Insurance Exclusions Against Transgender Persons Should Be Eliminated

Relevant definitions: According to the American Psychiatric Association, 1.Sex: "Generally assigned at birth by external genital appearance, due to the common assumption that this represents chromosomal or internal anatomic status." 2.Gender: "Increasingly, the term gender is being accepted to define psychophysiologic processes involved in identity and social roles. Therefore, it is not uncommon to hear references to "gender" by professionals from numerous disciplines, including medicine, psychology, anthropology, and social science." a.Gender identity: "An individual"s internal sense of being male, female, or something else." NCTE. b.Gender dysphoria: "A condition in which there is a marked incongruence between an individual"s sexual and gender identity." The National Center for Transgender Equality additionally defines: 3.Transgender: "A term for people whose gender identity, expression or behavior is different from those typically associated with their assigned sex at birth. . . . "Trans" is shorthand for transgender." "Trans" is a Latin prefix meaning "across," e.g. "transatlantic." Non-transgender persons are sometimes referred to as "cisgender" or, simply, "cis." "Cis" is a Latin prefix for "on the same side," e.g. "cisatlantic." I prefer not to use the cisgender label because it is confusing and, instead, usually refer to cisgender persons as "non-transgender a.Transgender Man: "A term for a transgender individual who currently identifies as a man (see also FtM)." b.Transgender Woman: "A term for a transgender individual who currently identifies as a woman (see also MtF)." c.Transsexual: "An older term for people whose gender identity is different from their assigned sex at birth and who seek to transition from male to female or female to male. Many do not prefer this term because it is thought to be overly clinical." d.Crossdresser: "A term for people who dress in clothing traditionally or stereotypically worn by the other sex, but who generally have no intent to live full-time as the other gender. The older term "transvestite" is considered derogatory by many in the United States." This argument deals with those with Gender Dysphoria as defined above. Gender Dysphoria ("GD") is recognized by the DSM-V. GD has been studied for over a hundred years and various cultures, even those we like to think of as primitive compared to our own, recognize the existence of this phenomena. Native Americans had their "two-spirited" people and in India the mistreated Hijra. A 2011 Williams Institute study from UCLA found that .3% of the United States population self-identify as transgender. The actual number may be closer to 1%. Many of these individuals may not have dysphoria or require treatment, e.g. the cross-dressers. Reality for a transgender person with GD is markedly different than most people. According to the American Academy of Pediatrics, a ". . . child's awareness of being a boy or a girl starts in the first year of life. It often begins by eight to ten months of age, when youngsters typically discover their genitals. Then, between one and two years old, children become conscious of physical differences between boys and girls; before their third birthday they are easily able to label themselves as either a boy or a girl as they acquire a strong concept of self. By age four, children's gender identity is stable, and they know they will always be a boy or a girl." The APA has long recognized the condition. WPATH has promulgated standards of care which are flexible and do not always result in surgery. The American Medical Association has approved WPATH"s standards of care. Even transgender persons who have insurance are faced with both the hurdle of preexisting conditions and of systematic exclusions which have been upheld in court. The Affordable Care Act will, in large part, address the former but the exclusions remain an iron wall to treatment. Currently, only six states offer trans health care as part of the insurance exchanges under the Affordable Care Act. Without treatment life is miserable for this population. The suicide attempt suicide rate is ten times the national average at 41%. Virtually all have suicidal ideations in despair of ever finding a path forward. 200% higher unemployment, 41% attempt suicide, 4x more likely to live in with less than $10k in household income, and a growing number of trans young people are resorting to the sex trade to get some forms of treatment. The Hormone Replacement Therapy they get is often black market creating risks for both Transmen and Transwomen. Violence is often directed towards this population which could be avoided if the participants were more physically matched with their self-identity. Just last month, four transwomen were killed three identified as homicides and one as "suspicious." The earlier corrective hormones can be taken, the better in this regard. Faced with discrimination and poverty, homelessness is rampant. Without any chance of affording treatment, suicide often is considered in lieu of living an inauthentic life. Even those who are older often have difficulty raising the money for this care. They settle into situations which grind at them on a daily basis instead of finally turning off the blaring dysphoric pain which comes with GD. I will not attack a strawman as to the historical basis for these exclusions which have now been disproved. Suffice it to say that the WPATH Standards of Care provide concrete, reasonable and necessary care for a condition recognized by the APA, AMA and WPATH. There is no basis for denying coverage uniquely to this disadvantaged population. The harm to those with GD is obvious. Current policy also harms society as a whole which (i) must deal with uninsured transgender people who get no insurance rather than pay for insurance which does not cover their most pressing need, (ii) discourages people from living authentic lives, (iii) sends a message to those who victimize transgender and gender non-conforming individuals that this minority is not legitimate, and (iv) sends a message of conformity to our young people rather than finding value in the unfolding exquisite complexity of the human condition. Summary: An impoverished, at risk, minority is being discriminated against to their great detriment by the denial of insurance for a recognized medical condition for no good reason. I affirm this resolution.