Health co-op first to rule that transgender exclusions are wrong

By Katie Kerwin McCrimmon

A new health insurance company that is offering some of the lowest prices for health coverage on Colorados new exchange is now the first to decide that it will cover transgender care.

Colorado HealthOP, a new nonprofit member-owned health cooperative formed with federal grants under Obamacare, has vowed that it will not discriminate against any groups.

Currently most plans sold in Colorado and around the country specifically bar medical care for transgender people. That means most health carriers wont pay for hormone treatments or gender reassignment surgeries. Now that the U.S. Supreme Court has strengthened gay marriage and civil unions are legal in Colorado, the battle for equal access to health care has become a new civil rights frontier for LGBT activists.

Colorados Division of Insurance issued a bulletin in March barring discrimination based on gender identity or sexual orientation. Its unclear, however, whether carriers will comply with the order on a narrow case-by-case basis or join Colorado HealthOP in eliminating exclusions.

A transgender teen in Colorado also settled a civil rights case with Kaiser Permanente earlier this year. (Click here to read more about Alex Manigualt.) Under its agreement with Colorados Civil Rights Commission, Kaiser is supposed to be convening meetings about transgender care, but those meetings have not happened yet.

A Kaiser spokeswoman, Amy Whited, declined to comment on whether Kaiser would follow Colorado HealthOPs lead and bar exclusions related to transgender care. Whited said announcements about the meetings related to transgender care would be coming soon.

Solutions also contacted other large health insurance companies in Colorado. None were able to say whether they would join Colorado HealthOP in removing exclusions. Anthem Blue Cross and Blue Shield initially denied chest surgery to a transgender man, Kelly Costello, who shared his story with Solutions. Then Anthem reversed itself. But its unclear if Anthem will cover similar surgeries in all cases or will remove all transgender exclusions from its policies sold in Colorado.

Were in the process of deciding how we will proceed on this, but at this point, were unable to comment, said Anthem spokeswoman Joyzelle Davis.

Colorado HealthOP made its move after a written requestfrom the LGBT advocacy group, One Colorado,and other groups seeking non-discriminatory health plans. Colorado HealthOP recently notified the groups that none of its plans will have arbitrary condition-specific exclusions that target any population.

There is no place for discrimination in health care. Colorado HealthOP aspires to provide health insurance options for ALL Coloradans, based solely on medical necessity, Lindy Wallace, chair of Colorado HealthOP, wrote in a letter to One Colorado and the other groups.

We hope to provide all Coloradans with a high standard of comprehensive, affordable coverage, and to allow small group customers to treat their employees equally, Wallace wrote. We believe our organization represents a true change in health insurance.

Ashley Wheeland, an attorney and health policy director for One Colorado, said Colorado HealthOPs decision marks a huge step forward for transgender health in Colorado.

Most transgender Coloradans live in fear of what their health plans will cover, Wheeland said.

She said Colorado HealthOPs decision is a big deal because I havent seen a plan yet that doesnt include exclusions.

Our ultimate goal is not to have any exclusions that are based on gender identity.

While insurers should be complying with the Division of Insurance bulletins, Wheeland said most have been denying services to transgender patients arbitrarily in many cases even when the patients doctors deemed the services to be medically necessary.

The HealthOP is leading the way in opting not to follow the discriminatory use of these exclusions to limit care that many individuals need.

Dede de Percin is an advocate for health access along with LGBT issues. She also heads a nonprofit that contracts for health insurance for its employees.

De Percin, executive director of the Colorado Consumer Health Initiative, said she plans to switch to Colorado HealthOP.

Its great to have at least one carrier that is clear that theyre not going to discriminate against transgender people. None of the other carriers have taken that step, de Percin said.

She said she receives grants for LGBT advocacy groups that require her to offer non-discriminatory health insurance options. In the past, de Percin said she could not find a policy without transgender exclusions.

Now there is clearly a plan that does not discriminate, she said, adding that she has internal non-discriminatory language. Now that a plan is available, de Percin has determined that she must switch to it both because she believes its the right thing to do and because an employee could sue her if she didnt.

Now that theres a product available, you could have your funding yanked or you could be sued by an employee for violating internal policies, de Percin said.

Her group signed the One Colorado letter to the Colorado HealthOP and de Percins group is now checking the language on each of hundreds of new health plans that will be offered in Colorado to determine which ones include exclusions.

Im hoping that since the Colorado HealthOP has set the bar, others will meet it.