Obama Administration: Federal Benefits Can No Longer Exclude “Gender Transition Services”

A transgender man prepares to inject himself with testosterone.

Photo by Erin Siegal/Reuters

A hard-won victory was granted to the LGBTQ community last week when the Supreme Court decided to strike down state bans on same-sex marriage. But the battle for LGBTQ rights is still an uphill one—a fact that John Oliver highlighted on the most recent episode of his HBO show Last Week Tonight, in which he dedicated 16 minutes to transgender civil rights issues. “For all the strides transgender people have made lately, let’s not get too complacent about how far we’ve come,” Oliver said. He pointed to official rules that legitimize prejudice, such as laws that force people to use bathrooms corresponding with their biological sex and DMV practices that make transgender women remove their wigs before being photographed for licenses. Oliver noted, “When you’re transgender, any interaction with bureaucracy can be humiliatingly difficult.”

Bathroom laws and disrespectful treatment are just two examples. The transgender community faces a slew of social and legal difficulties that have been systemically dismissed by the government. But at least one particular difficulty has finally been taken seriously—the issue of transgender-specific health care. More than a half-dozen U.S. states, including New York and California, recently began offering health insurance coverage to state workers for transgender-related treatments such as gender reassignment surgery and hormone therapy. Starting this week, Nevada is the latest state to adopt such policies. And thanks to a quiet announcement last week by the Obama administration, change will soon come at the national level: Beginning next January, all transgender federal employees will be eligible for at least some forms of transition-related health care coverage.

Despite coming without much fanfare, in the form of a short letter from the Office of Personnel Management telling insurance carriers in the Federal Employees Health Benefits Program that they will no longer be allowed to maintain blanket exclusions on services related to gender transition, the announcement is huge. It effectively puts an end to a long history of discriminatory federal health care. For decades, transgender government workers have had to pay steep out-of-pocket fees for transgender care, even if the care is deemed necessary by their doctors. In 2014, the Office of Personnel Management removed its outdated ban on transition-related coverage, thus allowing federal insurers to offer transgender coverage, but not necessarily encouraging it. Now, the administration is actively calling on insurers to provide transgender care. “This letter clarifies OPM’s earlier guidance recognizing the evolving professional consensus that treatment may be medically necessary to address a diagnosis of gender dysphoria,” the memo states.

Researchers estimate there are nearly 700,000 transgender people in the United States today. The Obama administration’s insurance policy change only affects transgender people who work for the government—but given that federal employees number in the millions, there’s bound to be some impact. Beyond providing a direct benefit, the policy change also has the power to change public perception. The new policy puts an important legal casing around a person’s right to be transgender in the first place—under the new health care rules, a person’s decision to seek a gender transition will be formally and financially recognized as a medical necessity, rather than a quirky lifestyle choice. Treatment for transgender-specific issues will be regarded in the same way as antibiotics for a bacterial infection or surgery for a burst appendix. And government workers with bigoted views will have one fewer institutionalized excuse to ostracize their transgender colleagues for being different.

The administration’s policy change is also important in and of itself. Transition-related transgender care can be wildly expensive for those who must pay for it without coverage, with reassignment surgery alone costing tens of thousands of dollars. Long-term hormone therapy adds thousands more to the bill. Even with proper insurance coverage, transgender health care can still be a headache: Some providers cover some surgical procedures and not others; some insurers don’t cover surgery but will pay for hormones and mental health therapy. The medical landscape for transgender care is so difficult to navigate that one nonprofit group has created a customized database to help transgender individuals find care options in their area. And none of this even begins to deal with the massive problem of itemizing transgender medical costs on tax forms: Though the Internal Revenue Service started allowing tax deductions for transgender medical costs a few years ago, transgender people still have to jump through hoops to prove they qualify for each specific deduction.

The Office of Personnel Management’s new prohibition on federal insurers from having a “general exclusion of services” for transgender health care does nothing to address any of these concerns, of course. The administration’s letter to insurance carriers is only three sentences long. But it does turn a much-needed spotlight on critical issues that have been plaguing the transgender community for years.

The list of U.S. businesses with transgender-inclusive health coverage is not long, but it is growing every day. The same holds for universities, nonprofits, and other organizations. It’s about time the federal government joined the movement to normalize transgender identity in a legal and medical framework. But as Oliver noted in his last show, the fight is far from over. Hopefully, at the very least, the Obama administration has given it a heavy nudge in the right direction.

Want to hang out with Outward? If you’ll be in or near New York City on Monday, July 13, join June Thomas, J. Bryan Lowder, and Mark Joseph Stern—and special guests Ted Allen, of Queer Eye and Chopped fame, and marriage-equality campaigner extraordinaire Evan Wolfsonfor a queer kiki at an Outward LIVE show, hosted by City Winery. Details and tickets can be found here.