Follow-up thoughts on trans healthcare and coverage

Lately I have been doing more thinking about the issue of health care coverage for trans people. My original post on this topic can be found here. This topic seems to be one that comes up repeatedly, and I think that it is one that deserves more attention and more analysis. Over the next few weeks or so, I am going to do more research into the issue, looking at coverages, barriers to health care access, costs of health care for transitioners, and the medical needs of the transgender community.

A few months ago, we had the Town Hall call on this topic, but I have seen little follow-up in this issue. In fact, we have seen things get worse in some respects. Recently we saw the policy changes allowing doctors to refuse treatments if it goes against their religious beliefs, and this was followed closely by the Pope’s condemnation of homosexuality and transsexual persons. Was this a coincidence? Maybe, but the timing is suspect. I wonder if this will be followed up with statements and opinions about what “good” Catholic doctors should and should not do. I grew up Catholic, and I have always held out hope that the Church will move into the 20th Century, but it seems to continue to root itself in the dark ages. 

Anyway, I would like to ask for your help with this little project of mine. If anyone has any stories about health care issues such as being rejected by doctors, insurance plan issues, or any other problems related to being trans and seeking health care, please e-mail them to me. E-mail me at transgenderhealthcare@gmail.com. I would even like to hear the good stories, the improvements in coverage, etc. When sharing your stories, I will always keep your personal information confidential, but please let me know if you would prefer me not to republish your story as part of this. If you don’t I will just use the information as a reference points as I look for trends, opportunities, or discriminatory practices. Thank you to anyone willing to share their experiences. Also, if you have any good links to information you may feel is relevant, please send me that as well. I think the more information I can pull together, the better I can put together a picture of where we stand today, where we need to be, and some ideas of how we can get there.

Trinidad

Last night, the documentary, Trinidad, was shown as part of the Austin Gay and Lesbian International Film Festival. We organized a group to go to dinner and see the film through TENTex. Prior to the film, we met up at the Spaghetti Warehouse. If you visit the Austin area, this is likely a restaurant you may want to skip. It is located right in the Warehouse district, and is reasonably priced, but it not the best Italian food in the world. Fortunately, the company was much better than the food. I don’t want to complain too much about the food, since it is a restaurant with ample space and reasonable enough to accommodate everyones budget. Dinner gave me the opportunity to meet a few people who I had not had a chance to meet, so for this it was a wonderful meal. I elected for the chicken alfredo, which was not really very tasty, but I was hungry, so it served a purpose. 

After dinner, a few of us rushed ahead to the theater to make sure we got tickets for everyone, unfortunately you could not buy tickets in advance. The theater, which we were told was just a few blocks away ended up being six or seven blocks away. Half way through this walk, I figured out that my shoes, which I had only worn once before, were starting to rub on my toes. It ended up being a bit of a painful walk, not to mention I was going to have to walk this distance back to my car at the end of the evening.

Anyway, we got the theater only to find a very long line in front. This is not your average metroplex with 500 screens. It only has two screens and is an Alamo Draft House cinema. For those of you not familiar with Alamo Draft house, these are theaters in which there is full service dinning during the film, and yes that included beer, wine, and mixed drinks. Because there are tables at each row of seating, the theater probably only hold half of what a similarly sized theater will hold. When we got the front of the line, we realized the theater was going to be packed. I had to wait while they tried to figure out how many seat were left. In order to keep our group together, which numbered 15 or so, we had to sit in the front row. You know, the row where you are looking almost straight up to see the film. The last time I sat in that row was when I was ten years old and went to see Indiana Jones and the Temple of Doom with my best friend. Again those were the only seats left for us.

Were were very fortunate to at least get seats where we could all sit together. Once seated, we were introduced to the directors of the fild, PJ Raval and Jay Hodges. These are two local film makers, so even though the film was about Trinidad, Colorado, it was really kind of an Austin film, which is pretty cool.

For those of you who have not heard of the film, Trinidad is about Trinidad, Colorado, and follows not only Dr. Mari Bowers, but also two other trans women, and takes a look at the setting in which Dr. Biber began his practice, and the setting in which Dr. Bowers continues his work. One of the reasons the directors chose this location and this particular surgeon was the apparent dichotomy of GRS being done in what is essentially a frontier town. 

Trinidad has a population of approximately 9,000 souls, and is very much still a part of the wild west. It is not unlike many towns you would find in West Texas. For those of you who have never ventured into West Texas, let me tell you it is probably not the most LGBT friendly part of the state, and is probably very fundamentalist is their view points. It was interesting to see in the film that despite the apparent similarities to such areas, Trinidad is really a very accepting place. When you get past all the churches and pick-up trucks, you find a town that is really at ease with the idea that Trinidad is considered such a special place for many in the transgender community.

One thing I had a difficult time with the in film was the fact that some considered Trinidad to be a kind of spiritual center for the transsexual community. This view just did not sit well with me. I can understand and appreciate the importance that this location plays in the lives of trans women who had had their GRS performed in Trinidad. This is not small even in the lives of these women. But, to say that it is more important than other locations where GRS is being performed really, to me, minimizes the importance of those other surgeons and locations to the women who travel there to have their GRS performed. I tend to take the point of view that the trans community is extremely diverse, and when we place a value on one path to transition or one surgeon over other, we minimize the experience of those women who have chosen a different path or a different physician.

Anyway, back to the film. The film also followed two trans women who planned to open a recovery center for women having their GRS performed by Dr Bowers. These women liquidated what they had, and planned to renovate a house and open it as a recovery house within six months. The renovations ended up stretching out over a year. During the course of that time, I sensed this real resentment that Dr Bowers was not helping to fund the renovation and help open the house. 

This resentment really bothered me. The project, at least to my knowledge, was not started because Dr Bowers asked them to do it. Instead, it felt as though these women wanted to be a part of Dr Bowers success, and expected her to embrace their efforts fully and support them in their efforts. There were several things that went wrong along the way, and I can completely understand Dr Bowers not getting financially involved in the project. 

Overall, I really enjoyed the film. I am still mulling over many aspects of it, and considering much of what I saw and learned. It is thought provoking. Not only does it make one consider the journey of transition, but it also makes you consider the idea that not everyone is as they may appear. Just as we ask that people not judge us for being trans, we have to realize that we cannot judge everyone else on how they appear. Trinidad, CO may appear from a distance to be a town that would not be accepting of the transgender community, and would be an unlikely place for GRS surgery to be occuring. Yet, the town supported Dr Biber when he was alive, and they welcomed Dr Bowers into the community to continue Dr Biber’s work. Dr Bowers continues her work in, of all places, a Catholic hospital in a town on the edge of civilization. 

I may write more about this film later, as I reflect more on the film, the issues present in the film, and the people involved. This film really touches on many aspects of transition, family, children, acceptance, employment, prejudice, and the journey of self acceptance. If you have a chance to catch a screening I would highly recommend it. 

After the film, I got a chance to go out with some friends to a bar across the street. This was an opportunity to talk more about transition and just spend time with some good friends. One topic that came up was about comfort, and being comfortable in a new gender role. This is an important topic to me and I will talk about it in my next post, so I won’t go into too much detail here.

One last thing I do have to mention, mostly because I am sure Tiana is dying for me to write about it. Last night I got hit on for the first time. As we walked into the bar, I was approached by a guy who asked me if I was 21. I said that I was. He then asked if I was really 21, and flashed a badge. I again said that I was over 21. He said we wanted me to step to the back of the bar with him. I asked him to se his badge again, he then used the line he was working his way up to. He asked me to step to the back of the bar and ,”Put you legs behind your head.” Obviously a seriously bad way to pick up on a woman, but flattering none the less. We laughed and and pleasantly declined. I think I left that interaction bright red and with a big smile on my face. Tiana teased me about it the rest of the evening. It was certainly flattering, and very much a confidence booster. Having at one time wondered if I would ever pass to being hit on in a regular bar was definitely something that boosted my confidence. And this happened well before midnight, so the guy was not even drunk yet!

All in all this was a wonderful evening and just nice to be able to go out in the middle of the week. unfortunately I am going to be missing out on some media training being given by GLADD this weekend. I was really hoping to be able to make that, but it was not in the cards this week. I hope they will offer this training again in the near future. Hope the rest of you had a great week and have a great weekend!

Surgical Status, Important or Irrelevant?

During lunch yesterday, when we were doing introductions, a few people at the table included their surgical status as part of their introduction. I declined to say anything about mine, in fact I nearly introduced myself saying that my surgical status is not important, but I held back. The subject was brought up by someone else at the lunch, saying that we should avoid identifying ourselves by our surgical status. She made some very valid points, such as the need to overcome the societal view that transition is all about the surgery, and the validity of all surgical statuses, pre, post, and non. What are your thoughts on this topic? I am doing my first poll here on this topic, and I would love to see a discussion on this as well. Let me know what you think.

Access to Health Insurance

I want to start off by just apologizing for being a little haphazard in my posting here. I am hoping to get on a more regular posting schedule. I have had I lot of different things going on, and I have had a lot that I have wanted to write about but little time to do it. I do appreciate those who have stopped by to see what is going on here, and I look forward to writing more and engaging in some discussions of the topics and issues.

I just got off the Town-Hall conference call with Donna Rose, Jamison Green, and Becky Allison. I thought it was a good start, and I hope there can be more opportunities for our community to come together like this. I think one of the major benefits of calls like this is the breaking down of economic barriers. Todays topic was essentially health care, and underlying the need for coverage is the need to break down economic barriers. Far too many in our community are unemployed or underemployed. For many, making the journey to a conference may not be possible for economic reasons. Calls such as this will help those members of the community to be able to reach out and interact with the Transgender community at large. I think this will also be of value to those who may live where there is no trans community to speak of. 

Now on the topic. I think most of us have heard about the AMA resolution in June and the WPATH statement in July. These were both significant statements. I would like to start with the AMA statement, which was actually three statements related to removing barriers to care, removing insurance barriers, and removing financial barriers. The one thing that struck me was the repeated use of GID throughout the statements. They did, however, reference GID as a medical condition, and referenced not only the DSM but also the ICD. Now, I was not familiar with the ICD until this evening. I would appreciate information about it if anyone knows a little more about it, and how GID is treated in the ICD. I think that it is positive that the AMA referred to GID as a medical condition as opposed to a mental disorder. I am curious about how this statement in conjunction with the WPATH statement and other papers could serve to help legitimize our need for treatment if GID were removed from the DSM.

I am behind Kelley Winters’ efforts, my only concern being that we have another avenue by which can can continue to gain the medical treatments necessary to transition. I know some have argued that they do not want to be medicalized. To those I would argue, how can one justify medical treatment in the absence of a medical condition. I want to be medicalized, I just don’t want to be pathologized. I believe that part of our process towards equal health coverage is strengthening the medical need and the recognition of GID in the medical community as a medical condition.

I rather liked the fact the the WPATH statement included things such as chest reconstruction and FFS. A Jamison mentioned, many chest reconstruction is the only surgery that many FTM’s want at this time, and for many of them, this surgery is very validating for their gender presentation. The WPATH statement acknowledges that the path to transition is about more than GRS. There are other surgeries and procedures, which some consider cosmetic, that go a long way towards helping to affirm ones gender identity and help make a transition more successful and less emotionally painful (I think anyone who has been through laser or electrolysis knows these don’t reduce physical pain!). 

I think one of the most powerful things in this statements was the AMA’s statement of dispelling the myth that treatments, procedures, and surgeries for trans people are cosmetic or experimental. For us, these procedures are necessary for us to be able to live a life that is more genuine and more true to who we really are. These procedures reduce the emotional stress that can cause so many other health problems. When it comes to insurance companies arguing about cost, I have a few examples of my own situation. Prior to coming out and beginning transition, I smoked almost a pack of cigarettes a day and I was borderline high cholesterol. Within days of coming out, I quit smoking. I stopped cold turkey, now that I was on the road to being me, I didn’t need that crutch. I also changed my eating habit and reduced my stress levels significantly. I was no longer eating the bad foods we eat when we stress eat, fast food, high fat foods, high cholesterol food, you know that stuff that tastes so good but is horrible for you. Since then, by cholesterol is half of what it was before. Not smoking and reduced stress are also significant. Essentially, I likely saved my insurance company easily hundreds of thousands of dollars by transitioning. I greatly reduced my risk of heart attack and stroke, reduced my need for cholesterol and blood pressure reducing medications, slashed my cancer risk each year that goes by, and greatly reduced the potential costs if depression were to lead to suicide of suicide attempts and the related hospitalizations. You tell me, which is better. I think I would take the road of paying for therapy for a few years, GRS and a few other procedures, and HRT. Over my lifetime I bet that it will cost them a lot less then the bypasses and other procedures I was headed towards! 

Another thing I did take away from this was the need to education, Educating our employers, the insurance companies, and the insurance brokers that our companies deal with. There were several stories of brokers discouraging Trans benefits, or pricing them too high to be affordable. I worked in the insurance industry for a brief period of time, and when you are a smaller company, you have little or now ground to negotiate when it comes to benefits. It all comes down to what can I and my employees afford, and what do we have to give up this year. The education has to start with the insurance companies and the larger companies that have the negotiating power. If every company listed in the Fortune 500 index said we want full coverage for out trans employees, I am sure that the insurance companies would take notice.

I find it interesting that many insurance companies offer full benefits to their trans employees, and yet make it difficult and expensive for other companies to provide the same benefits. I wonder about the concept of creating and index that would measure and rate insurance companies not only on the benefits they provide their own employees, but also on how they make the same benefits available to subscribers. Imagine being self employed and having to shop for health insurance with trans benefits, I am sure that is impossible, and if possible prohibitively expensive. 

We need insurance companies to recognize trans benefits as a fundamental part of any group or individual plan. Spread over a sizable group, the costs are negligible. I believe one study showed that it was pennies per premium. I will find that presentation and post it later, I think it was from and Out & Equal conference. If this is part of every policy, cost would not be an issue, and we would finally have equal access to health insurance and the procedures that we need. 

I look forward to future calls, and the discussions and actions that they will generate. There are a few things out there that are dividing some of us, we need to concentrate on many of the things that bring us together. We will always have differing opinions on how to tackle a particular issue, but I think we need to respect the diversity of opinions in this community. We are an educated community, and we need to realize that there is more than one way to approach an issue. Good night to everyone, and hope to talk about some of this more.