Social Equity Series: Business Case for Trans-Inclusive Health Care

I can remember ten years ago when I was first coming out that “transgender” wasn’t a word that’s was necessarily understood or recognized in my community.

Photo credit: Basic Rights Oregon

When speaking about LGBT issues, the assumption in a community of middle class white gay folks was that the “T” was silent, something beyond the spectrum of gay vs. straight. After spending a weekend at the Transgender Leadership Summit hosted by Basic Rights Oregon, I’ve come to realize that the conversation of transgender rights has come a long way. More and more transgender folks are finding their voice at the table of healthcare, and yet we still have so far to go when it comes to accessibility of trans-related care with our insurance companies and healthcare providers. One avenue most of us can help move this forward is our work places.

Unfortunately, many workplaces provide a health care provider who explicitly prohibits trans-inclusive care. Without awareness of this issue, employers can inadvertently (or sometimes advertently) select health care insurance plans that include a statement specifically excluding transition-related care coverage. Therefore, one readily available way for all of us to contribute to the fight for trans-inclusive care is to act as conscious employers and employees and make the business case for transgender-inclusive health care plans in our workplaces. Not only is transgender health care the right thing to do, the costs are negligible and providing trans-inclusive care is becoming an increasing standard.


The truth is almost all of the procedures that one considers transgender-related care are covered for cis-gendered folks (meaning people who mostly identify with the gender assigned to them at birth.) For example, male hormone imbalance is covered by hormone treatment and it’s common practice to receive breast augmentation following mastectomy as part of treatment for women with breast cancer. The truth is these things have become part of the normal cost of medical care for cis-gendered folks and yet many insurance policies have specific trans-exclusive clauses in their insurance policies that don’t allow the same exact treatment for trans-folks. There’s no reason for this difference in care as transgender treatment has been officially deemed medically necessary by the American Psychological Association, the American Medical Association and even the United States Tax Court. So not only is denying coverage unfair, it’s also unethical and may very well be considered a legal risk of discrimination.

But wait a minute, you may say, “I don’t work with any transgender people. Why should we go to all this unnecessary trouble?” There are a number of reasons why transgender folks may choose not to come out, or may choose to “pass” in their professional lives, safety and privacy being among them. Therefore, you very well may be working with trans-folks without your knowledge. While populations are rarely counted and folks may choose not to disclose, I’ve seen estimates that say anywhere as high as 1.0% of the US population are transgender. That is 1 in 100 people require transition-related care. If we see no problem with advocating for access to treatment for diseases such as Multiple Sclerosis in which around only 400,000 Americans suffer, we can make this a medical priority as well.


Won’t everyone’s premium go way up if we add yet another thing to the list of coverage? In short, no. Take San Francisco as an example. In 2001 the City of San Francisco became the first US city to provide trans-specific health care to all its employees. It did this against concerns that the city would rack up massive medical costs that would need to be absorbed by the majority of city workers to benefit of the few, and that trans-folks across the country would flock to San Francisco and flood the market increasing costs even further. To account for projected rising costs employees were charged $1.70 per month for the first 3 years. By 2004 the city had collected a surplus of over $4.1 million, while only covering 7 claims for surgery. In response, San Fran dropped the premium to $1.16. Again, collection of premiums far exceeded the cost of coverage to the point that in 2007 the costs of including trans-coverage were deemed to be “de minimis” and the surcharge was completely dropped. After 11 years, costs have continued to be 0.08% of total premium coverage and therefore negligible. As other cities and companies have followed suit these costs again and again prove to be relatively inconsequential in the scheme of total coverage that is makes little to no difference to the bottom line.


At the end of the day, companies can’t afford to not seek out trans-inclusive health care in their company policies. Out of the top Fortune 100 companies, 25% currently cover transition-related care. Transgender folks are more and more a part of the average workplace whether visible or passing, and business today would be remiss to lose out on the opportunity to attract talent based on insufficient care. To not do so would leave your company with a competitive disadvantage that in the current business environment, it can’t afford.


If you’re an employer, ask your health insurance provider if they have a transgender exclusion clause. If you work for a company, ask your employer if your coverage includes transition-related care. If not, look to the these insurance providers for such coverage, and encourage the company to make it standard practice to let incoming applicants know regardless of whether they come out as transgender. With this simple action, we can advocate for equal rights in our workplaces and further health care justice in our communities. You can also work with Basic Rights or like-minded advocacy groups to develop your personalized business case for trans-inclusive health care.


Courteny Morehouse is studying Local Living Economies with an emphasis in finance. Currently she works with a Farm Incubator started by the East Multnomah Conservation District. Drew Jones is studying Organizational Leadership with Ashoka Seattle in communications, BGI in advancement and IdealSeat as a research and development intern. Courteny Morehouse and Drew Jones are both second year MBA students at BGI and co-chairs of the DSJ Committee.


The BGI Diversity and Social Justice Committee is the co-sponsor of the Social Equity Series. DSJ is dedicated to furthering the work of diversity and social justice in the world of sustainability and business. Because a socially just world is a sustainable one. Find DSJ on Twitter @BGI_DSJ.


The Social Equity Series features members of the BGI community sharing their knowledge, insights, and experiences on social equality issues as pertains to sustainable business.


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