Transgender community looks to Pa. to mandate coverage of transition-related care

With the U.S. Supreme Court legalizing same-sex marriage across the country last month, some may think the fight for LGBT rights is over. But transgender people still struggle to get basic rights, including comprehensive health care.

Pennsylvania could join a handful of other states in requiring insurance coverage for all transition-related medical care for transgender people. It would be the first state to do so by way of legislation.

Some people are not very optimistic about the chances of that. After all, Pennsylvania still has no statute outlawing discrimination against the LGBT community.  

Jennifer Lydon, a 49-year-old transgender woman, came out a little over a year ago. While it was difficult to come to terms with who she really was, the fact that she didn’t have coverage for transition-related procedures made her journey even harder.

“Coming to grips with being transgender was about a lifelong struggle. I didn’t come to grips with it until I was about 40, 41,” she said. Part of the anxiety stemmed from the financial costs.

“How am I going to afford all this?” Lydon said. “Because it’s not an option … it’s something we have to do.”

Other transgender Pennsylvanians dealing with who they are may have a slightly easier journey following state Rep. Mark Cohen’s legislative proposal to mandate coverage for procedures and medications for those in transition.

“People believe it’s time for us to ensure equal rights for transgender people,” he said. “Transgender rights are important issues for the history of Pennsylvania.”

But not everyone thinks so; the bill has just been sitting in the House Committee on Health since March with no indication it will move forward.

“It’s frustrating,” said Lydon, a Philadelphia resident. “There are so many people in need of this legislation, it kinda makes me feel we’re not there yet. Maybe it’s starting to seem like we’re there, because everything in the media, transgender is all over the place now, and it just seems like the consciousness is there. But I guess we just haven’t caught up yet.”

Scattered approach to coverage

Nurse-practitioner Dane Menkin at the Mazzoni Center, Philadelphia’s LGBT health care and wellness center, said delving into what procedures are covered and what is not, is “a big can of worms.”

With no universal standard for transgender health care, passing the kind of legislation sponsored by Cohen, D-Philadelphia, would make it easier for patients to understand what kind of coverage they can get, Menkin said.

For example, some insurance companies in Pennsylvania already offer some kind of coverage. So for many, including Lyndon, it would really just be another step toward equality.

“What this bill would do is bring to the floor again in a different venue the need for comprehensive medical and surgical coverage for transgender people, instead of this sort of piece-by-piece system that is in place,” Menkin said.

Passing the bill would show that all people have a right to basic health care, and that transgender people have real health needs that need to be addressed, Menkin said.

As more states require transition-related insurance, the better chance for some kind of universal coverage across the country, said Ethan Rice, staff attorney at the Transgender Legal Defense and Education Fund.

“About five years ago, there were not any states that had explicit laws or policies that required insurance carriers, either public or private, to provide coverage for transgender related health care,” he said.

“Now we are seeing … that more and more states are requiring insurance carriers to provide coverage for transition-related care, at least on the same level that they provide care for any other services in that state.”

Nine states and Washington, D.C., already mandate some kind of insurance coverage. Most require Medicaid and private insurance to cover transition-related expenses.

But Pennsylvania would be the first to mandate coverage through legislation.

States with antidiscrimination laws have required coverage under the umbrella of existing laws declaring that not issuing coverage amounts to discrimination.

And some state agencies that regulate private insurance companies have issued bulletins and guidance for insurance companies to follow. For Medicaid, most states have simply removed a previous rule that excluded the coverage.

However, Pennsylvania lacks an antidiscrimination law. A bill to ban discrimination was reintroduced in the Statehouse last month.

Cohen said it’s going to take a long time for his bill to go anywhere because of opposition in the Republican-controlled Legislature.

“I would like it to pass while I am still alive,” he said. “We should not have to wait 150 years in order to get this legislation through.”

Asked about the bill’s chances, House Health Committee Chairman Rep. Matthew Baker emailed: “I will have my staff review this legislation. We have many requests pending right now and given the budget impasse all legislation must be given careful review for cost and fiscal impact.”

Taking the issue seriously

But like Menkin, Rice said just the introduction of the bill in Pennsylvania is significant.

“It’s very encouraging to see this introduction even if it does not pass because it means that there are legislatures and also, hopefully, state agency officials that are looking at this issue and taking it seriously,” he said.

“People need to know the real struggle and that it’s a health issue, it’s something we can’t help,” said Lydon.

“We didn’t say one day, ‘Hey I’m going to be transgender.’ It’s something we struggle with our whole lives, and when we come to grips with it, it would make a world of difference if you could get the help you need.”

Lydon, who hasn’t had her gender reassignment surgery yet, said if the bill passes, she’ll be able to take that next step in what she says is living her life as her true self.

This story has been updated with a clarification on Dane Menkin’s position at the Mazzoni Center.