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D.C. health plans to include gender-reassignment surgeries
Question of the Day
D.C. Mayor Vincent C. Gray on Thursday announced that the city will recognize gender dysphoria as a medical condition, forcing insurance companies to cover treatments such as gender-reassignment surgery for transgender people.
The coverage extends to all D.C. residents with group or individual health insurance — including the roughly one-third of city residents receiving Medicaid benefits — whose doctors diagnose the condition and for whom treatment is deemed medically necessary.
“This action places the District at the forefront of advancing the rights of transgender individuals,” Mr. Gray said at his ceremonial office at City Hall. The District joins California, Colorado, Connecticut, Oregon and Vermont in requiring the coverage, which the federal government will not be made to offer to its employees.
Transgender activists applauded the move, saying it guarantees coverage for treatments such as gender reassignment surgery that can cost tens of thousands of dollars and which have been denied by insurance companies that deemed the procedures cosmetic.
“This isn’t about who’s paying for things. This is about whether or not it’s medical care and who gets to decide that,” said Mara Keisling, executive director of the National Center for Transgender Equality. “Nobody in America wants their health care decisions made by the insurance companies.”
The National Center for Transgender Equality estimates that 2,000 transgender people live in the District, though it’s unclear know how many might seek treatment under the coverage.
A survey last year of more than 600 transgender people from the D.C. area indicated that 46 percent living in the area earn less than $10,000 a year — making the specific inclusion of Medicaid in Thursday’s announcement an important factor, said Nico Quintana, a senior organizer with the DC Trans Coalition.
City officials pointed out that the move was a clarification to a bulletin issued in March notifying health insurers to remove language that discriminated on the basis of gender identity and expression so that transgender individuals could obtain medical benefits.
After receiving numerous inquiries about the scope of last year’s announcement, the District’s Department of Insurance, Securities and Banking sought greater detail.
“I don’t think we got any formal complaints. What we did get was a lot of questions,” said Philip Barlow, the department’s insurance commissioner. “I suspect that people were waiting for clarity before they moved ahead.”
As a result, the city’s position on the matter is “the clearest and most direct of any of the jurisdictions out there,” Mr. Barlow said.
The American Psychiatric Association last year replaced the term “gender identity disorder” with “gender dysphoria” in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
In a statement explaining the change to its official listing of diagnoses, the association said the purpose was to make clear that “gender nonconformity is not in itself a mental disorder.” The critical element of the diagnosis, the statement said, is “clinically significant distress” and that the association sought a diagnosis that would not stigmatize all transgender people but would ensure access to medical care and insurance coverage to those who suffered from the condition.
The District, in recognizing gender dysphoria, mandated that insurance providers determining the medical necessity of treatment refer to the World Professional Association for Transgender Health Standards of Care, the standard of medical care for transgender people.
City officials have noted that insurance companies operating in the District had explicit policies that excluded transgendered people from some of the same services offered to others — including mastectomies for breast cancer, hormone replacement therapy and high blood pressure medications.
“These residents should not have to pay exorbitant out-of-pocket expenses for medically necessary treatment when those without gender dysphoria do not,” said Mr. Gray, who is running for re-election this year among a crowded field of contenders.
© Copyright 2014 The Washington Times, LLC. Click here for reprint permission.
About the Author
Andrea Noble is a crime and public safety reporter for The Washington Times. She can be reached at firstname.lastname@example.org.
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