KANYE’S NEW MOTHER-IN-LAW

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Obamacare, states and insurers make gender reassignment surgery more accessible

By Quentin Fottrell

Published: June 3, 2015 9:29 a.m. ET

Caitlyn Jenner’s “Vanity Fair” cover has created a rare, possibly even enlightening moment in American culture. The cover image went viral in minutes, garnered Jenner more than 2 million Twitter followers in 24 hours and — along with transgender activists like actress Laverne Cox, who recently appeared on the cover of “Time” magazine, and writer Janet Mock — will help promote more understanding and, in an ideal world, less discrimination against the transgender community. On Monday, hours after Jenner’s cover photo appeared online, President Barack Obama tweeted: “It takes courage to share your story.”

The former Olympic champion known as Bruce Jenner, who appeared in the E! television series “Keeping Up With the Kardashians” and will chronicle her own journey on that channel, has had facial and breast surgery, although it’s not clear whether she has had or will have full gender reassignment surgery. The World Professional Association for Transgender Health, a professional association dedicated to promoting respect, research and advocacy for transgender health, advises people undergoing a gender transition to live for a year as their new gender before choosing full reassignment surgery.

The good news: It’s never been easier for transgender people to access gender reassignment surgery — if they have insurance and live in the right state. More than two dozen major insurance carriers provide plans without blanket exclusions for transgender-related health care, either through fully-insured plans or as a third party administrator of self-insured plans, according to the Human Rights Campaign, a nonprofit group that works for lesbian, gay, bisexual and transgender equal rights. They include Aetna AET, +0.19% , at least eight Blue Cross state programs, Cigna CI, +0.15% , UnitedHealth UNH, +0.68% and Emblem Health.

Regulators in nine states and the District of Columbia have also introduced laws banning insurance discrimination against treatments for gender reassignment. The other eight are California, Colorado, Connecticut, Illinois, Massachusetts, Oregon, Vermont and Washington, according to the Transgender Legal Defense & Education Fund. “But some insurers still deny claims and flout the law until someone pushes back against them,” says Michael Silverman, executive director at Transgender Legal Defense and Education Fund. Last December, New York Governor Andrew Cuomo told insurers in a letter: “An issuer may not deny medically necessary treatment otherwise covered by a health insurance policy solely on the basis that the treatment is for gender dysphoria.”

New federal laws have also helped create a more inclusive environment. In May 2014, the Obama administration lifted a 33-year-old ban on Medicare coverage for gender reassignment surgery. The 2010 Affordable Care Act does not explicitly require insurers to cover gender reassignment surgery but, according to this White House letter, insurers “can no longer turn someone away just because he or she is lesbian, gay, bisexual, or transgender.” This has not yet been tested in court, says Josh Block, a senior staff attorney with the American Civil Liberties Union LGBT Project in New York.

Full gender reassignment surgery can cost from $10,000 to $100,000, but most people don’t spend more than $30,000 or $40,000, says Jamison Green, president of the World Professional Association for Transgender Health, an international nonprofit. While 61% of transgender Americans reported having medically transitioned with hormone therapy, for instance, only 33% said that they had surgically transitioned, according to a 2011 survey by the National Center for Transgender Equality and National Gay and Lesbian Taskforce. It may be because they chose not to have gender reassignment surgery or, the report found, because a sizable percent of those who have had hormone therapy are not yet living full-time in their new gender.

And society at large can be less than accepting in the workplace and online, Silverman says, despite the positive overall reaction to and conversations about Caitlyn Jenner’s first photographs in “Vanity Fair” as a trans person. Some 41% of respondents in the 2011 survey of 7,500 transgender Americans reported attempting suicide compared with 1.6% of the general population, with rates rising for those who lost a job due to bias (55%), were harassed or bullied in school (51%), the victim of physical assault (61%) or sexual assault (64%). The sample was nearly four times more likely to have a household income of less than $10,000 a year compared with the general population.

There’s been tremendous progress in recent years in providing access to health care, Block says, but significant barriers remain. He says the public needs to be careful that we don’t equate transition-related health care with genital surgery because there’s a far broader range of medically necessary treatments such as hormones and therapy that are important for trans people to have access to. “There are still too many people that fall within the gaps of the patchwork of different public and private insurance programs,” Block adds. “It’s critical that we get to a place where any trans person in America is able to access medically necessary treatment.

The estimated 700,000 transgender people in the U.S. can still face discrimination and harassment in the health care system and society, Silverman says. “Seeking health care is a complicated process for transgender people who have to plan around issues that other people don’t have to think about, such as room assignments based on sex,” he says. “A transgender man in a gynaecologist’s waiting room can be made to feel very uncomfortable and a transgender person may not want to have his/her legal name called out in the medical waiting room. Very few legal providers have taken steps to deal with these issues.”