Wednesday, Washington State Insurance Commissioner Mike Kreidler made an announcement clarifying that health insurance policies sold in Washington state cannot discriminate against transgender Washingtonians.
Private health insurance policies routinely include clauses that specifically preclude transgender people from accessing medical and mental health care that is covered for other policy holders. The Office of the Insurance Commissioner, which oversees Washington’s private insurance companies, clarified that under both Washington’s 2006 non-discrimination law and the Affordable Care Act, these categorical exclusions are illegal, and that insurance providers must cover the same services for transgender people as non-transgender people.
As in other states that have paved the way, the Coalition for Inclusive Healthcare hopes that insurance providers will utilize this guidance letter to update their policies—bringing parity to healthcare coverage. The coalition looks forward to working with insurers on implementing this guidance.
“Today’s announcement by the Insurance Commissioner affirms what we already know—that providing parity in healthcare coverage is not only the right thing to do, it’s also the law.” said Marsha Botzer, founder and board co-chair of Ingersoll Gender Center.
“Removing these outdated exclusions brings Washington up-to-date with the latest information from medical experts and will provide transgender Washingtonians with access to life-saving and medically necessary health care,” said Danielle Askini, member of the Coalition for Inclusive Healthcare and Advocacy Director of the Gender Justice League.
Removing transgender exclusions in healthcare is also cost-effective. A 2013 study of Fortune 500 employers who offer transgender-inclusive health coverage to their workers found that providing such coverage had a negligible impact on costs. The City of Seattle, the Washington Education Association, Microsoft, Amazon, Boeing, and a growing number of large employers that self-insure already provide transgender-inclusive health coverage to their employees.
“As a smaller employer without the ability to self-insure, Pride Foundation found that we could not purchase an insurance plan in Washington that would provide these much-needed benefits to our employees,” said Seth Kirby, Board President of Pride Foundation. “We were compelled to create a supplemental policy to cover those services so that we could treat all employees fairly and remain a competitive employer.”
National and medical health experts—including the American Medical Association and more than eight major medical associations—have recognized that gender transition-related health care is medically necessary. Yet many transgender Washingtonians are routinely denied coverage for basic, medically-necessary care simply because they are transgender.
Nearly all insurance plans in Washington categorically exclude coverage for transition-related medical treatment, even when that same treatment (such as mental health care or hormone replacement therapy) is covered for non-transgender people. This discrimination can lead to serious—even life-threatening—conditions. Forty-five percent of transgender Washingtonians have attempted suicide at some point in their life according to the National Transgender Discrimination Survey. With access to gender transition related care medical research has shown that suicide attempt rate drops down to roughly 3 to 5 percent—only slightly higher than the general public.
“I know from personal experience how much these exclusions can hurt transgender people and their families,” said Gwen Yeh, a transgender woman. “Having been denied hormones and doctors’ visits sent a clear signal that I was not equal. This letter sends a strong message that all Washingtonians should be treated fairly by their insurance companies.”
“This care is life saving and medically necessary,” said Dr. Roberta Dalley, a physician at the University of Washington. “After 30 years of practice, refusing transgender people medical care because of who they are goes against everything I believe in as a physician.”