Obama Health-care Plan Vs. Trans?

[Guest gentleman1]

Will Obama's health care cut us out of being treated and being able to receive our hormones and any potential SRS? Today, a friend of mine told me he was worried that if Obama's health care plan took effect, that is, if government took over health care then we would no longer be able to get hormones or any treatment other than counseling? for

[Guest Janis]

From reading the bill in it's current form the best I can say is, I do not know. What it comes down to will be is if Trans care is considered necessary. My thoughts are if it is covered there will be yet another serious of gatekeepers that we will have to go through to get the treatment we need.

Janis

[Guest Evan_J]

The thing that makes all of this hard right now is the budget/ state of economics. ANYthing that requires dollars and isn't benefitting the cisgendered non-lgb will be open for hysteria. It can be done, but it won't be "specific" and "blatant" (no big statements about "and I'm doing x for the transsexuals"). Instead it would need to be inherent in the fairness of medical provision.

[Guest NatalieRene]

I don't think that will happen. Obama has been great so far what with the tax credit for buying a house, and $4500 for trading in the clunker to get a new car. I just don't think Obama is that type of person. I agree with Evan the bill will probably have a open door but not specifically welcome or shoo us.

[Carolyn Marie]

I think it's way too soon to even begin discussion of specific conditions that might be covered.

Congress hasn't even decided whether they will approve it in any form, much less details

like that.

The only thing that I've heard that might be helpful is that pre-existing conditions

would be covered. The Administration isn't going to risk a public backlash by mentioning

something like HRT or SRS. It isn't fair, but it's politics.

Carolyn Marie

[Guest Evan_J]

Id pay for it in cash

....and if thats the case you have nothing to fear. Anything you pay cash for you can get. As someone famous once said (John Liguizamo) "For enough money, even a camel can dance up a pyramid".

[Guest Donna Jean]

The only thing that I've heard that might be helpful is that pre-existing conditions

would be covered. The Administration isn't going to risk a public backlash by mentioning

something like HRT or SRS. It isn't fair, but it's politics.

Carolyn Marie

Yes, Carolyn.....

And I think that being born Transgendered is about as "Per-existing" as you can get. They can't dwell on specific things in a bill of this size and we can only hope and pray that if it passes we are caught underneath that wide brush stroke!

Yeah, it's politics and we're a minorities minority! Keep your fingers crossed boys and girls!

An insurance paid SRS would be awful nice!

Love..

Donna Jean

[Guest Joanna Phipps]

for those who wish to read the bill in its entirety here is the link to the full text of HR 3200

[Guest Joanna Phipps]

here is the outline of the proposed basic package

21 SEC. 122. ESSENTIAL BENEFITS PACKAGE DEFINED.

22 (a) IN GENERAL.—In this division, the term ‘‘essen23

tial benefits package’’ means health benefits coverage,

24 consistent with standards adopted under section 124 to

ensure the provision of quality health care and financial

2 security, that—

3 (1) provides payment for the items and services

4 described in subsection ( in accordance with generally

accepted standards of medical or other appropriate

clinical or professional practice;

7 (2) limits cost-sharing for such covered health

8 care items and services in accordance with such

benefit standards, consistent with subsection ©;

10 (3) does not impose any annual or lifetime limit

11 on the coverage of covered health care items and

12 services;

13 (4) complies with section 115(a) (relating to

14 network adequacy); and

15 (5) is equivalent, as certified by Office of the

16 Actuary of the Centers for Medicare & Medicaid

17 Services, to the average prevailing employer-spon18

sored coverage.

19 ( MINIMUM SERVICES TO BE COVERED.—The

20 items and services described in this subsection are the fol21

lowing:

22 (1) Hospitalization.

23 (2) Outpatient hospital and outpatient clinic

24 services, including emergency department services.

(3) Professional services of physicians and other

2 health professionals.

3 (4) Such services, equipment, and supplies inci4

dent to the services of a physician’s or a health pro5

fessional’s delivery of care in institutional settings,

6 physician offices, patients’ homes or place of resi7

dence, or other settings, as appropriate.

8 (5) Prescription drugs.

9 (6) Rehabilitative and habilitative services.

10 (7) Mental health and substance use disorder

11 services.

12 (8) Preventive services, including those services

13 recommended with a grade of A or B by the Task

14 Force on Clinical Preventive Services and those vac15

cines recommended for use by the Director of the

16 Centers for Disease Control and Prevention.

17 (9) Maternity care.

18 (10) Well baby and well child care and oral

19 health, vision, and hearing services, equipment, and

20 supplies at least for children under 21 years of age.

[Guest Jean Davis]

I think it's way too soon to even begin discussion of specific conditions that might be covered.

Congress hasn't even decided whether they will approve it in any form, much less details

like that.

The only thing that I've heard that might be helpful is that pre-existing conditions

would be covered. The Administration isn't going to risk a public backlash by mentioning

something like HRT or SRS. It isn't fair, but it's politics.

Carolyn Marie

Hi Carolyn

I'm sorry but I have to disagree. This is a very good time to familiarize ourselves with this subject, this way if they try to pass something we at least have a basic knowledge and have a chance to voice our opinion on it. We may not have a very big voice in this matter but every voice helps.

And you never know, I always hear that the gov. monitors internet sites to gain knowledge on a certain subject. Perhaps they are monitoring this topic right now.

LUV

Jean

[Guest mia 1]

From what I know SRS will not be included...hormones will.

[Guest NatalieRene]

From what I know SRS will not be included...hormones will.

The hormones being included is good and all but that is such half assed srs is very import to some of us. Heck some people are doing it themselves and getting themselves killed. It needs to be included too.

[Guest mia 1]

The hormones being included is good and all but that is such half assed srs is very import to some of us. Heck some people are doing it themselves and getting themselves killed. It needs to be included too.

It does but it won't be..sorry I wish it were the case...but the pols can only go so far.....with the public option..private insurance is still available......

[Guest Joanna Phipps]

It does but it won't be..sorry I wish it were the case...but the pols can only go so far.....with the public option..private insurance is still available......

the proposed basic plan, see my previous post, includes prescription medications. As yet I dont see any limitation on what kinds of meds they can be so I would say that, as proposed, yes hormones and AA's will be covered

[Guest Charlene_Leona]

I think allot of you are overreacting in the last two years medicare has covered SRS for those deemed a medical necessity for the patients health and well being. I think with the AMA'a resolution 122 and WPATH's statements of medical necessity any attempt to deny us care will be found illegal. My HRT has been covered and I'm waiting to find out if my SRS will be approved right now, I have been told it will be but I still have a wait and see attitude.

[Guest StrandedOutThere]

Will Obama's health care cut us out of being treated and being able to receive our hormones and any potential SRS? Today, a friend of mine told me he was worried that if Obama's health care plan took effect, that is, if government took over health care then we would no longer be able to get hormones or any treatment other than counseling? for

I'd worry less about Obama's plan and more about what is considered the "norm" in the medical community. That bill will affect how health insurance functions, to some extent, but that doesn't mean that it will definitely dictate what is covered. The health care systems in other countries pay for TS treatment. The only reason ours wouldn't is because we are socially backwards, not because it has anything to do with how our health care system is structured.

If anything, something as small as not allowing companies to exclude people for pre-existing conditions works in our favor. One of my friends was recently denied health insurance because of being trans. He'd been on his parents insurance until graduation but wasn't able to purchase an individual policy because of being trans. I'm not sure if it was the GID diagnosis (which I think he needed for his surgery letter) or the fact that he'd been on hormones (isn't now) that they used as an excuse, but it happened.

I may be wrong, but I think we should worry first about getting everyone health insurance. Health insurance policy follows social opinion. If being transsexual is a diagnosable disorder that requires treatment, then it'll eventually be covered. I think part of the battle we are fighting is showing that 1) it is a true, medical condition, and 2) that hormones and surgery are effective treatments. Once that's done, we're golden.

Here's an issue I see, and I don't know how to cope with it. Homosexuality isn't a diagnosable illness now. It isn't listed in the DSM and is considered by most medical professionals to be part of the range of normal human behavior. However, there isn't any special kind of medical intervention that homosexual people ask for. In our case, it's different. In many cases, and I'm aware this doesn't apply to everyone, we are asking for medical intervention. If GID is removed from the DSM and being transsexual becomes accepted in the same way homosexuality is, how can we also have insurance pay for our treatment? You have to have a diagnosed condition before you can file an insurance claim to pay for the treatment.

[Guest Joanna Phipps]

Cancer, and other things are part of the human condition, I realize that insurance companies have been know to be callous enough to cut off people with life threatening illnesses as a community we need to see that even if GRS is not explicitly covered that there is a clause we can use to make sure we get it fully or partially paid.

IMHO

[Guest Eth]

Here's an issue I see, and I don't know how to cope with it. Homosexuality isn't a diagnosable illness now. It isn't listed in the DSM and is considered by most medical professionals to be part of the range of normal human behavior. However, there isn't any special kind of medical intervention that homosexual people ask for. In our case, it's different. In many cases, and I'm aware this doesn't apply to everyone, we are asking for medical intervention. If GID is removed from the DSM and being transsexual becomes accepted in the same way homosexuality is, how can we also have insurance pay for our treatment? You have to have a diagnosed condition before you can file an insurance claim to pay for the treatment.

Here's how I see it: being transsexual IS a medical condition.

Something that was said earlier- I think by Lizzy (or was it Sally? They both have a lot of great thoughts and posts)- about us being one mind in the wrong body, like "coke in a pepsi can", really opened up my eyes in a lot of ways and helped me to think about this in a way I really hadn't beforehand.

I think that we are a form of 'intersex'. If a person with XYY or XXY or some other chromosome "disorder" qualifies as a type of 'intersex', then why shouldn't a male or female brain in a female or male body respectively be considered similar? Medical research (like the longer Androgen Receptor Gene found in MtF transsexuals) is slowly proving that things did happen in the womb, and our brains were treated differently than the rest of our bodies, and we ended up having 'some of both sexes'. Is that not what 'intersex' is? A combination of both the male and female sexes? AIS, mixed chromosomes, mixed or indeterminable genitals/reproductive organs and several other 'conditions' are classed as forms of 'intersex'. I think that our case is really quite comparable to that, when you think about it.

People with other forms of intersex often need medical treatment/intervention to shape their bodies into what they believe properly suits them. Not to do so can be potentially dangerous and life-threatening for a number of reasons, ranging from severe depression that can and often does lead to suicide to drastic hormone imbalances and so on. If a woman was born with testes in place of ovaries, and the hormones they produced were causing her great distress, would anybody question her having them removed? Very few people would, if any. Would you consider that a medical condition? I would say so.

In conclusion, I'd just like to say that, YES, transsexualism IS a medical condition. That doesn't make it "bad" or "unnatural". I'm a girl trapped in a male body, which is very comparable to the example I gave above with a woman with testes who produces a significant amount of androgens instead of estrogen. However, just because it's a medical condition does not mean it's a mental disorder, and that's where I see a problem. Ideally, transsexualism should be seen as a medican condition, but not a mental disorder. This is far more comparable to intersex (a physical condition), than to say, Obsessive Compulsive Disorder, ADHD, Autism or Bipolar.

Transsexualism is a medical condition that needs to be covered and treated through the appropriate means (generally hormone therapy and possibly surgery), but it's society's fault for being narrow-minded and giving it the stigma of being some kind of "disorder" or "fetish" that we just need to "get over". I believe that Gender Therapists are very important and need to be there, but more for just generally helping people who want/need (not be forced into it) the help (in discovering themselves, or coping with their identity, etc.), and it should also be there to just make sure you're in the right state of mind (and this should be fairly quick) before giving the "go ahead". Similar to how many people have to see a therapist before and after heavy weight reduction surgery.

So in short:

Transsexualism = Medical Condition

Medical Condition =/= Bad

The end.

Sorry I got a bit off topic. I just wanted to reply to that with my thoughts on the matter. As for the topic at hand, based on what I said above, yes I do think hormones and SRS and such need to be covered, and I really hope that they will be. We'll just have to wait and see, though. If anyone knows who I'm supposed to contact or how, to let them know that I think this should be included, please give me the information so that I can do so. Thanks!

[Guest Amanda joan]

Will Obama's health care cut us out of being treated and being able to receive our hormones and any potential SRS? Today, a friend of mine told me he was worried that if Obama's health care plan took effect, that is, if government took over health care then we would no longer be able to get hormones or any treatment other than counseling? for

This is a real concern of mine also. My concern is that my employer would drop everyone and force us to use the Government plan. I work for the largest food company in the world Nestle. We have very good medical insurance but, I do not yet know if they would cover SRS or HRT. I spoke to my HR Manager today and told him that I was getting divorced and that I am Transgended and he was very supportive. That was a big step for me and I am a little scared about where this will take me. You see I am one of the many faces of the company. I am in sales and I fear they might not want me in front of the customers as I am transitioning. Enough about me, How the heck is this country going to pay for this. They're just guessing now that it will cost Trillions of dollar that we don't have to give this to everyone. I think we should try to fix what we already have before we try to do this. MEDICARE is almost bankrupt! Are the same people going to be running this new Government Health Care Program? We need to keep our eyes open for more than just our own interest about surgery. If this can't be done in a way that make financial sense then we should oppose it!

Peace & Love Amanda

[Guest Joanna Phipps]

This is a real concern of mine also. My concern is that my employer would drop everyone and force us to use the Government plan. I work for the largest food company in the world Nestle. We have very good medical insurance but, I do not yet know if they would cover SRS or HRT. I spoke to my HR Manager today and told him that I was getting divorced and that I am Transgended and he was very supportive. That was a big step for me and I am a little scared about where this will take me. You see I am one of the many faces of the company. I am in sales and I fear they might not want me in front of the customers as I am transitioning. Enough about me, How the heck is this country going to pay for this. They're just guessing now that it will cost Trillions of dollar that we don't have to give this to everyone. I think we should try to fix what we already have before we try to do this. MEDICARE is almost bankrupt! Are the same people going to be running this new Government Health Care Program? We need to keep our eyes open for more than just our own interest about surgery. If this can't be done in a way that make financial sense then we should oppose it!

Peace & Love Amanda

If the tax code is applied fairly, which it never is, then there will be the money to pay for it. Honestly, there must be something they can tax the ultra rich for.. like being ultra rich.... 55%+ of their income will go along way.

[Guest Ryles_D]

It's my understanding that most private insurance doesn't cover transitioning- I didn't figure this would be any different.

[Guest Janis]

It's my understanding that most private insurance doesn't cover transitioning- I didn't figure this would be any different.

Some cases this is true. For my case my insurance will cover therapy (up to 60 sessions), doctor visits, and my prescriptions without any questions. Surgeries however are considered elective cosmetic surgeries and will not be covered. Though any surgery follow ups or health issues caused by the surgery will be covered.

I have spoken with people on the extremes tough. One of my friends insurance through her university paid for everything with no questions. While another denied every claim.

Janis

[Guest Edu]

While I'm not affected by this plan, I'd like to share my point of view. Here in Spain we have had a public health system for long time; and there are many things on Obama's plan that are very likely to be similar to the Spanish system:

1. Public health is a complement/alternative to private health, not a replacement. Thus, whatever you can get from it, good for you; but for stuff that is not included you aren't losing anything you already had: if transgender needs (or some of them) were not included in the plan, then you'd get no gain from it, but no loss either.
   
2. Most health systems I know about include, at the very least, medical visits. That would include therapists (in Spain, for example, they are always available through the public health system, regardless of reason).
   
3. Meds are generally included, to some degree, into any health system. For long-term treatments (like hormones) you should get, at least, discounted prices.
   
4. There is a slow drift of the world's point of view about SRS: as time goes by, less people and entities undestand it as a cosmetic, voluntary intervention and more realize that, for some people, it's a life-or-death need. If major insurance companies in the USA don't cover for SRS, I wouldn't expect Obama's plan to cover it from the beginning; but as society evolves it would eventually get included.
   

Now, just to put an specific example, I'll tell you the basics of transgenderism on the Spanish public health system (which I think is quite one of the "inspiration" sources for Obama's plan):

Therapists are fully included: I'm having therapy at absolutely no cost right now. The issue, because of state economics, is that it normally takes one or one and half month between sessions. I'd place my bets on Obama's plan including therapy in a similar way.

All prescription meds in Spain have a 60% discount which is covered by the state. This includes all meds that are prescribed, regardless of whether they are available without prescription (for example, if a doctor prescribes Aspirine for a patient, the patient would get the discount; but someone who just has a headache and goes to the pharmacy to get some Aspirine (without going to the doctor) would have to pay full price). On some cases (pensionists, life-long treatments, and some others), the state funds 100% of the meds' price. Hormonal treatments are treated as any other med; and they are only sold with prescription, so any TS here in Spain gets at least a 60% discount on them. On Obama's plan, my guess is that hormones will be treated just like any other prescription meds: whatever applies to the general case, will apply to them.

Surgeries: as of now, if my sources are correct, SRS is not covered by the Spain's public health system. Hope is there, however: our government is actively working on it. IIRC, there were a few "pilot plans" going on in one or two hospitals that do state-founded SRS, to figure out how things will need to be (knowing about costs, side effects, post-surgery needs, etc), which means we're getting closer. Since it seems most medical insurances in the USA do not include SRS, I wouldn't expect Obama's plan to include it initially, but there is hope for it to be studied and addressed later.

Oh, and as a side comment, I'll add that few (3 or 4) years ago there was a significant change in Spanish laws: having gone through SRS is no longer a requirement to get a gender and name change on official records (most prominently ID card, which is the basis for any other records): it is now enough with a therapist's letter requesting the change.

So, that's an example of how transgenderism is addressed from a public health system; and my guesses on how much about it would extrapolate to most public health systems (including Obama's). Hope this is useful and/or informative.

Regards,

Ethain

[Guest Joanna Phipps]

Excellent post Ethain, however it misses one key point about Canada's public health system and a detail that might be in any U.S. Plan. In Canada the money from the Federal level is given to the provinces who administer individual provincial plans, there are certain must haves that the Feds make sure are in all of the plans but, in general, it is a provincial thing. I can see something similar happening here because unless each of the states is on board then they will tie up the legislation forever as a states rights issue. Id cards, birth certificates, drivers licenses and the like are already state issues; my feeling is that any health care thing is going to end up being a patchwork just like the Canadian system.  

[Guest Edu]

How could I miss that point?

The España de las Autonomías (lit.: Spain of the Autonomies) is often considered the most decentralized country in Europe (maybe closely tied with others) and amongst the most decentralized ones in the world.

Actually, Autonomous Communities have more competences on our health system than the central government: the central government defines the basic health issues that public health must address, and grants each Community a budget for it. After that, it's entirely up to each community to decide how to handle address the covered issues and how to manage the budget, as well as many other stuff.

Anyway, I guess, based on raw proximity, that Obama will be more likely to take as example a neighbour like Canada than an overseas country. Even so, I'd expect for therapy at least to be covered by the vast majority of USA states if Obama's plan is finally pulled out: regardless of the opinion each one might have about transgender conditions, the stress, anxiety, depressions, and similar issues arisen from it are well known mental issues that are likely to be included in all cases. Adding blatant discrimination (like saying "anxiety is covered unless derived from transgenderism") would create too much controversy compared to the relative low savings in budget (when comparing to saying simply "anxiety is covered").

Even if this is far less than ideal; it'd still be an improvement: if people can get their therapy for free, they may save that money for further treatment when the time for it comes. Also, this would enable those people who just can't afford a therapist to at least have some of their mental health needs properly taken care of.

Still, this is pure speculation anyway (based on some reasoning, but still probably biased). Just sharing my viewpoint.

Regards,

Ethain