The fight for transgender healthcare at work

Transgender people often require a great deal of medical care. Mental health counseling, hormone therapy, sp...

Posted: Oct 9, 2018 4:13 AM
Updated: Oct 9, 2018 4:13 AM

Transgender people often require a great deal of medical care. Mental health counseling, hormone therapy, speech language therapy, mastectomy, facial feminization, sperm retrieval or egg freezing — just to name a few — can cost thousands, or even hundreds of thousands of dollars.

But if an insurance provider classifies a procedure as "cosmetic" rather than "medically necessary," trans people are forced to pay out-of-pocket. Or risk going without care that can be vital to their health.

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Even when insurers won't cover certain procedures, some employers will step in and offer coverage. In the last decade, hundreds of companies have revised their healthcare plans to financially assist employees in gender transition and gender affirmation surgery. In 2009, when the Human Rights Campaign first began asking companies about transgender-inclusive benefits as part of their company rankings, only 49 major US employers offered them. In 2018, HRC says a record 759 companies now offer transgender-inclusive healthcare coverage.

"To get to that point, at HRC, we had to do a lot of educating not only of the companies and the benefits managers about what it means, but also of insurance companies, what it means to be able to offer it and fulfill it," says Beck Bailey, deputy director of HRC's workplace equality program.

The realities of care

Not all transgender people want or need medical assistance as they transition. But for those who do, the process can be time consuming and extremely expensive.

Many insurers will deem hormone therapy or other procedures as "medically necessary" for the treatment of gender dysphoria, the distress a person experiences when confronted by the difference between their current body and their gender identity. But a slew of other procedures, like speech therapy or further surgery, can also be considered elective.

As a Master's student and former staff assistant at the University of Michigan, Vidhya Aravind says she paid out-of-pocket for procedures that were vital to her health. She says explaining that to cisgender people is taxing.

"I think that even well-meaning cis people who consider themselves allies don't know what trans people go through to get medical care," she says. "For 99% of things, our healthcare is great. But for trans things, it's completely a disaster."

Throughout the last year, she has been working with other graduate students to make medical care more accessible for her transgender colleagues.

Aravind and her fellow student Monica Lewis both received coverage from University of Michigan's GradCare, the insurance plan provided to unionized graduate student employees.

Aravind and Lewis say it's not uncommon for transgender peers to travel out of the state for surgery, looking for a provider they trust. Both trans women have paid out-of-pocket for procedures, even canceling some because of financial strain.

"The end result is I was making less than my [cisgender] colleagues, because I was paying out-of-pocket for some of these procedures that I don't believe I could've done without," Lewis says.

Companies expanding care

Some well-known American companies, like Starbucks and Pinterest, for example, offer coverage for trans people.

"We believe everyone should have the opportunity to create a life they love and feel welcome at work," Candice Morgan, head of inclusion and diversity at Pinterest, said in a statement to CNN. "That's why we offer a range of benefits to help our employees across their lives, including gender affirmation and fertility treatments, and continue to foster an inclusive culture that embraces diversity."

Companies like Starbucks have pioneered trans-inclusive coverage. Since 2012, employees at the coffee chain have been able to rely on Starbucks coverage for gender affirmation surgery. Starbucks also comps some procedures other employers consider too "cosmetic" to cover, like hair transplants, electrolysis, facial feminization or masculinization.

When putting together the pieces of its trans-inclusive healthcare benefit, Starbucks first asked its employees — they call them "partners" — what they considered necessary as part of their healthcare package. From there, the company decided to extend the benefit to all partners who work 20 hours or more a week, says Reggie Borges, senior manager of global communications at Starbucks. That means even if you're balancing a Starbucks job part time, you're eligible to receive that care.

"It was something our VP of Benefits was really passionate about," Borges says. "We understood, 'If we're going to do this, we need to do this the right way, for partners who want to go through this transition."

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 314710

Reported Deaths: 7254
CountyCasesDeaths
DeSoto21646260
Hinds20369416
Harrison17949309
Rankin13643278
Jackson13450246
Madison10113217
Lee9986174
Jones8384163
Forrest7689152
Lauderdale7198240
Lowndes6403148
Lamar623686
Lafayette6203119
Washington5341134
Bolivar4802132
Oktibbeha462998
Panola4596107
Pearl River4519146
Marshall4450103
Warren4393121
Pontotoc420872
Monroe4115133
Union411176
Neshoba4031176
Lincoln3969110
Hancock379586
Leflore3498125
Sunflower336290
Tate334784
Pike3327105
Scott316274
Alcorn313368
Yazoo311770
Itawamba300577
Copiah297465
Coahoma295579
Simpson295388
Tippah288768
Adams286982
Prentiss280060
Marion269380
Leake268473
Wayne262841
Grenada261587
Covington259881
George248148
Newton246862
Winston227581
Tishomingo227067
Jasper221148
Attala214473
Chickasaw208057
Holmes189174
Clay185554
Stone182833
Tallahatchie178941
Clarke178080
Calhoun170932
Yalobusha164638
Smith162534
Walthall134245
Greene130633
Lawrence128724
Montgomery127142
Noxubee126734
Perry126338
Amite123142
Carroll121829
Webster114532
Jefferson Davis107133
Tunica105726
Claiborne102430
Benton100025
Humphreys96733
Kemper95828
Franklin83923
Quitman81116
Choctaw76418
Wilkinson67531
Jefferson65728
Sharkey50217
Issaquena1686
Unassigned00

Alabama Coronavirus Cases

Cases: 537813

Reported Deaths: 11024
CountyCasesDeaths
Jefferson791691529
Mobile41177808
Madison35002507
Tuscaloosa25871454
Shelby25076249
Montgomery24549591
Baldwin21290309
Lee15946171
Calhoun14556319
Morgan14364280
Etowah13890353
Marshall12262223
Houston10602282
Elmore10115206
Limestone10031151
St. Clair9890245
Cullman9730194
Lauderdale9449243
DeKalb8853188
Talladega8325176
Walker7259277
Autauga6971108
Jackson6830112
Blount6750139
Colbert6317134
Coffee5546119
Dale4869113
Russell444338
Chilton4343113
Franklin426282
Covington4138118
Tallapoosa4040152
Escambia394577
Chambers3581123
Dallas3564153
Clarke351361
Marion3137101
Pike311977
Lawrence302298
Winston275673
Bibb263064
Geneva252577
Marengo249664
Pickens234862
Barbour231956
Hale223677
Butler217869
Fayette212462
Henry189644
Cherokee184345
Randolph182042
Monroe178140
Washington167639
Macon160750
Clay156957
Crenshaw153357
Cleburne149241
Lamar143035
Lowndes139653
Wilcox127430
Bullock123041
Conecuh110629
Coosa108928
Perry107826
Sumter104932
Greene92634
Choctaw61024
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