Although some insurance company executives say they are now using analytics, others say they’re still on the fence about it or only beginning to explore its possibilities.
June 02--For Laura Harrington's family, medical costs sometimes have to take a back seat to other bills.
The University of Washington employee is married to a transgender man, and her 12-year-old son is also transgender. She met her husband in 2008 while attending a conference to learn how better to work with her son, who first expressed that he was male at age 5.
Under exclusions in health care policies, many of her husband's treatments are not covered and the costs are too much for her family to handle.
"There have been times when we've had to decide between paying the electric bill or paying for his hormone therapy. The electric bill has necessarily won out," Harrington told state officials earlier this spring. "As a result, he suffers bouts of depression, anger, frustration, stagnation, all of the logical outcomes for someone who isn't living the life they need to live."
Harrington and other advocates approached the state Public Employees Benefits Board in April about the challenges faced by transgender people.
As a result of the prodding, the benefits board decided last week to see how quickly the coverage can be included in private and state-run insurance plans serving government workers and retirees. The board is considering requiring worker health plans to cover transgender services by January 2016 -- and to remove specific exclusions for hormone treatments and other care before that date.
"This will require careful, thoughtful work on our part and due diligence to develop a comprehensive, evidence-based benefit ... that assures the highest quality of care to people with gender dysphoria,'' said Dan Lessler, chief medical officer for the state Health Care Authority, which administers health insurance programs for more than 350,000 state employees, family members and retirees through the benefits board.
A growing number of insurance plans cover transgender care. Oregon is one of five states plus the District of Columbia that already bar exclusion of these services in health plans, and both Oregon and California cover or are moving to cover all government workers in state-subsidized health plans, advocates say.
Seattle and King County already cover such treatments for public employees, and so do major employers, including Microsoft, Nike, Best Buy, Pepsico and Group Health Cooperative, according to the Health Care Authority.
Medicare announced Friday that it also was lifting an automatic ban on paying for sex reassignment surgeries. In Washington, the Medicaid program offers hormonal therapy and mental health services but not gender reassignment surgery -- a policy that is under review.
Lessler described gender dysphoria as persistent feelings of discomfort with one's gender and a strong desire to live as a member of the opposite sex. He said the gender identity condition was recognized in 2008 by the American Medical Association as a "serious medical condition" but one that is relatively rare and can be helped by treatments.
Harrington and other advocates who approached the state benefits board say they applaud the state's initial steps. But they also hope action takes place more quickly than 2016.
"I personally know a number of Washington state employees who need transgender health benefits. It seems that the 18-month time line ... (is) awfully long from our point of view. These people are suffering now and could use health care,'' Dr. Bobbi Dalley told PEBB on Wednesday.
Dalley, associate professor of radiology at the UW's School of Medicine, described herself as transgender. She told the board in April that she is fortunate in having a job that affords her the opportunity to pay the medical expenses that were not covered by state insurance.
Dalley noted that a transgender man getting a mammogram might be denied coverage.
"It's not just about surgery. It's also about coverage for hormone therapy, psychotherapy which would not be covered if you put gender identity disorder in the (billing) code, as well as routine health care," Dalley told the benefits board last week.
State officials say three major plans offered to employees -- state-run Uniform Medical Plan, Group Health and Kaiser Permanente -- all cover mental health care related to gender identity issues. The two private plans also cover hormonal therapy, but all three plans exclude genital surgery.
Danielle Askini of the Gender Justice League of Seattle said the lack of coverage creates a lot of strain on people and families like Harrington's that cannot afford to pay the costs out of pocket. The Associated Press has reported that costs can run higher than $25,000 for some gender reassignment surgeries, but Askini said the expense is relatively minor for larger health plans.
She cited a 2013 survey of employers by the Williams Institute, based at UCLA, and a 2012 report by the California Department of Insurance that examined the experience of Golden State government agencies with coverage. Both found slight costs and one showed less use of the new benefit than insurers expected in some jurisdictions.
Several benefits board members said they are ready to move ahead.
"I would hope that we could move this benefit (into being) as quickly as possible in a manner that maintains high quality," Greg Devereux, executive director of the Washington Federation of State Employees, said during PEBB's meeting last week.
Brad Shannon: 360-753-1688 [email protected]
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