Oregon Bans Discrimination Against Trans People by Health Insurance Companies

Comments

1
Yep. The only thing wrong with this is that there shouldn't be a hyphen after "medically." That's a non-elective punctuation removal procedure right there. If a breed standard woman needs non-elective hormone therapy, then a trans woman should also be eligible for non-elective hormone therapy.
2
@1 but the point, if I read correctly, is to get insurers to cover gender dysmorphia. In insurance land, non elective will never be covered. But if you can get them to acknowledge a legitimate problem and then cover it, you're good.
3
Bugger I meant "elective" and also misread your comment. That's what I get for slogging before coffee.
4
I'm confused. Does this mean that, say, FTM transgender individuals are entitled to have a hysterectomy covered by insurance even if the only reason they 'need' a hysterectomy is because they're transgender?

If so, what is medically-necessary part? Treatment for a psychiatric condition? Are there any other examples of major surgery that is considered medically-necessary due to a psychiatric condition?

Furthermore, how is not covering such a procedure discrimination, since that scenario would never apply to a non-transgender woman?

Now both transgender and non-transgender females (by which I mean biological females, born with a uterus) might need a hysterectomy for other reasons, such as cancer, and of course should receive equal coverage for that.

I'm not necessarily opposed to covering gender reassignment surgery, but this sounds like a back-door way to achieving that by calling gender reassignment "medically-necessary".

Or maybe I'm missing some big points here, so I am happy to be made better informed.
5
@4: The point you are missing is that there are surgical interventions which are medically necessary for the treatment of gender dysphoria.
6
#5: Also, that "medically necessary" requires no hyphen.
7
@ 4 the way I read it is that trans-folks will be covered for any treatment that is considered medically necessary for treatment of gender dysphoria, if that treatment is also covered for non-trans folks for whatever medically necessary reason. This should mean hysterectomies, and hormone therapies should be pretty accessible. FTM top surgeries might be borderline because it is slightly different surgery than a mastectomy. Breast implants, and phaloplasty might be possible because they are sometimes covered for non-trans folks for reconstructive surgeries. Sounds like vaginoplasy and metoidioplasty are prob out. Sucks for transwomen. Haven't read much about this, I wonder what the folks who wrote the law think it covers...
8
This seems like an expansion of the term "medically necessary". Gender dysphoria is a psychiatric condition. Are there any other psychiatric conditions for which major surgery is considered medically necessary?

Also, since medical necessity currently means something to treat an illness, injury, or loss of function of a body member. Is gender dysphoria therefore to be considered an illness? Is that any better than calling it "gender identity disorder"?

Just because a treatment exists for one case (say, uterine cancer) doesn't mean that it's medically necessary and thus should be covered for any possible cause for which it may be considered a treatment. Plastic surgery may be medically necessary for someone who has been shot in the face, but that doesn't mean I should get it covered for myself to please my vanity, and if my insurance chooses not to cover it for that latter reason, that doesn't mean I'm being discriminated against.

Again, I am not necessarily opposed to covering gender reassignment surgery via insurance, but I'm hesitant to support it under the 'medically necessary' label.
9
@7,

Now I'm wondering what the distinction might be between what's considered medically necessary and what's considered cosmetic. A double mastectomy for a transman seems like it could go either way. I'm sure he would feel it necessary to get that surgery in order to transition fully, but then there are plenty of cisgendered men who have large mammary glands. If they got breast reduction surgery, that would be considered cosmetic and would not be covered by insurance.

The same thing with transwomen. Is it medically necessary for them to get breast implants? There are many cisgendered women who are flat chested, but insurance does not cover implants for them. Is the body dysmorphia diagnosis sufficient to make mastectomies and implants medically necessary?
10
@4/@8 - breast augmentation following mastectomy is fairly standard and completely covered. Women don't need that breast to live... rather it can be considered a fundamental aspect of their physical identity they have lost.

@9 Elective is a term used to describe not the *need* of a procedure but simply whether it can be scheduled. For example, most heart surgeries are elective as opposed to emergency... whether or not a procedure is "elective" doesn't actually speak to the necessity of the procedure.
11
@10 Good point about breast augmentation following mastectomy, although in that case, there is a clear cause and effect- the woman has lost a body part that she had due to the treatment for a disease (or high potential for a disease), and the augmentation is meant to reconstruct that.

Whether the augmentation is therefore medically necessary is thus debatable, but there is a clear operation that was medically necessary (the mastectomy) and I think a case could be made that the augmentation ought to be covered as a continuation of that procedure.

In the case of a MTF transgendered person, a breast augmentation would be a procedure by itself, not based on any medical condition other than gender dysphoria, which again, is a psychiatric condition. I'm curious if there are any other such psychiatric conditions for which major surgery is prescribed and covered. For instance, can/should people with body integrity identity disorder have an amputation covered by insurance?
12
All cosmetic reconstructive surgeries after some form of damage would count as insured medical procedures, generally surgical, to treat psychological issues. It's not uncommon to get some form of cosmetic surgery after some form of injury. It is also done for people who are born with abnormalities, to help them appear more normal. Which is completely analogous to a transsexual getting surgery to appear more normal for the gender they actually are, while fixing a problem that was there from birth.
13
@12 You make a strong case, except I'm not sure the terms "reconstructive" or "abnormalities" apply to someone born with a normal body of a particular sex but with a brain that makes them feel like the other sex. I raise again the question about body integrity identity disorder... let's assume that's something someone is born with... should they be able to get their desired amputation(s) covered by insurance? And if they don't, is that discrimination against them, or it just a sad fact that they can't receive coverage for their desired "treatment"?

The term "discrimination" is thrown around a lot, but it ought to be limited to cases where two people under similar situations are treated differently for reasons irrelevant to their situation (e.g. someone forced to move to the back of a bus because of their skin color). Choosing not to cover a series of gender reassignment procedures due to a psychiatric condition is not the same scenario as choosing to cover the same or similar procedures due to a physical illness like cancer, whether it's the direct treatment in question (hysterectomy) or a reconstructive treatment after the direct treatment (breast augmentation). It may be a good idea to cover the former, but I don't see it as discrimination not to.