Keith Ellison: Stop denying insurance coverage for gender reassignment

Keith Ellison and Andrea Jenkins, a local LGBTQ rights historian, say it's wrong for insurance companies to deny coverage of transition surgeries.

Keith Ellison and Andrea Jenkins, a local LGBTQ rights historian, say it's wrong for insurance companies to deny coverage of transition surgeries.

Despite monumental gains in civil rights for the LGBTQ community, trans people still face discrimination, violence, limited access to healthcare, poverty and unemployment.

A staggering 41 percent of transgender Americans attempt suicide at least once in their lives. More than 55 percent of trans Americans have been fired due to their gender identity. Trans Americans are four times more likely to be living in extreme poverty than the general population.

These figures are tragic but they are not surprising to trans folks — it’s what happens when a group of people faces discrimination in our society. Discrimination at work leads to unemployment and poverty. Persecution by law enforcement causes fear and despair.

And at the heart of all of the issues facing the trans community is a lack of access to the care they need to live safely, securely, and with the dignity all Americans deserve. All over the country, it is still legal for insurance companies to deny coverage for transition care. Even here in Minnesota, we have a statute that bans government funds from being used to provide transition surgery.

Think about that. We have a law in our state that makes it illegal for the government to give low-income trans people the care they need to survive. Dylan Flunker, a healthcare advocate for Rainbow Health Initiative, is familiar with the barriers to healthcare. After facing discrimination with pharmacists and insurance companies, Dylan paid exorbitant rates for medical necessities simply because of his gender identity.

But that has only strengthened his resolve to help those following in his footsteps. “I had to figure out how to pay out-of-pocket for my own surgery because my insurance at the time didn’t cover any transition-related care,” he told me. “No one should be denied healthcare because they are trans.” Most trans Americans have similar horror stories — being denied emergency services due to their gender identity, or fighting for insurance to cover medically necessary treatments like hormones.

Although our state’s Human Rights Act prohibits discrimination against trans people, insurers frequently deny transition care immediately. Even when they don’t, the application and reimbursement process can be so complicated that nobody can get coverage. Sadly, there are few examples of insurance companies providing transition care simply and affordably.

The passage of The Affordable Care Act was a step toward ensuring trans folks are not unjustly denied care, thanks to a provision that barred discrimination on race, color, national origin, age, sex, or ability. A recent rule proposed by the Department of Health and Human Services clarifies that, yes, this includes trans people.

If enacted, this rule would bar healthcare plans on federal exchanges, as well as any plans receiving federal funds, from discriminating against trans patients. It also extends protections for care like breast exams and pregnancy care for trans men, filling an important gap in federal policy. Though this rule is a signal that times are changing, it still does not remove all the barriers to transition care.

We should push back against the insurance companies that put profit above the lives of their patients, cis or trans. We should work to stop the prejudice that leads to trans people being denied care. A person’s medical decisions are between themselves and their doctor, regardless of their gender identity. Every person in this country has the absolute right to life, liberty, and the pursuit of happiness.

Denying trans people the care they need means denying them these rights.

Co-written by DFL U.S. Rep. Keith Ellison and Andrea Jenkins, a local advocate and historian of LGBTQ rights. Jenkins was profiled by City Pages earlier this year in our Pride issue.