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Colorado now requires gender-affirming care to be covered by private health insurance


Most insurance policies in the U.S. don't cover what's known as gender-affirming care, things like hormone treatment and surgeries that help transgender people live in bodies that reflect their gender identity. But Colorado now says health insurers it regulates must cover gender-affirming care by 2023. And that is a very big deal, according to Andrew Miller. His job at Denver Health, the big public hospital in Denver, is to educate doctors and others about how to treat LGBTQ patients equitably and effectively. Andrew joins us now. Thank you so much for being with us.

ANDREW MILLER: Thank you so much for having me.

MCCAMMON: Can you just begin by giving me an example of the kinds of treatments that are not being covered that now will be?

MILLER: Absolutely. Generally, what we're talking about for this plan is things like hormone replacement therapy and then different gender-affirming surgeries such as chest reconstruction or breast augmentation, facial feminization surgeries as well as things like hair removal or electrolysis.

MCCAMMON: I understand, Andrew, that you're a trans person yourself. Can you talk at all about the ways that these treatments affect mental health for trans people?

MILLER: So when I was able to start hormone therapy, when I was able to receive gender-affirming surgeries, it was the first time that I was able to look in the mirror and actually see myself, to walk in public and have others see me as the way that I've seen myself my whole life. We recognize transgender communities face high rates of suicidality. And often what we see shift is when folks can feel at home in their body, their ability to want to stay, my ability to want to stay and thrive as a transgender person was transformed by access to gender-affirming care.

MCCAMMON: And at the moment in Colorado and most of the country, what kind of coverage do most health insurance policies provide when it comes to gender-affirming care?

MILLER: Yeah. So that's a tough one. What we found is that often health insurance programs fail to specify what care is actually covered for transgender and non-binary patients. A survey found by Out2Enroll did find that 7% of health care plans did explicitly exclude some procedures for transgender patients. Oftentimes, it is up to the transgender and non-binary person and their medical provider really to try to navigate what can be covered and what isn't covered even if a medical professional deems it medically necessary to have this coverage treated.

MCCAMMON: And what reasons have insurance companies given in the past for not covering these kinds of procedures? Do they claim it will drive up costs, for example?

MILLER: Yeah, I think cost is a big one that comes in with that. And what we recognize is oftentimes transgender and non-binary folks have been left out of medical research. And so it is only now in the last five, 10 years that we are able to have research backing that this is deemed medically necessary care. And so for this now to be covered as an essential health benefit, I think, is a very large statement that our lives are worthy and necessary and our care is medically necessary.

MCCAMMON: People have been pushing for this - for health insurance companies to broaden their coverage to include gender-affirming care - for years now. Why is this only happening now?

MILLER: You know, I think a big part of that does have to do with the Biden administration. You know, we know on President Biden's first day in office that he signed an executive order preventing discrimination on the basis of gender identity or sexual orientation. And then in May, the Department of Health and Human Services announced it will interpret and enforce ACA's prohibition on sex discrimination to include gender identity and sexual orientation. This has allowed the state of Colorado to receive the necessary support from the federal government.

MCCAMMON: Andrew Miller is an LGBTQ health education trainer at Denver Health. Thanks so much for joining us.

MILLER: Thank you for having me.

MCCAMMON: And if you or someone you know may be considering suicide, you can call the National Suicide Prevention Lifeline at 1-800-273-TALK. That's 1-800-273-8255. Transcript provided by NPR, Copyright NPR.

Sarah McCammon
Sarah McCammon is a National Correspondent covering the Mid-Atlantic and Southeast for NPR. Her work focuses on political, social and cultural divides in America, including abortion and reproductive rights, and the intersections of politics and religion. She's also a frequent guest host for NPR news magazines, podcasts and special coverage.
Lauren Hodges is an associate producer for All Things Considered. She joined the show in 2018 after seven years in the NPR newsroom as a producer and editor. She doesn't mind that you used her pens, she just likes them a certain way and asks that you put them back the way you found them, thanks. Despite years working on interviews with notable politicians, public figures, and celebrities for NPR, Hodges completely lost her cool when she heard RuPaul's voice and was told to sit quietly in a corner during the rest of the interview. She promises to do better next time.
Christopher Intagliata is an editor at All Things Considered, where he writes news and edits interviews with politicians, musicians, restaurant owners, scientists and many of the other voices heard on the air.
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