image by Ted Eytan ]