Insurance Exclusions for the Treatment of those Diagnosed with GID Should be Illegal in the US

Gender Identity Disorder (a/k/a Gender Identity Dysphoria per the new DSM-V) is a recognized condition. GID 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. Unfortunately, without treatment life is miserable for this population. 41% attempt suicide and virtually all have suicidal ideations in despair of ever finding a path forward. 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. The statistics for this population are grim: 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 not so jarring in their appearance. The earlier HRT 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 am 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 GID. At least requiring the exchanges to cover treatment for those with GID would be a huge steps in improving the lives for this population. Costs will be minimal. Given the pain and drastic irreversibility of the surgical option, few will opt for surgery unless it is essential. Only .3% of the US population is out right now as trans but as much as 1% of the total population may have GID. Please note that much of this population would not need the most expensive surgery. Transmen (FtM) often elect only for top surgery and do not attempt bottom surgery because it is not, at present, satisfactory. Summary: An impoverished, at risk, minority is being discriminated against to their great detriment by the denial of insurance for a recognized condition for no good reason. There is no reason not to cover these people and many reasons to provide coverage. Benefits include (i) more productive citizens as youth follow more of an educational route rather than the sex trade to fund what they must have, (ii) lower medical costs because trans* rarely get insurance at all since it does not cover what they need most , (iii) reduced suffering with little cost to cis-gendered premium holders. In fact, given the fact that trans people will now have an incentive to get coverage, the overall cost to the cis-gendered population is likely to decline as trans persons would now enjoy the benefits of preventative medicine.