Article posted from on Generation Progress (genprogress.org), July 15, 2013:
Link: http://genprogress.org/voices/2013/07/15/20726/trans-friendly-student-health-insurance-policies-on-campuses-around-the-country/
You’ve seen this kind of disclaimer on most applications you’ve ever completed: So-and-so does not discriminate against any individual on account of that individual’s sex, race, color, religion, age, disability, or national or ethnic origin. But you might or might not see a clause about sexual orientation. And you’ll rarely see one with protections for gender identity and expression.
Only about
10 percent of colleges and universities have trans-inclusive nondiscrimination policies—a disheartening statistic.
Trans students face a number of well-documented challenges when applying to, and ultimately attending, institutions of higher education. These problems range from gender-inclusive bathrooms and housing, to allowing for the use of preferred name and gender in college records, and even admission itself. Because in most cases a patient
under the age of 18 must have parental consent and a diagnosis of
Gender Dysphoria(
formerly Gender Identity Disorder) from a medical professional, prospective college students have usually not transitioned before they apply to college and/or arrive on campus.
After years of advocacy against the labeling of trans individuals as mentally ill, the psychiatric diagnostic and statistical manual of mental disorders, or DSM,
reclassified “Gender Identity Disorder” as Gender Dysphoria. A Gender Dysphoria diagnosis is appropriate when an individual
demonstrates a “marked incongruence between one’s experienced/expressed gender and assigned gender.” Classifying transgender individuals as mentally ill and “disordered” was a stigmatizing (and inaccurate) anachronism. Though the reclassification is a triumph, the use of the term “disorder” once provided strong justification for insurance companies to cover gender reassignment, better-called
gender confirmation, surgeries. The argument that said surgeries are cosmetic, and not necessary, is unfortunately bolstered by the terminology shift away from disorder.
At the intersection of health policy and campus policy is the question of whether student health insurance plans cover transition-related hormone therapy, surgeries, and counseling. In
2007, a short six years ago, no college or university offered comprehensive health care benefits for trans students.
Today, over
three dozen college and university student health plans cover gender confirmation surgery. Roughly an additional
twenty-five cover surgery-related hormone therapy. And
twenty universities cover hormone therapy, surgeries, or both for their employees. This is encouraging, but nowhere close to the
4,495degree-granting institutions of higher education counted in the U.S. as of 2010.
The percentage of colleges and universities that cover trans health needs also pales in comparison to the corporate realm:
One-quarter of Fortune 500 companies cover gender confirmation surgeries, and an even larger percentage cover hormone replacement therapy.
For many but not all who identify as trans, hormone replacement therapy and gender confirmation surgeries are crucial to easing an often painful struggle with gender identity and presentation.
Noah Lupica, a rising sophomore a Brown University and a male-identified transgender student,
told the
Brown Daily Herald in February that for some, the surgeries are “life-saving.”
Recent Policy Changes
In the same month, Princeton University
extended gender confirmation surgery coverage to their employee health plan, and a parallel change to the student health plan may be in the works.
“While I applaud Princeton’s decision to extend coverage to transgender employees in this manner, it is a shame that the same inclusion has not been extended to students,” Princeton Pride Alliance co-president John Parvin told the Yale Daily News in May.
“Princeton is lagging behind many of its peer institutions despite having one of the largest university endowments and despite supposedly advocating for the welfare and inclusion of all its students,” Parvin said.
The University of Pennsylvania, Harvard, Stanford, Brown, and Cornell Universities—typically considered Princeton’s peers—
all cover gender confirmation surgeries for students.
Ironically, Princeton did
cite parallel changes at peer institutions in their rationale: “Many of our peers are moving in this direction, and it seems to make sense for our population,” Michele Minter, the vice provost for institutional equity and diversity and chair of the
transgender working group, said to
The Daily Princetonian, an independent student publication at Princeton University.
“It seems like a very straightforward thing that would have minimal cost implications and have many potential benefits,” Minter said.
Now that Yale and Harvard Universities cover gender confirmation surgeries, it seems it can only be a matter of time before Princeton joins their ranks.
“This change is not a theoretical gesture,” Gabe Murchison, a rising senior at Yale University and member of the student group The Resource Alliance for Gender Equity, or RAGE, told Campus Progress. “The number of transgender graduate and undergraduate students will increase as it becomes possible for more people to change their gender during or before college, but a number of current students will be using this coverage, and there are many who graduated in years past and never had the chance.”
Young Trans People, the ACA, and Broader Trans Healthcare Concerns
“When a trans or queer student still has trouble finding a therapist, gynecologist, or primary care provider who is comfortable working with them, we still have a lot left to do,” Murchison stressed.
The Affordable Care Act will fund
LGBT cultural competency trainings, which will hopefully address some of these issues. Furthermore, the ACA’s Patient Bill of Rights will
preclude insurance companies from treating trans identity as a pre-existing condition, and the ACA will
extend Title VII federal nondiscrimination protections to the healthcare field and to
gender identity.
Hopefully these developments will also encourage less “elite” schools to implement trans-friendly healthcare policies, thereby reaching a broader range of students.
The Opposition
Opponents are concerned that covering gender confirmation surgery could lead to higher premiums or increased tuition. In the case of public schools, opponents further
claim that tax dollars should not be used for medical procedures that not all taxpayers support.
In May, Duke
responded to allegations that extending student insurance coverage to include gender confirmation surgery was directly responsible for a hike in tuition costs: “The addition of gender reassignment surgery represents 0.3 percent of the premium increase for student health insurance, or about $5.25 for the average student who utilizes the plan. This change has no impact on tuition, and no tuition or fees are used to subsidize the student health insurance plan.”
“This argument arises from a combination of prejudice against transgender people and a misunderstanding how health plans work,” Murchison said when asked about similar statements.
The same release also
stated, “Through its practices and policies, Duke strives to be a welcoming and inclusive place for all individuals.”
“[RAGE’s] work is not limited to issues that affect transgender students in a narrow sense,” said Murchison. “Taking a broader view of student well-being helps us build stronger coalitions. For instance, improving all students’ access to mental health care is near the top of our agenda.”
On campuses without openly inclusive trans policies, a sympathetic healthcare provider
may diagnose a student with “endocrine deficiency” or a similar affliction, so that their insurance will pay for hormone therapy. But relying on a sympathetic doctor in order to receive necessary medical attention is, to say the least, not ideal.
Why We Need Trans-Friendly Campus Health
Some argue that the percentage of transgender students is so low that it’s not necessary for campuses to have more inclusionary health policies. But this a subjective assessment; furthermore, reported percentages are likely inaccurate given that many individuals who have transitioned identify as their preferred gender, rather than as “transgender.”
“It’s common for students and administrators to speak and act as though the presence of trans, genderqueer and gender variant students were hypothetical,” Murchison said, “when in fact there are significant numbers of us at Yale right now.”
And some positive effects are less quantifiable. As UIC student trustee Ken Thomas
said, “Diversity is not just a tool for recruiting. We embrace it and change lives with it.”
