ELIMINATING WA TRANSGENDER HEALTHCARE EXCLUSIONS
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1 ELIMINATING WA TRANSGENDER HEALTHCARE EXCLUSIONS Roberta W. Dalley, M.D. Associate Professor of Radiology University of Washington Seattle, WA FCBR Committee Presentation 1/2014
2 Transgender (TG) Healthcare Exclusions TG: Transgender, Transsexual & Gender-nonconforming people Why was TG healthcare excluded in past? Bias, discrimination, sexual minority Experimental or cosmetic surgeries & therapy Flawed studies from 1980 s Hayes study
3 States Now Banning TG Healthcare Exclusions California Colorado Connecticut Oregon Vermont D.C. All in the last 2 years, accomplished by an Insurance Bulletin issued by the state s Insurance Commissioner
4 Who in WA Has TG Healthcare Coverage? UW Undergraduate Students City of Seattle Group Health Coop Employees Privately Insured Corporations Microsoft Boeing Amazon Google
5 Who in WA Doesn t Have TG Healthcare Coverage? UW Graduate Students UW Employees UW Faculty
6 UW Faculty Health Insurance Options Uniform Medical Plan Regence Blue Shield Group Health Cooperative Kaiser
7 Current TG Exclusions Uniform Medical Plan-Classic (2014) What the Plan Doesn t Cover #68. Sex Reassignment: Drugs, surgery, services, or supplies for sex (gender) reassignment. Group Health Cooperative-Classic Benefit Exclusions & Limitations #11. Sex reassignment surgery, services and supplies.
8 Excluded Medical Benefits Hormone therapy: Estrogen, Testosterone Hormone blockers / Puberty blockers Psychotherapy Post-transition: Gynecologic care (MtF & sometimes FtM) Breast exam / mammography (MtF)
9 Excluded Medical Procedures Mammography, Breast U/S (MtF) Gynecologic care PAP smear (FtM) Prostate exam or PSA (MtF) Electrolysis (MtF)
10 What Gender Affirming Surgery is Excluded? Male-to-Female (MtF): Transwomen Breast augmentation (reconstruction) FFS: Facial Feminization Surgery Tracheal shave (reduce Adam s apple) Orchiectomy GRS/SRS: Genital Reconstruction Surgery Vaginoplasty
11 What Gender Affirming Surgery is Excluded? Female-to-Male (FtM): Transmen Bilateral Mastectomy (Top surgery) Hysterectomy Oophorectomy GRS/SRS: (Bottom surgery) Metoidioplasty Phalloplasty
12 Why Remove TG Exclusions? TG Healthcare Benefits are Medically Necessary Negligible Cost to Insurance Plan Illegal to Discriminate in WA State Add to UW Diversity & Competitive Edge Right thing to do!
13 Medical Necessity Medical Associations with Policy Statements of the Medical Necessity of TG Healthcare: American Medical Association American Psychiatric Association American Psychological Association American Academy of Pediatrics American Congress of Obstetricians & Gynecologists World Professional Association for Transgender Health
14 Medical Necessity AMA Policy Statement: RESOLVED, That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient s physician. (American Medical Association HOD Resolution 122, 2008)
15 Medical Necessity Medical Treatment of Gender Dysphoria Saves Lives 41% of TG people have attempted suicide vs. 2% of general U.S. population who attempt suicide Gender Dysphoria can kill Surgical outcomes are excellent High patient satisfaction! Psychotherapy Conversion (reparative) therapy doesn t work & is unethical. American Psychological Association Banned by law in California & Washington Gender supportive psychotherapy leads to self-acceptance and happiness!
16 Low Cost of Insurance William s Institute UCLA study Eighty-five percent (85%) of the 26 employers that provided information on costs of adding coverage to their existing health benefits plans reported no additional costs to add the coverage. Based on the experiences of surveyed employers, 1 out of 10,000 employees (among employers with 1,000 to 10,000 employees) and 1 out of 20,000 employees (among employers with 10,000 to 50,000 employees) will utilize transition-related health benefits annually when they are available. City of Seattle (Group Health) No actuarial data yet
17 WA State Law WA Human Rights Commission Statement on Insurance: Sexual orientation, which includes gender identity and expression, is not a permissible consideration in insurance. Insurers may not refuse to issue or cancel or decline to renew insurance coverage on the basis of sexual orientation, nor may insurers offer different amounts of benefits payable, terms, rates, conditions, or types of coverage on the basis of sexual orientation.
18 Diversity & Competitive Edge at UW Medical Center Getting 100% on the Health Equality Index (HEI) and Corporate Equality Index (CEI) for a hospital requires being trans-friendly and having transgender services for patients and employees. Does UW want to lose potentially faculty to Oregon, California or even the City of Seattle because UW has discriminatory health care insurance plans? Such plans may cause potential or current faculty who are transgender or faculty with transgender family members, to eliminate UW from their consideration because of these economically disadvantageous and discriminatory policies.
19 It s the Right Thing to Do! Transgender Healthcare Exclusions are blatantly discriminatory towards a minority population which is vastly under-served by the medical insurance system and medical community.
20 Request to the FCBR Please help end this discriminatory policy for UW Faculty. Please send the WA PEBB and the UW Benefits Office a letter from your committee recommending Removal of TG Healthcare Exclusions Purchasing policies with full TG healthcare benefits.
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