When most of the city's approximately 10,000 employees seek mental health care, steroid treatments, or a variety of other services, they don't need to prove medical necessity to be covered under the city's employee benefits plan. But once an employee has been classified by the city's insurance carrier as transgender, those services are "universally denied," says the Seattle LGBT Commission in a letter to city officials. "First and foremost, transgender medical treatment is not cosmetic. It is necessary medical treatment. Psychological care, hormonal treatments, and surgical procedures are all medically necessary for transgender-identified individuals."
The discrimination is, in fact, quite explicit for the city's trans employees: The benefit plan for city workers says insurance won’t cover “Any treatment, drug, service or supply related to changing sex or sexual characteristics, including: Surgical procedures to alter the appearance or function of the body; Hormones and hormone therapy; Prosthetic devices; and Medical or psychological counseling." The commission, which advices the mayor and city council, says these exclusions should be removed when the city writes the new employee contracts in 2013.
Mayor Mike McGinn agrees.
“This is something we should be working to improve,” says McGinn, who only learned about the exclusions last Thursday. “This is not frivolous issue. It’s a fundamental issue about the effect on a person’s physical and emotional well-being, and this exclusion means that you are denying appropriate health services to people when they are in need.”
In response to the letter, which was first reported by Seattle Gay News, Seattle City Council member Sally Clark tells The Stranger she didn’t know about the exclusion, either, until the letter. Clark says, “I’ll be looking at how we can change what we should cover.”
The commission will be meeting tomorrow with Council Member Bruce Harrell, chair of the council's civil rights and technology committee.
The commission says officials should modify those contracts by both removing exclusions for transgender employees and explicitly covering care relating to and including transitional surgeries. “This fact of medical necessity is no longer open to debate,” writes the commission, citing opinions of the American Medical Association, American Psychological Association, and other authorities. Employees who are denied coverage can have "debilitating secondary medical conditions, have substantially higher risk for suicide, and experience increased psychological distress."
Extended coverage comes at a higher cost, but employees probably won't rush to obtain expensive procedures. For instance, San Francisco began covering trans employees in 2001. The commission writes, "During the period 2001-2006, the City of San Francisco increased premiums for transgender coverage totaling $5.6 million, but only paid out $386,417 in claims."
“This is a pretty modest issue compared to the significant issue we have of health care costs of the city as a whole,” says McGinn. But he adds: “This is a fairness issue, it’s not about costs.”