More US companies covering transgender surgery

More US companies covering transgender surgery

This is a welcome trend, and it indicates the importance that more major employers are giving to inclusion of trans employees in their diversity efforts.

CBS Sunday Morning reports on sex reassignment surgery

CBS Sunday Morning presented a feature story on sex reassignment surgery yesterday. It was startling to see the topic presented in that venerable forum. The real story here is the idea that CBS Sunday Morning would present the story at all. CBS Sunday Morning is a revered television show. It is almost 30 years old, rarely heard of in the ratings-driven world of television, and still going strong. With 4.5 million viewers, many of whom are long-time aficionados, it has dominated the Sunday morning market practically forever. Its viewership is high in the 25-to-54 age demographic, which explains why many of the show's sponsors are large, stolid, conservative organizations — pharmaceutical companies, agricultural conglomerates, brokerage houses. The presentation of a segment on sex reassignment surgery to such an audience with such a sponsorship suggests that this is an issue whose time has come.


I was pleased to see the topic presented in the usual optimistic but offbeat tone of the show. It tells the story from the oblique angle of "ho-hum" town residents in what is known colloquially as the "sex change capital of the United States," Trinidad, Colorado. (I say colloquially, because "sex change" is a non-preferred term because of its often-pejorative connotation.) The residents express their amusement at the cast of CBS Sunday Morning because the story is old news from forty years ago, when, in 1969, Dr. Stanley Biber started the first private U.S. clinic in the field, now a venerable institution in Trinidad, Colorado. The chummy mayor and the brotherly pastor were amused by the idea that yet another media outlet is coming to town, expecting to find a salacious new story, and instead finding a very old story in a small Western town where everybody knows their neighbors and "live and let live" is alive and well. They've lived through Giraldo and Oprah and their ilk, and they're like battle-hardened media veterans at this point. Dr. Biber's partner, Dr. Marci Bowers, gives an interesting interview, as do some of her patients, patiently explaining (yet again) the psychology that drives people to sex reassignment surgery.

You can see the video and transcript here.

Update on Transgender Employment Issues

So many interesting things have happened in the last month on transgender employment issues, I'm going to make a list. The most important news is about the signing of legislation in Iowa, Vermont, Colorado and Oregon. But not all is rosy...

- The Governor of Iowa signed the bill including gender identity into the state's antidiscrimination law, as did the Governor of Vermont, the Governor of Colorado, and the Governor of Oregon.

The Governor of Ohio by executive order restored a ban on discrimination against state employees based on gender identity and sexual orientation, which had been removed by his predecessor in 1999 However, the Governor also noted his opinion that any Ohio legislation purporting to outlaw discrimination based on sexual orientation or gender identity would be rendered unconstitutional by the state's constitutional ban on same-sex marriage It is difficult to understand the connection, and I note that federal court opinions already cover all transgender employees in Ohio.

A transgender employee won a lawsuit against an insurer, Highmark Blue Shield, that refused to cover the costs of her sex reassignment surgery This comes on the heels of reports that more employers are covering the costs of such surgery

However, not all is rosy for transgender employment rights:

The Connecticut legislature failed to pass legislation adding gender identity to the state's non-discrimination law (I note that all transgender employees in Connecticut are covered by a state administrative ruling.)

The transgender experience in the job market: The American Lawyer publishes a letter, by one of the few transgender lawyers in a large law firm, discussing its article on strides made by gay lawyers in overcoming employment discrimination in large law firms, and noting that transgender lawyers have not been included in the largesse

ENDA: An editorial published in the Washington Blade, an important gay newspaper, suggests that the inclusion of transgender people in anti-discrimination legislation threatens gay people

Identification records: At a "Town Meeting" held on the newly released regulations under the Real ID Act, two witnesses testify about the negative effects on the transgender community, with one noting that "you don't know what it's like to get carted off the security line by a couple of burly cops" (comments at 41:00 and 1:15)

ENDA: The Concerned Women of America suggest that the federal legislation to ban employment discrimination based on gender identity and sexual orientation, the Employment Non-Discrimination Act, would be an unconstitutional infringement of employers under the First Amendment rights to freedom of speech and freedom of religion

Corporate Diversity: Micron Corp., after a shareholder resolution requiring protection of employees based on gender identity and sexual orientation, adds sexual orientation but refuses to add gender identity

And here are some other notable transgender tidbits:

The National Center for Transgender Equality and the Human Rights Campaign release a groundbreaking guide for transgender people about coming out as transgender

Identification records: Transgender passengers are having more and more passport problems because of federal rules written by people who don't understand transgender identities

A transgender police officer on the Kansas City police force came out, and things are going well for her so far

The San Francisco police commission elected a transgender woman as its president

Schools K-12: A Texas transgender high school student, suspended from school for dress code violations, is reinstated after intervention by a pro bono lawyer

Transgender experience in the job market: The Transgender Economic Empowerment Initiative, aimed at reducing chronic unemployment and underemployment in the transgender community, established in San Francisco, and a similar program in Los Angeles, the Transgender Job Placement Program

Trans culture: Executives at Frameline, San Francisco's LGBT film festival, made the unprecedented decision to yank a film, The Gendercator, from this year's schedule due to community outrage over its satirical portrayals of transsexuals in a mythical future

A transgender woman, Jenny Bailey, has been chosen mayor of Cambridge, England, as it celebrates its 800th anniversary

Transgender Wellness Benefits: Sex Reassignment Surgery

Yesterday I blogged about the just-issued 2006 Corporate Equality Index, published by the Human Rights Campaign. The 68 page report contains much fascinating information. The first thing that catches my eye is the listing on page 7 of the advances in various policy areas. There has been a 64% increase in companies offering at least one transgender wellness benefit. The report notes that 28% of companies offering these offer benefits for surgical procedures. I was surprised at the magnitude of this number.

Many health insurance benefit plans contain an exclusion for costs associated with "transsexualism." Since employers negotiate insurance benefits for their employees, some employers have revisited this issue with the insurer. However, many corporate HR departments are reluctant to provide surgical benefits because they have been told that sex reassignment surgery is cosmetic in nature, and that the costs would be overwhelming.

These exclusions began appearing in insurance contracts in the 1960s, after media publicity about new treatments for transsexuality. There are generally three reasons for the blanket exclusion for transsexualism: the experimental nature of such medical treatments, the belief that such treatments are never medically necessary, and the fear of onerous costs. These reasons, which had some force when the exclusions were first put forward, may now have been superseded by advancements in medical science.

It is important to note that the removal of the blanket exclusion of all treatments for transsexualism will not require coverage of all procedures in aid of sex reassignment. Most insurers limit benefits to those considered medically necessary, and have a blanket exclusion for cosmetic procedures or treatments. Thus, when the exclusion is removed, coverage extends only to those items usually considered medically necessary, i.e., hormone replacement therapy and genital surgery. Facial cosmetic surgery and breast augmentation (though not breast removal) would likely continue to be non-covered expenses, depending on the policy. Some of those employers who currently offer wellness benefits to transgender employees follow this policy.

With regard to hormones and hormone blocking agents prescribed in aid of sex reassignment, most insurers agree that such items are "medically necessary" when prescribed by a physician after a positive consultation with a qualified mental health professional, and are then not considered cosmetic treatments. However, these would clearly be costs associated with transsexualism and therefore excluded.

Many insurance companies now pay for these items despite an exclusion for transsexualism. Hormones and hormone blocking agents are used for many purposes, and if the physician does not specifically mention the diagnosis code for "gender identity disorder," then the insurer will not flag the item. Most transsexuals seek out physicians who are skilled in transgender medicine, and these physicians usually refrain from using the diagnosis code for gender identity disorder in order to protect the privacy of the patient. While some might question the appropriateness of this decision, it is rarely argued that such a decision is outside the bounds of medical ethics.

With regard to surgeries, insurers have been far less willing to admit that such procedures are necessary, even when prescribed by a physician. The weight of medical opinion, however, appears to be that "primary" sex reassignment surgeries are "medically necessary" because studies have shown that the vast majority of individuals who meet the diagnostic criteria of gender identity disorder have cessation of all serious psychiatric symptoms after primary sex reassignment surgery.

Primary sex reassignment surgery differs in natal males and natal females. For natal males, the primary procedure is vaginoplasty. This procedure costs between $10,000 and $25,000. The main variable of cost is the surgeon's fee. For natal females, the primary procedure is mastectomy, the removal of the breasts. This procedure costs between $3000 and $7500. Phalloplasty is an option not often chosen because of lack of function and nerve sensation. It is also more expensive, costing between $20,000 and $50,000. For these reasons, many female-to-male transsexuals do not obtain phalloplasty, nor do they consider it necessary for gender transition.

Dr. M A. Horton, an expert who has researched the issue of increased insurance premiums for SRS (sex reassignment surgery), has estimated that the increased cost for coverage of primary SRS in the US would be about $0.11 per insured. Dr. Horton has also reported the results of large employers that have extended coverage for primary SRS, showing the costs to be lower than expected. Her report is available at http://www.tgender.net/taw/

On a lexicographic note, some people refer to these surgeries as "gender reassignment surgery." Because it is my opinion that gender is not based on physical attributes, I do not believe that surgery changes gender. Rather, it reassigns "sex," which is the complex of physical, psychological, behavioral and social attributes we call "male" and "female."

Kodak updates trans health benefits

Kodak has updated its health plan coverage to include health benefits specific to transgender employees. Most U.S. benefit plans contain an exclusion for any health services related to transsexuality, but qualifying transgender employees at Kodak will be able to receive benefits including psychotherapy, hormone replacement therapy, and sex reassignment surgical procedures on or after July 1, 2006, provided it is part of a medically supervised treatment.

I previously blogged about health benefits for transgender employees. This issue is of increased relevance for all companies because the Human Rights Campaign, which issues the Corporate Equality Index (CEI), a measure of corporate diversity, is reviewing health benefits for transgender employees beginning with the 2006 rankings. A company cannot get 100% on the CEI unless there is "parity in at least one transgender wellness benefit."

On another note, this blog has now had over 5,000 visitors since I started it 5 months ago. Thank you for making it successful.

Issue: Health Benefits

Although many companies have included "gender identity" as a protected category, the relationship between such a policy change and health benefits are poorly understood. Most benefit plans contain an exclusion for "transsexualism." This means that mental health counseling, hormone replacement therapies and surgical procedures will not be covered if they are associated with transsexualism. Since employers negotiate insurance benefits for their employees, the inclusion of "gender identity" as a protected category may make it appropriate to revisit this issue with the insurer. For example, Microsoft not only recently added "gender identity" to its EEO policy, but also announced increased coverage of transgender-specific health benefits.

This issue is of increased relevance for all companies because the Human Rights Campaign, which issues the Corporate Equality Index (CEI), a measure of corporate diversity, is reviewing health benefits for transgender employees for the 2006 rankings. A company cannot get 100% on the CEI unless there is "parity in at least one transgender wellness benefit."

The exclusion for "transsexualism" began appearing in insurance contracts in the 1960s, after media publicity about new treatments for transsexuality. There were generally three reasons for the blanket exclusion for transsexualism: the experimental nature of medical treatments, the lack of evidence of medical necessity, and the onerous costs. This reasoning may no longer be as persuasive. Most physicians no longer consider them experimental, there have been medical studies demonstrating medical necessity, and the cost per insured is low. This is not to say that health benefits should in every case be changed to cover any and all treatments for transgender employees, but rather that health benefits should be reviewed to determine whether the organization considers its current coverage appropriate.

Bottom line: Communication between the CDO and the benefits department may be useful, especially when there is a policy change to include "gender identity" in the EEO statement.