Still too Many Insurance Companies Still Deny Trans Health Care

By TMPlanet

An investigation by the California Department of Managed Health Care found that Health Net, a health insurance company in the state, discriminated against seven transgender people between 2013 and 2015. The patients were denied coverage for gender-affirming surgeries such as testosterone injections, bilateral mastectomy, facial feminization surgery, and gender reassignment surgery, according to the San Francisco Chronicle¹. One of many insurance companies that still want classify transgender health care as an elective cosmetic procedure.

Health Net was ordered to pay $200,000 for violating state anti-discrimination laws, and to update their policies to comply with state law by September 30, according to a letter of agreement. It’s a huge win for transgender rights to healthcare in California, but also highlights out how difficult it is for transgender people to access gender-affirming treatments.

California is one of only a handful of states that has anti-discrimination laws requiring health insurance companies to provide coverage for gender-affirming surgeries. Last year, the most recent data, shows that 14 states had laws explicitly banning transgender exclusions in both private health insurance and Medicaid, according to the National Center for Transgender Equality. Five more had laws offering some protection for transgender people, banning discrimination from private insurers or Medicaid but not both. The other 31 states had no protections whatsoever.


Health issues of trans
Higher rates of depression and suicide. Higher rates of smoking, alcohol and drug abuse. Higher rates of physical and sexual abuse. Lack of basic primary/preventative care (refusal/harrassment or postponed care) Higher rates of HIV. Unsupervised hormone use. Poor access to health insurance and coverage of needed services. Task Force National Transgender Discrimination Survey (6450 participants): 41% suicide attempt rate compared with 1.6% general population. 26% physically assaulted and 10% sexually assaulted due to transgender bias. 28% reported harassment in medical setting, 2% physical violence. 2-4x the national unemployment rate, worse for people of color. 4x national HIV rate. 19% reported refusal of care based on transgender/gender non-conforming status. 50% reported teaching their healthcare providers. Over 25% report abusing drugs/alcohol to cope with mistreatment because of gender identity. One Colorado – Becoming Visible, 73 -> 86% covered by insurance from 2013 to Sanchez, et al. Health Care Utilization, Barriers to Care, and Hormone Usage Among Male-to-Female Transgender Persons in New York City. Am J Public Health April; 99(4): 713– Unsupervised hormone use prevalence 30-60% among M-F transgender persons in urban settings.

Yet, even in a state that has had a law explicitly banning discrimination from health insurers since 2012, transgender people still faced discrimination and restrictions to coverage.

That can mean that transgender people aren’t able to afford hormone replacement therapy that, for example, would deepen a transgender man’s voice and facilitate body hair growth. Trans people have also been denied coverage for top surgeries that would augment breasts for a transgender woman or remove them for a transgender man, and other treatments to aid in transition on the misguided idea that these treatments are not medically necessary.

Even health screenings that are considered medically necessary for everyone else, like prostate exams for transgender women and pap smears for transgender men, are more difficult to access once a person has legally changed their gender identity.

Cole Hayes, a transgender man who was seeking a hysterectomy, wrote about his experience in The Advocate in May. “Initially, my insurance said no to paying for the hysterectomy — not because I hadn’t completed the list of medical prerequisites, but because I was a man,” he wrote. “It didn’t matter that I was a trans man with a uterus. The insurance company doesn’t give men hysterectomies; there was nothing else the people there could tell me other than that their policy hadn’t been updated in quite a few years.”

The California law, as well as guidelines the governor of New York sent to health insurance companies in a letter on Wednesday, forbid health insurance companies for denying coverage for gendered screenings and treatments like these just because a person’s legal gender doesn’t match the gender of those who typically need the treatment.

But California, New York, and the 12 other states that have forbidden discrimination from health insurance companies are the standouts, and there’s so much more work that needs to be done to ensure that Hayes and other transgender people have access to the care they need. “Feeling human, healthy, and comfortable shouldn’t be considered cosmetic,” Hayes wrote. “In my case, the removal of my reproductive organs is a medical necessity, not only for my transition but for my overall health.”


  1. The coverage by the San Francisco on the California Department of Managed Health Care.
  2.  Map: State Health Insurance Rules by the National Center for Transgender Equality.
  3. My Health Care Is Not Cosmetic: COLE HAYES,  a 25-year-old trans man living near Seattle, recently told The Advocate.
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Conservative Disgrace: Old Innuendos in Trump’s Transgender Ban

By Lynnea Urania Stuart

This “President” offered no new arguments.  Congress knows it.  So does much of the United States.  What a significant number of Americans don’t realize is how old and disproven those arguments really are pertaining to transgender military service and their medical coverage.  In fact they had been visited in government over 15 years ago and even then its champions defied national ridicule.

The details of Trump’s surprise tweets announcing his ban on transgender troops serving “in any capacity” have yet to be worked out, much the same way as Conservative religionists often posit their conclusion first and work out the premises later.  But like many issues involving religio-political positions, facts have not been on their side, nor are they now.



Let’s look at exactly what @RealDonaldTrump tweeted that caused his latest uproar:

(5:55 am on July 26, 2017) “After consultation with my Generals and military experts, please be advised that the United States Government will not accept or allow……”

(6:04 am) “….Transgender individuals to serve in any capacity in the U.S. Military. Our military must be focused on decisive and overwhelming…..”

(6:08am) “….victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail. Thank you.”1

Trump reportedly took more than 13 minutes to announce a “policy” in a set of 3 tweets.  He might have saved time to simply have his aides to type up an executive order.  But no other written directive has yet been issued from the White House let alone a signature upon legislation.

Pentagon Spokesperson Jeff Davis appeared dutiful in its doublespeak, but scarcely concealing non-commitment to immediate enforcement when he said, “We will continue to work closely with the White House to address the new guidance provided by the commander-in-chief on transgender individuals serving in the military. 2

 The White House tweets followed another significant action pertaining to transpeople in the military including an amendment titled, Prohibition of Department of Defense Medical Treatment Related to Gender Transition which failed in the House of Representatives 209-214 after Defense Secretary James Mattis lobbied against it.3

Former Governor Mike Huckabee, a Baptist minister and father of the newly installed White House Press Secretary Sarah Huckabee Sanders, blasted Republicans who voted against the amendment.5 Governor Huckabee had previously distinguished himself as an anti-transgender force in politics with this vile Red Herring designed to impugn the entire demographic, couched in what he disingenuously claimed to be a “joke” in 2016:

“Your seven-year-old daughter, if she goes into the restroom, cannot be offended and you can’t be offended if she’s greeted there by a 42-year-old man who feels more like a woman than he does a man.  Now I wish that someone told me that when I was in high school that I could have felt like a woman when it came time to take showers in PE.  I’m pretty sure that I would have found my feminine side and said, ‘Coach, I think I’d rather shower with the girls today’.”4

Huckabee’s voice joined with those of Congressional anti-transgender politicians, especially the staunchly anti-LGBT Representative Vicki Harzler [R] MO who was the strongest proponent of the failed amendment.  Politico reported that Chief Strategist Steve Bannon, from the “Alt-Right” publication Breitbart, weighed in as well:

“‘Conservatives were telling [the] White House they didn’t want money in a spending bill to go to transgender health services,’ said one senior administration official, noting that it accelerated Trump’s decision.  Their argument fell on sympathetic ears, White House sources said. Chief strategist [sic] Steve Bannon encouraged Trump to deal with the matter now.  Hartzler and her supporters were elated.”5

The new White House Press Secretary defended Trump’s decision, calling transgender inclusion a “very expensive and disruptive policy” and claimed the “National Security Team” had concluded that “it erodes military readiness and unit cohesion.”6

After Sarah Huckabee Sanders’ announcement we might question who’s included in Trump’s “National Security Team” now.  Where was the Secretary of Defense in all of this, especially after going through all that trouble to lobby against Harzler’s amendment?  He seemed to be a cipher in this decision, a non-entity.  We didn’t hear explicitly from the Secretary of Defense till the following day when his chief spokeswoman Dana White relayed that “detailed guidance” will be implemented “in the future” and the Defense Department will continue to “focus on our mission of defending our nation and ongoing operations against our foes, while ensuring all service members are treated with respect.”7

 Marine Gen. Joe Dunford wrote in an internal memo that there will be “no modifications to the current policy until the President’s direction has been received by the Secretary of Defense and the Secretary has issued implementation guidance.”  In other words, he cannot accept a set of tweets as a basis for policy changes.8

It’s difficult to ascertain at this juncture what “treating all service members with respect” is supposed to mean.  It’s also impossible to say whether existing trans service members will be removed with less than honorable discharges.  The level of discharge matters when it comes to receipt of future pensions, allowances, or medical coverage.  In the past servicemembers determined to be LGBT had often been given “undesirable” or even “dishonorable” discharges which rendered them virtually without any hope for future help from the Veterans Administration or any special consideration for hiring in general employment.  The practice of expelling “undesirables” with less than honorable or general discharges have condemned such people to a lifetime of virtually guaranteed ostracism.



The reasons stated by Trump’s tweets this week revealed much of the same kind of appeal that people like Representative Harzler indicated and they were nothing new.  The tweets themselves represented three:

  1. Transgender servicemembers detract from the focus of the mission of the armed forces.
  2. Transgender servicemembers represent a personal distraction to all servicemembers, destroying morale and readiness.
  3. Transgender servicemembers result in massive medical costs.

None of these claims have been supported by anything but the stigma imposed by Evangelical Dominionists who refuse to tolerate anyone their religion declares “evil”, something which has shifted over generations.  But the issue of mission as pertaining to focus and distraction are the same arguments presented against other minorities at various times, each which over time have been disproven.  Overall morale and combat readiness continued irrespective of minority inclusion.

In fact Trump’s decision came on the 69th anniversary of an order by President Harry Truman order to integrate Blacks into the armed forces.  Objections to Black servicemembers often followed a claim by Senator Lister Hill of Alabama who said that integration of Blacks would “seriously impair the morale of the Army at a time when our armed forces should be at their strongest and most efficient.”9

It certainly represented gross displacement.  The only “morale” that might be “impaired” might be that of the bigoted who were unwilling to welcome Blacks as fellow human beings.  Time proved through decades of honorable Black service histories that they did their work well.  The bigoted, on the other hand, proved themselves unworthy of military service having represented the worst of America to the world, acting as ambassadors of arrogance, prejudice, and social slime.

The case of women and gays has entirely been colored by attitudes regarding sex and the insistence of military and governmental leaders to impose sexual stereotypes, even in more recent years.  Women would be considered prone to “use their sexuality to garner special favors” to use the words of Chaplain Colonel Vincent J. Inghilterra of Fort Leonard Wood in 1997 as reported in the Washington PostDavid Marlowe, Chief of Military Psychology at Walter Reed Hospital was quoted to say concerning homosexuals, “Introduction of sexual attraction destroys cohesion.”10

In retrospect such comments sound like wishful thinking.  Integration of women and gays never categorically represented any introduction of “sexual attraction.”  Women and homosexuals aren’t categorically about imposing sexual guile upon everyone else and this has been evidenced again and again by those of both demographics who have honorably served.



The third issue, the “tremendous medical costs” to use Trump’s words, isn’t about budgets.  It’s the iron-fisted unwillingness of Evangelical Dominionists to benefit any transperson in any manner whatsoever.  How much money was at stake?  Consider this from William Padula of the Johns Hopkins Bloomberg School of Public Health:

“U.S. policymakers generally deem medical services to be cost-effective if the price falls below $100,000 per year of quality of life. The Hopkins research team found that in the first five years of care for transgender people, associated medical care costs between $34,000 and $43,000 per year of quality of life. After 10 years, the costs drop to $7,000 to $10,000 per year.  To put these numbers into context… cystic fibrosis affects just 30,000 people in the U.S. but can be treated as a chronic condition with new medications for $300,000 a year.  While this is neither cost-effective nor individually affordable, society has decided to cover treatment out of compassion. The same philosophy can apply to medical care for transgender people.”11

Of course that “compassionate philosophy” pertains to insurance companies and the federal government is self-insured.  Government must consider costs for such coverage in its appropriations.  A 2016 study by the RAND Corporation commissioned by the Defense Department estimated transitions for active transgender servicemembers to cost between $2.4 million and $8.4 million per year.  In other words, even in the most extreme scenario they could identify, the costs amount no more than .13% of the military health spending budget.12

Not a few critics, like Beth Skwarecki of LifeHacker were quick to point out that the military spends $42 million annually for Viagra and $84 million on erectile dysfunction drugs generally.  The “President” with his entourage, having spent many a weekend on golf trips during his first months in office, leaves the taxpayer a bill for $3.6 million per pop.  Each trip exceeds the low estimate by the RAND Corporation and 3 trips exceed the high estimate.13



Claims that transitions drain government treasuries are nothing new.  They existed from the first time a government entity examined transition benefits for its employees.  For that we turn to the first such endeavor.  In the City and County of San Francisco in 2001 the issue had been raised by certain members of the Transgender Civil Rights Implementation Task Force by the end of 2000.  Transition benefits were championed by then Supervisor Mark Leno who also convened that task force in the summer of that year.  News of this hit national media like a firestorm in January 2001, inciting criticism and ridicule by editorial commentators and late night pundits.14

Dr. Jamison Green made an important observation in 2001 when transition benefits were being debated by the San Francisco Board of Supervisors.  He noted that the arguments for not considering medical coverage for trans employees in any system, public or private boiled down to 2:

  1. Not enough transition people exist to warrant any consideration of coverage.
  2. If we provide coverage we’ll be overrun with people who want to transition.

Dr. Green called both extremes “very bad jokes,” and noted that virtually all procedures required for transition are available for those not transgender and these are routinely covered by insurance.  But only when we’re identified as trans do these entities deny the same benefits.  In other words, if not enough people exist to warrant coverage, why do insurers cover them for everyone else outside our minority of minorities?  If there was any concern about being overrun, why have transgender support organizations never amounted to millions of members?15

Transition benefits passed on April 30, 2001 with 9 of 11 votes in favor. Several trans activists gathered for the decision including, Dr. Joan Roughgarden, Gwendolyhn Ann Smith, Ayme Kantz of The Channel, Theresa Sparks, and several other members of the Executive Committee of Transgender San Francisco (TGSF).  The gathering included the San Francisco Chronicle, and KPIX, as reported by TGSF member Janis Ryan who also died in October of the same year, herself having faced starvation despite being a paralegal.16

But the issue would be revisited when a new mayor, Gavin Newsom, took office.  San Francisco’s Human Rights Commission produced this letter in 2006 and included some of Dr. Green’s observations (For a full size view, please follow this link):

With an initial premium amount of $1.70 per month bringing in $4.3 million dollars, only 7 claims for surgery came in with a payout of only $156,000.  The fear that transgender would overrun and bankrupt the system never happened.  In fact it proved to be so profitable; the insurers eliminated the added premium entirely.17

This was an immensely successful insurance program instituted over 15 years ago.  The fears about “immense costs” and people rushing into service so they could milk transition amounted to fear-mongering.  The transgender benefit continues today for employees of the City and County of San Francisco and this has been a model for other such programs ever since.  When it comes to long term effects upon treasuries, this program proved the following:

  1. Transgender employees never drained the treasuries of any insurance company.
  2. Transgender employees never proved “too insignificant” to consider coverage.
  3. Claims that one or the other must be the case are a Red Herring.
  4. The unproven nature of such a Red Herring reveals a cultivated social animus unrelated to transpeople.

Seeing that was the case for San Francisco where the highest incidence of transgender life can be expected, there’s no reason anything different should be expected for transgender servicemembers in the military, or anywhere in federal, state, county, or municipal governments.



What it ultimately comes down to these disproven innuendos is that widespread animus fostered against transpeople for generations as against other minorities; rooted in a false religiosity that arrogantly finds every excuse it can to exalt one’s self and chosen communion over others.  It’s that same false religiosity to which the current regime panders that exalts itself above more genuine values that count for goodness and greatness that grow from the rule to love one’s neighbor.  It’s a false religiosity that threatens science and minority faiths, seeking a dominion upon Earth that won’t be satisfied till it can subjugates everyone irrespective of conscience under their own rod of iron in the image of a Roman fasces.

It’s an animus whose constitutionality may be challenged in the courts for as long as Dominionists have not succeeded in subverting the independence of the judiciary.  It’s an animus that demonstrates their genuinely compassionless character that prefers to impose the blarney of innuendo over fact while declaring reports of facts “fake” if they don’t suit preconceived conclusions.  But for us who are trans and whose proclivities to the spiritual represent a more direct and vibrant walk than the continued mummery of liturgy and dogma will have a special role in the future:  the assertion of liberty as liberty really is, reflecting the ethos of a lowly man from Galilee who seeks to heal and free others while having no place of His own to lay his head.




Featured Image:  The tweets in question on July 26, 2017 alongside a detail of the official public portrait of Secretary of Defense James Mattis and a modified detail of a public domain image of servicemembers in action.  The difference in size and incidence between the Defense Secretary and the Tweeter in Chief is more than incidental.


  1. Donald Trump. (Tweets July 26, 2017). Timeline of the tweets from Abby Phillip, Thomas Gibbons-Neff, and Dan Lamothe. “Trump announces ban on transgender people in the U.S. military” Washington Post (July 26, 2017, accessed July 26, 2017) .
  2. Vera Bergengruen. “Pentagon caught off guard by Trump’s ban on transgender troops” McClatchy DC (July 26, 2016, accessed July 26, 2016) .
  3. Stuart, Lynnea Urania. “July, the Federal Roller Coaster” Transpire (July 25, 2016, accessed July 26, 2016)
  4. Nick Duffy. “Mike Huckabee hits out at Republicans who voted down anti-trans law (July 18, 2017, accessed July 26, 2017) .
  5. Ibid.
  6. Alex Horton. “Trump called transgender troops a costly disruption.  An expert who studied it says he’s wrong” Washington Post (July 26, 2017, accessed July 27, 2017)
  7. Bryan Bender and Jacqueline Klimas. “Joint Chiefs: ‘No modifications’ to transgender policy from Trump Tweet”. Politico (July 27, 2017, accessed July 27, 2017)
  8. Philip Bump. “Trump’s argument against transgender soldiers echoes one used against gays, women, and blacks” Washington Post (July 26, 2017, accessed July 27, 2017) .
  9. HUB Staff, Johns Hopkins University. “Study: Covering transgender health care would be cost-effective for insurance companies” HUB, Johns Hopkins (December 3, 2015, accessed July 26, 2017) .
  10. Christopher Ingraham. “The military spends five times as much on Viagra as it would on transgender troops’ medical care.” Washington Post (July 26, 2017, retrieved July 26, 2017) .
  11. Beth Skwarecki. “The Military Spends More on Viagra Than on Transgender Soldiers’ Medical Expenses. Life Hacker (July 26, 2016, accessed July 26, 2017)
  12. These facts are personally known to the author who served as Employment Committee Secretary for the Transgender Civil Rights Implementation Task Force in 2000 and followed the progress of these developments in various media. Then Supervisor Mark Leno is now State Senator Mark Leno.
  13. Green, Jamison “An End to Exclusions” Visible Man (February 2001, out of print but distributed online at the time. Copy in the author’s collection.  Visible Man is different from the volume, Becoming a Visible Man, available through various online services.)
  14. Ryan, Janis. “Transgender History Made in San Francisco” The Channel, Volume 20, Issue 6 (June 2001) Transgender San Francisco. Lynnea Urania Stuart, as a member of TGSF during this time, personally knew Janis and remembers relaying the news of her untimely death in Berkeley.  Janis never transitioned, but she was notably proud to be transgender.
  15. Human Rights Commission (memo 2006 revisiting the issue of transition benefits) available also through Transgender At Work Project. .


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