Recent Progress in Trans* Health Law: Sweden and the US

by on February 13, 2013  •  In Health, Transgender
transgender symbol

We have recently seen two long-overdue victories in the area of trans* health. Most notably, Stockholm’s Administrative Court of Appeals finally struck down Sweden’s indefensible–and remarkably culturally incongruous–law (text available in Swedish only) requiring that trans* people be sterilized before the government would issue them identity documents with their preferred sex indicated. This welcome ruling helps pave the way for victory in an upcoming class action suit demanding damages for more than 100 of the trans* people who have been victimized by this law.

Also significantly, insurance regulators in California and Oregon have recently issued rules in their respective states that require commercial insurance plans (i.e. those regulated by each state, but not Medicaid or Medicare plans or self-insured businesses) to exercise parity in coverage of treatments, meaning that they must use the same threshold of medical necessity when evaluating claims from trans* and cis (i.e. non-trans*) customers. No coverage of specific treatments is mandated by the rules, but items such as hormone therapy, breast reduction, and cancer screenings are examples of treatments that these insurers must cover if deemed medically necessary for trans* patients.

Lastly, the NY Times reports that a significant chunk of America’s premier universities are adding coverage for trans-specific health conditions and bragging about it:

No college or university offered [coverage for gender reassignment surgery] just six years ago, but when Brown University said last week that its student health plan would be extended to cover sex-change surgery beginning in August, advocates for transgender students said Brown would become the 36th college to do so. Twenty-five additional colleges do not cover surgery, but their student plans do cover related hormone therapy, and 20 universities have plans that cover some or all sex-change treatments for their employees, according to the Transgender Law and Policy Institute.

Those lists include many of the top American universities — Harvard, Stanford, Cornell, Penn, Emory, Northwestern, the University of California system, Yale, Princeton, M.I.T., Washington University and others. Colleges are not required to provide health coverage for their students, many of whom are still covered by their parents’ plans, but they generally do…

But since 2008, the American Medical Association has advocated the same thing, for treatment of gender identity disorder. Other medical groups, like the American Psychiatric Association, have taken the same position. Several major insurers have taken the stance that the treatment, including surgery, can be considered medically necessary. The Internal Revenue Service considers the expenses tax-deductible.

The issue directly affects only a tiny number of students; no one knows how many. But universities recognize that their insurance plan sends a signal to the much larger number of students for whom the rights of transgender people have taken a place alongside gay rights as a cause that matters.

“Students notice whether the issues that they care about, that make them feel like it’s a more comfortable and welcoming place, are being discussed and addressed,” said Ira Friedman, a doctor who is associate vice provost for student affairs at Stanford and director of the student health center there. Stanford began covering sex-change surgery in 2010.

Princeton says on its Web site that it has been named a “top 10 trans friendly university” and that “recently, we launched an online guide” for transgender students. The university’s student policy covers hormone therapy but not surgery, but it is, along with Yale, one of several in that category that say they are considering adding surgical coverage.


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