Oregon Health Plan transgender

In 1997, Olivia Jaquay made headlines when she asked Oregon Medicaid officials to cover her sex reassignment surgery.

(Paul Kitagaki, Jr./file photo)

Olivia Jaquay sees a vastly different world from when her own gender reassignment surgery dominated the newsstands in Oregon.

She saw Bruce Jenner become Caitlyn Jenner on magazine covers. She watched as Oregon leaders agreed to pay for hormones and surgery for other transgender Oregonians living in poverty.

Those victories came too late for Jaquay. Fighting for the health insurance benefit in a public forum in the 1990s, she said, "really cost me my life." She doesn't want the recognition as a pioneer in transgender rights for Oregon.

Now when the 60-year-old leaves the detached garage she calls home, Jaquay pulls her Stetson low. She lost everything after fighting for Medicaid benefits two decades ago. Her family deserted her, and strangers called her names. The hat has become her shield.

In 1995, when Jaquay was 40, she asked Oregon health officials to approve her for an $11,000 procedure to transform her genitals. CareOregon, the insurance organization that managed Jaquay's Medicaid benefits, denied three requests.

What happened next was nothing short of a public trial as state officials debated what to do with her.

After the third denial, Jaquay appealed to the Oregon Medical Assistance Program, a board of medical and insurance professionals that then operated the state's Medicaid. The commission held several hearings about her case.

"It got to the point where I needed it," Jaquay said. "Otherwise, I didn't want to survive."

Jaquay had by then scraped by on salaries earned as a janitor and diner cook. She began taking estrogen in 1980, when she was 25. Medicaid paid for the prescription for 15 years. The female hormones softened her features and spurred breast development. But Jaquay's penis tormented her. In public, she felt she could no longer use either the men's or women's restrooms. She attempted suicide three times.

By August 1997 she decided to appear before the commission, with cameras rolling and reporters in the audience, to challenge an Oregon rule that doled out Medicaid benefits from a list. At the time, the list included 745 diseases, disorders and ailments. The state paid for the top 578. What was then called gender identity disorder came in at No. 692.

"If you can fund heart transplants, kidney transplants, liver transplants, you damn well sure can do this, because this is a hell of a lot cheaper," Jaquay told the commission. "You've got to take into consideration that there's a person's life on the line."

At the hearing, CareOregon's assistant medical director Bruce Goldberg testified that his organization would not have paid for hormones if workers had known Jaquay was transgender.

Her request for surgery "was the first time the plan became aware that we were indeed providing estrogen therapy to a male," Goldberg said at the hearing.

Half a dozen transgender people testified in favor of Jaquay's request. All said they had considered suicide. Most said they had paid for surgeries themselves and had gone on to live happier, successful lives.

One woman said she had been a prostitute before the surgery. After the procedure, she had become a typist and secretary. Jaquay hoped to study computer science after her own operation.

Portland surgeon Toby Meltzer testified that transgender people hadn't chosen the affliction: Dutch researchers had found a biological explanation for gender identity disorder. The researchers' 1995 study found that the hypothalamus, a portion of the brain that links the nervous system to the endocrine system, is about 50 percent larger in men than in women, and almost 60 percent larger in men than in male-to-female transgender people.

Meltzer told the panel that he performed 150 surgeries a year, most on people from out of state, and that the procedures had saved lives. Board members balked. Meltzer charged between $11,000 and $13,000 at the time. If 150 people a year wanted surgery, that would cost nearly $2 million.

In the middle of all this, reporters from Texas to Alaska flew in to profile Jaquay. They described her red hair and long legs, the fuchsia nail polish she loved and the guy she hoped to marry. Some described her as a man masquerading.

The board debated for two years.

Jaquay grew tired of waiting and sold her Monte Carlo, jewelry and furniture to pay for surgery with Meltzer. She hoped the state would repay her.



The board convened an outside task force to review medical journals. But few U.S. hospitals had researched treatments for transgender people. The board concluded it didn't have enough medical evidence to support Meltzer's claim that the surgery had saved patients' lives.

In February 1999 board members called a final meeting to announce their decision. They would not pay, they said, for Jaquay or other transgender people's treatment.

Jaquay boycotted the meeting and told reporters she was furious. But outside the limelight, the anger dissolved into depression.

The hearings demolished her, she said last year. She had the body she wanted but little else. She put off plans to pursue a college degree. She drank vodka to forget.

"It wasn't an easy life," she said. "The news media hounded me. They wanted to be in my surgery."

Employers were reluctant to hire her, Jaquay said. She had no possessions left to sell, so she moved into a friend's east Portland garage, a spare room with no sink or bathroom, just a military cot and a space heater to keep her warm. She lives there still.

Before the publicity, Jaquay went to groups for transgender women. Afterward, she stopped socializing. She uses Facebook, but her profile photo is a sunset over water.

She's on Medicare now, but she avoids hospitals even when something serious is afflicting her. Early this year she skipped three appointments at a women's clinic because she hadn't met the doctor and feared the gynecologist would discriminate against her.

Jaquay said she was initially angry when Oregon leaders announced in 2015 they would reverse their 1999 decision and begin paying for hormone treatments and surgeries. She couldn't understand why they hadn't helped her.

But as the year wore on, she read about transgender people who used the new Medicaid benefits. She watched a documentary about transgender children. They won't have to fight the way she did. Maybe, she said in late 2015, her struggle had purpose.

"Something came out of it." She said. "I kind of broke the barrier. I was the only one willing to fight for what is right. Why should I regret it?"

-- Casey Parks

503-221-8271

cparks@oregonian.com; @caseyparks