Thursday, February 2, 2017

Doors Slamming Shut on Trans Care

A Preamble

So much has happened so quickly since the Trump inauguration, so much of it damaging to marginalized people, that it's difficult for folks to keep up with what is going on. That is clearly the intent of Trump puppeteer Steve Bannon, with his desire to produce shock and awe, stir up society like an anthill, and remake it in his nasty image.

With so much going on, it's important that we make and listen to reports from the many fields of struggle, which is why I'm writing this post. But I do want to preface my report with a call for unity. We've been set up, by this initiation of battles on many fronts via tweets and executive orders. Our opponents in Washington hope to divide us. They hope that we'll splinter into "interest groups," each demanding primacy and seeing calls for help and attention from other embattled groups as acts of betrayal. Remember, the concept of "divide and conquer" is as old as the hills. 

None of us can fight every battle--but we can support one another's efforts. We have to focus our individual efforts on what we can do best to resist in our local communities, with the skillsets we each have. But we also need to have one another's backs.

So: I make this small field report, not to distract people from protesting the ban on refugees and travelers from seven Muslim-majority nations, or from pushing their representatives in Washington to oppose the nominations of unqualified ideologues to head federal agencies, or whatever other actions people are engaging in. I make it because we must keep one another informed of all the negative changes that are taking place. That's what we need in order to keep taking positive steps to resist.

A Trans Report from the Midwest

I am an employee of the state of Wisconsin, teaching at a state university. About a decade ago, the University of Wisconsin system added to its nondiscrimination clause protections based on gender identity or expression. Yet the insurance plans offered to people working and learning at University of Wisconsin schools all banned coverage of "procedures, services, and supplies related to surgery and sex hormones associated with gender reassignment." I've been fighting that ban ever since.

Until the summer of 2016, I got nowhere. It was a strange battle, because at every turn, I encountered expressions of surprise and sympathy from colleagues and benefits staff and administrators in the University of Wisconsin system. Colleagues presumed transition care must be covered by our insurance, since our antidiscrimination policy bans discrimination based on gender identity, and that must mean what it says. Human resources staff presumed the denial of coverage in our insurance plans must have originated with the insurance companies, and be their national exclusion policy. Upper university administrators saw that the discriminatory medical exclusion came from on high--proclaimed for all state employees by an entity called the Employee Trust Fund. But they regretfully stated that the university system couldn't tell the state what to do. They promised to bring the exclusion up as an issue to be addressed at the state level should an opportunity arise.

And so, year after year, I'd repeat this process of approaching people at various levels, reporting on the ongoing discrimination and asking for their help. I'd speak to them personally, and tell them how my family was impacted. With two gender transitioners and two disabled people in the little family of three I support, we couldn't afford any uninsured surgical care, and the lack of coverage for our trans endocrinological care was costing us between $1000 and $2000 a year out of pocket. Between our other medical expenses and the big hit my take-home pay received when the state withdrew much of its benefits support, my family's savings disappeared, and we have been sinking further and further into debt. And not being able to access surgical transition care is not "just" some issue of psychological discomfort for my wife and myself. It means relying on antiandrogens for year after year, with side effects that can be cumulative. It means relying on the extended wearing of chest binders for year after year, with their restrictions on breathing, exercise, and risk of rib injuryIt means if we fly, we regularly get stopped by airport security and detained due to our "anomalies."

And year after year, the people I contacted would express sympathy, but do nothing.

Then, in the summer of 2016, the U.S. Department of Health and Human Services posted the "Final Rule to Improve Health Equity under the Affordable Care Act." And one of the things this document said was that health insurance could not discriminate on the basis of gender identity or expression. Blanket exclusions of transition-related care were stated to be unacceptable discrimination.

And lo! Based on this federal guidance, the Employee Trust Fund, the entity declaring policy for state benefits programs, instructed all the health insurers providing insurance to state of Wisconsin employees to remove the ban on trans care.

In the fall of 2016, my family received a letter from our insurer stating that the ban on coverage for transition-related medical expenses would be lifted on December 1, 2017. We put the letter up on the fridge and celebrated.

And then Trump won the election.

I wrote a social media post a few days after the election saying to watch out, because I bet that trans medical care coverage would disappear for people in red states soon after his inauguration in January. A batch of people replied in comments saying that of course things were uncertain, but that I shouldn't be so alarmist. Once rights are granted, they are very hard to take back, they said. Insurers wouldn't want to look bad. If insurers did try to put back blanket bans, they'd face years of lawsuits. And anyway, Trump said he was ok with Caitlyn Jenner using the women's bathroom in Trump Tower.

Who was right? Well, it seems under the Trump administration there is no such thing as an alarmist progressive worry.

What followed Trump's election in Wisconsin was an immediate flurry of activity in the state health insurance regulatory world. Insurers, who a couple of months ago had sent out sunny letters about how they did not discriminate and offered wonderful health care coverage to all, regardless of gender identity, had private conversations with the ETF. Soon, Governor Scott Walker and our anti-LGBT activist state Attorney General, Brad Schimel, were voicing their opinions that the federal bullies who had forced the state to offer trans medical care had no more influence, and the state should reassert its noble, sovereign right to discriminate. The ETF asked the Group Insurance Board for a ruling on whether a "rescission of coverage" would amount to a "breach of duty" to the employees of the state of Wisconsin. The GIB basically ruled, "No, go for it, once Trump is inaugurated."

The very first executive order Trump signed after his inauguration was one stating that Trump intended that Obamacare be repealed, and that meanwhile, all possible actions should be taken "to minimize the unwarrented economic and regulatory burdens" of Obamacare, and give the states "more flexibility and control."

And so, in the name of freedom, states rights, and economic security, the ETF acted. On February 1st, they issued a statement saying that "the exclusion of services related to gender reassignment is reinstated as of today."

One month. That's how long trans medical care needs were acknowledged to be valid in the state of Wisconsin. I didn't even get to have a single refill of my testosterone covered, because of a backorder at my pharmacy.

Hold the Doors

This is a moment where doors are swinging shut all over America. Due to racial and religious bigotry, they are being slammed shut at the national level in the faces of refugees who are fleeing the horrors of war. We must fight for the refugees and immigrants whose lives and livelihoods are endangered by anti-immigrant sentiments and actions. 

But we should also notice and help resist the other doors slamming shut on the smaller levels of state and local action. And the Wisconsin re-adoption of trans discrimination in health care for state employees is one of those actions.

So, can you do anything to help? Well, if you are actually a University of Wisconsin employee, especially an administrator, now is the time to stand up against transphobic discrimination and speak out. Perhaps you didn't know there was a ban on trans medical care coverage before. Perhaps you knew it existed, but thought that was true across the U.S.. Perhaps you knew it was an ETF policy, but thought of it as a sort of ancient fossil, some passive, unconsidered barrier. But now you know. The ETF has pulled the rug out from under your co-workers who are transgender, or have spouses or children who are trans. Coverage is clearly possible, since for one brief month it was offered. It is being denied in a blatant case of discrimination.

I realize that nobody at the University made this decision to reinstate the discriminatory policy. I know that it comes from the state, and that if you are an employee in the benefits office, you don't want to hand out discriminatory plans. University staff supervising and hiring individuals who are trans or have trans dependents don't want them to face unfair financial burdens and negative health and safety outcomes. You are just part of a large system.

But when you hear yourself saying, "I am a cog in a huge machine. I am just following orders," I hope that this makes you shiver, then shake yourself, and do something to resist. This is a habit that we need to develop or redevelop in these times, when talk of creeping fascism is not hyperbole.

Most readers, of course, aren't Wisconsin state employees. But you can help as well. You can contact state legislators via phone or fax. You can make a donation to a trans advocacy organization or the Wisconsin ACLU or other group. Most of all, what you can do is be aware of what is happening here as an example of what is happening in many states and localities now. Find out what is happening with regard to trans health care discrimination in the localities and states you live in or have connections to. Help raise awareness of the issue. There is so much to fight, now: xenophobia, racism, religious discrimination, misogyny. . . I'm not asking people to put transmisogyny and transphobia at the top of some list of deserving causes. I'm asking people to focus on the work they are best at, but when it comes to the list of issues they are not concentrating their personal work on, to make that an inclusive list. We need to have one another's backs, and help one another out where we can, though none of us can effectively take everything on. This is what I am trying me best to do.

And now you know one way to have my back. 


  1. Thanks for blogging about this; since I've been taking an extended break from Facebook, I'm not as current on trans discrimination news as I should be. While I live in California, where my testosterone has (fortunately) been covered for the three years since I started my medical transition, I know not to take continued access and coverage for granted. We do indeed all need to be watching out for each other.

  2. Nazis are as Nazis do. Trump is more evil than Hitler but finally his approval rating is in the toilet.

    The oligarchs have a strategy of divide and conquer/distract and steal. They do it with race and religion and gender dysphoria is another thing they discovered to keep their slaves from uniting.

    Here is a song celebrating the trans woman.