TransHealthcareNow

By Erin Rook, PQ Monthly

Transgender individuals are routinely denied medically necessary health care based solely on their gender identity, but that’s about to change — in a big way — in Oregon.

In the week  before Christmas, the Oregon Insurance Division of the Department of Consumer and Business Services quietly issued a bulletin clarifying that Senate Bill 2 — the law passed in 2007 prohibiting discrimination on the basis of sexual orientation (defined to include gender identity) — requires equal treatment for transgender Oregonians in medical treatment.

“This is, I think,  a huge victory for the transgender community in Oregon. This is really making clear what trans folks know — that we deserve equal healthcare access,” says Basic Rights Oregon‘s Trans Justice Manager  tash shatz. “It’s such an incredible thing that it’s kind of hard to describe how big a deal it is.”

The clarification comes more than 5 years after the passage of the non-discrimination law, following pressure from BRO’s Trans Working Group and complaints from transgender Oregonians denied coverage of medical treatments on the basis of their gender identity. While it’s not clear how the bulletin (officially released Dec. 19) will affect federally managed insurance programs such as Medicare and Medicaid (Oregon Health Plan), it does apply to all private insurers transacting in Oregon.

The list of actions that, when based on actual or perceived gender identity, would constitute prohibited discrimination include:

• Denying, cancelling, limiting, or refusing to renew an insurance policy.

• Requiring different rates or premiums.

• Classifying “gender identity disorder” or “gender dysphoria” (GI/GD) as a disqualifying pre-existing condition.

• Denying coverage for a procedure that is provided for the treatment of other conditions or illnesses (such as hormone therapy, mastectomy, or vocal training).

• Categorically denying coverage of GI/GD.

• Denying mental health coverage for GI/GD-related issue in adults.

• Denying sex-specific care (such as pap smears and prostate exams).

To report discrimination, file a complaint online here. Insurance companies are required to respond to complaints within 21 days, says Ron Fredrickson of the Oregon Insurance Division’s Complaints Department.

“Once we get a response back, an advocate decides whether or not the insurer is in compliance. If they are in violation, we get good resolution for consumer,” Fredrickson says. “If we find that the company engaged in practice in violation of the law, we can investigate whether other consumers have been affected.”

Penalties for violating state law can include fines, but Fredrickson says the ultimate objective is changing behaviors and ensuring consumers are treated fairly.

“I think that any kind of clarification of law of this magnitude in terms of impact for a community is going to take some time to implement,” shatz says. “The good thing is this is coming from the insurance division… I think it bodes really well for the implementation of it.”

The clarification bring all insurers doing business in the state in line with a number of Oregon businesses who have pushed for inclusive coverage in their company plans, including Oregon Health & Science University (OHSU), New Seasons, the National College of Natural Medicine, Portland State University, Progressive Insurance, Starbucks, IBM, and Microsoft.

“This clarification is indicative of a sea change on the issue where more and more people are understanding that transition-related care is something that shouldn’t really be excluded,” shatz says. “The tide is really turning.”

Read the entire bulletin here. Basic Rights Oregon has also published answers to Frequently Asked Questions. PQ Monthly is following story and will provide more details and context as they become available.

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