Massachusetts on Friday became the third state in the nation to cover transgender medical services, including gender reassignment surgery, as a standard benefit in its government health plan for lower-income and disabled people.
The administration of Governor Deval Patrick also moved to prohibit private insurers from denying coverage for gender reassignment surgery or other treatments medically necessary for patients who are transgender, saying that would constitute sex discrimination.
The Patrick administration will strongly recommend similar reforms to the Group Insurance Commission, which provides coverage for thousands of state and municipal employees and their dependents.
“I am proud to be part of a Commonwealth that puts equality as its top priority,” Patrick said in a statement. “Massachusetts is a leader in health care, where we make the tough decisions for the good of our communities, and where discrimination, of any kind, will not be tolerated.”
Only two other states — California and Vermont — have Medicaid programs guaranteeing treatment for gender dysphoria, a condition in which there is a pronounced difference between patients’ feelings about their gender and their physical sex characteristics, according to Gay & Lesbian Advocates and Defenders, a Boston-based organization providing legal services for the lesbian, gay, bisexual, and transgender community.
“This announcement is really historic because I don’t think there is a state that has announced in one fell swoop, this comprehensively, that medical care for transgender people is essential,” said Bennett H. Klein, a senior attorney for the group. “It’s not very often that we see moments we can point to as groundbreaking . . . and this is one of them.”
Andrew Beckwith, president of the Massachusetts Family Institute, disagreed with the shift, saying that surgery is not an appropriate treatment for gender dysphoria. Beckwith’s group opposes abortion and same-sex marriage.
“In what other case does the medical profession go along with a mental disorder to the extent of radical surgery on the body instead of treating the underlying mental health issue?” he asked. “Instead of giving them the treatment they’re demanding, we should give them the treatment they need. That’s the ethical responsibility for health providers.”
In a policy statement earlier this month, though, the American Medical Association wrote, “The only effective treatment of [gender dysphoria] is medical care to support the person’s ability to live fully consistent with one’s gender identity. Efforts to change a person’s gender identity are futile and, like sexual orientation change efforts, can have a disastrously negative impact on the patient.”
The state policy shift follows a May decision by the federal Department of Health and Human Services to end a 1981 ban on coverage for gender reassignment surgery under Medicare, insurance that covers those 65 and older, though the ruling did not apply to state Medicaid programs such as MassHealth.
Last week, the Boston City Council unanimously supported an ordinance guaranteeing access to gender reassignment surgery for municipal employees and their dependents.
Joseph G. Murphy, the state’s insurance commissioner, said a number of businesses provide similar coverage for employees. Three of the state’s largest private insurers — Harvard Pilgrim Health Care, Blue Cross Blue Shield of Massachusetts, and Tufts Health Plan— offer plans covering gender reassignment surgery to companies that request them.
Lora Pellegrini, president of the Massachusetts Association of Health Plans, said in a statement that the cost of providing transgender health services is unknown. She said that with any new mandate, there must be a consideration of whether it conflicts with the Commonwealth’s goal of containing health care costs.
“While this, like other mandated benefits, may be well-intentioned, ultimately, the costs will be borne by individuals and employers, particularly small businesses, exacerbating the challenges they already face with the rising cost of health care,” Pellegrini said.
Andrew Cray, a policy analyst at the Center for American Progress, a left-leaning think tank in Washington, D.C., said research shows coverage for transgender treatments entails a minimal increase in health care costs for insurers and policy holders.
“We’re talking below 0.2 percent,” he said. “Part of that is because the transgender population is small, but also because many of these resources are only used one time, with the exception of hormone therapy, but that’s a low-cost treatment.”
California, Colorado, Connecticut, Oregon, Vermont, and Washington, D.C., prohibit private insurers from excluding coverage for gender dysphoria treatments, Cray said.
And in extending coverage for gender reassignment treatments to employees, Massachusetts follows the State of California as well as municipal governments in San Francisco; Seattle; Portland, Ore.; and the District of Columbia, Cray said, as well as more than 200 private-sector employers.
In San Francisco, where coverage for city workers has been mandated since 2001, claims for gender reassignment surgery averaged 7.4 per year in the first five years, he said.
No reliable estimates exist for the number of people who are transgender living in Massachusetts or how many might seek surgery under the new policies, Murphy and transgender rights advocates said.
The Williams Institute, a think tank at the University of California, Los Angeles School of Law that researches sexual orientation and gender identity law and public policy, estimated in 2011 that 0.3 percent of adults in the United States were transgender, which would amount to about 20,000 people in Massachusetts.