City Councilors Call for Healthcare Coverage for Gender Reassignment Surgery

City Hall Photo uploaded by cliff1066™ on flickr

City Councilors Michelle Wu and Ayanna Pressley filed an ordinance this week that, if passed, would allow city employees that identify as transgender to be fully covered under the city’s healthcare plan, including the costs for therapy and gender reassignment surgery.

“It’s the best economic policy and the right thing to do,” said Wu.

The goal of the proposed ordinance, which will be discussed during a City Council hearing on April 16, is to provide comprehensive healthcare coverage for all municipal employees, regardless of gender identity or expression.

With the backing of Mayor Marty Walsh, a move like this would set a new standard in the both the city and state, and, according to Wu, it could push other cities and towns toward enacting similar provisions to provide the same all-inclusive type of plan.

Dubbed the “gender identity non-discrimination ordinance,” the legislation advanced after years worth of work between Pressley and members of the Elevate Boston Coalition and other organizations. Activists have called the measure a “pivotal step” in the right direction for people in the transgender community.

Currently, health insurance companies are not required to cover municipal workers when it comes to transition-related care. This type of care— mental health services, hormone therapy, gender-affirmation surgery—also isn’t covered by the city-sponsored insurance plans. Under Wu and Pressley’s plan, the city would be barred from contracting with health providers that “discriminate” against this type of coverage.

Taking a cue from cities like Seattle, San Francisco, and Washington D.C., where coverage for transition-related care is provided, Wu and Pressley hope this proposal puts Boston among the most inclusive locations in the country.

Below, Wu explains the purpose of the legislation in further detail:

How long have the two of you been working on this?

Councilor Pressley was very active with the Elevate Boston Coalition through the summer, and so I know she has been part of the group that included MassEquality, and many other advocacy group organizations that have been pushing this as an issue. I have spoken with some members of the group, shortly after the election, around legislative priorities and have been emphasizing that I wanted to make sure that healthcare equity for city employees around physician-related care was something we could work on as soon as possible. So we had some great help from those groups, and we are lucky to have Mayor [Marty] Walsh on board as well in making this happen.

With Walsh on board as well, that’s a pretty good indicator that it will pass.

Yes, I hope so. There are a few different processes happening in parallel right now. I’m hoping we will see a very speedy legislative process around this ordinance. What the language says is we will be adding a section to Chapter Five of the Boston Municipal Code, which governs administration, and has provisions around employees, particularly paternity and maternity leave, and other residential requirements and employment-related issues. Adding a section would mean that the city can’t contract with health insurance companies that are discriminatory around gender identity or expression. Our health insurance as a city is negotiated between the mayor and Public Employees Committee. All unions will get together around healthcare, so that we can look at the costs, and bargain in a way that’s efficient but still adequately cover everybody that works for the city of Boston. The committee will need to vote on it at their next meeting, and negotiate a health care package that includes transition-related coverage.

When you say transition-related coverage, what does that mean for people who identify as transgender?

We are specifically talking about gender dysphoria, and many of the medically documented [issues] that have both extremely significant impact for transgender people and their families, as well as the care and the services. This would seek to cover mental health services, hormone therapy, gender affirmation surgery, and other medical-care related things related to gender dysphoria.

So this would provide coverage for people that want affirmation surgery?

Yes—some people call it GRS, gender reassignment surgery—whether for city employees or their family members.

People have commented on what the impact will be to the city’s health insurance. Do you see it as an issue?

Some cities have had fully-inclusive health care coverage for a number of years now, and have seen minimal financial burden form it. I keep getting the question, ‘how many transgender city employees do we have in Boston,’ but for me it’s not a question of the numbers—it’s an issue of equity and human rights, and sound economic policy to make sure Boston is setting the tone for being the most inclusive and best place to work, so we attract the most talented and committed people.

Will the surgery be completely covered?

The way that many of the city health plans work now, there is a component where you pay a certain deductible, and the rest is covered, but that is what needs to be negotiated between the public employees committee and the health insurance providers, in terms of how much a potential premium would go up to be shared by the unions and the city of Boston and the insurance company.

Are you concerned this will call into question debates about why this is allowed compared to other surgeries?

There’s been a huge amount of medical documentation from providers and medical associations around the medical necessity for gender dysphoria treatment, and if you look at the data and look at the studies, it is a medical issue, and we need to start thinking about equity for every family that’s working for the city of Boston.

Does this set a benchmark for the Bay State?

Yep. We are hoping. There are some states that are active on this as well, but in most places it has started at a city level, and in Boston we are hoping we are doing everything we can to set the tone, and employers throughout the Commonwealth will do the same.