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Gender therapy access pushed

Walsh, councilors seek insurance shift

City workers in Boston seeking gender reassignment surgery would for the first time have their care covered by health insurance under a City Council proposal supported by Mayor Martin J. Walsh.

City Councilors at Large Michelle Wu and Ayanna Pressley said they plan to file a proposal Monday that would guarantee transgender city employees access to gender reassignment surgery, hormone therapy, and mental health services.

Wu said Friday the ordinance is meant to affirm human rights for transgender people and also make city jobs attractive and welcoming to the widest range of talent.

“The city of Boston and our city government should be doing everything we can to make sure we are doing that with the most inclusive policies,” Wu said. “It’s the best business decision, as well as the right thing to do.”


Walsh recently recommended a coverage mandate for transgender treatment to the city’s Public Employee Committee, which advises officials on health care and other human resources issues, according to his spokeswoman, Kate Norton. With Boston’s strong-mayor form of government, Walsh’s backing is the surest sign the measure will become reality.

“This is something that Mayor Walsh is wholeheartedly in support of,” Norton said.

Walsh asked that the mandate take effect on July 1, when the city begins its new fiscal year, Norton said. The committee discussed the proposal at a meeting last week but did not vote.

The ordinance set to be filed by Wu and Pressley would ban the city from contracting with any health insurer that denies benefits or “discriminates in the amount of premium, policy fees, or rates charged” on the basis of gender identity, according to a draft provided to the Globe on Friday.

It grew out of the Elevate Boston Coalition, cofounded by Pressley during last year’s mayoral race to highlight issues affecting women and girls, communities of color, and the lesbian, gay, bisexual, and transgender community.


Pressley said Friday that, as candidates, both Walsh and his opponent, former city councilor John R. Connolly, signed a pledge saying they would pursue building safe communities and economic and health equity — including access to coverage for transgender health issues.

“This is just about equity and fairness and a continuation of the progress that has already been made as a city, to make sure that we do everything we can do to improve transgender equity,” Pressley said.

Transgender city workers are guaranteed medical treatment by statutes in San Francisco; Seattle; Portland, Ore.; Washington, D.C.; and other US cities, according to Andrew Cray, a policy analyst at the Center for American Progress, an independent nonpartisan educational institute in Washington, D.C.

In an e-mail, Cray also said regulators in California, Colorado, Connecticut, Oregon, and Vermont have mandated that private insurance plans in those states cover transgender health services for residents.

Ensuring that city workers have access to transgender health services appears to have little effect on the cost of insurance premiums.

Figures provided in the draft ordinance show that Portland, Ore., experienced only a .08 percent increase in insurance costs after removing exclusions on care for gender-transition services.

San Francisco, which has mandated coverage since 2001, saw an average of 7.4 claims for gender reassignment surgery per year in the first five years.

“Overall, cities have not seen this as a burdensome shift to make,” Wu said.


Payroll records released in February showed that Boston had 22,469 full- and part-time city employees last year.

Wu and Pressley were unable to say how many city employees are transgender.

The Williams Institute, a think tank at the UCLA 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 are transgender.

An attorney for the Human Rights Campaign, a national civil rights organization, said the group this year will begin to include transgender treatment coverage for city employees as a criterion in its Municipal Equality Index, which rates cities on their inclusion of lesbian, gay, bisexual, and transgender residents and visitors.

Last year, Boston scored a perfect 100 on the scale, but it could not do so again in 2014 without mandating that coverage, said Cathryn Oakley, the organization’s legislative council for state and municipal advocacy.

Not everyone sees the proposed ordinance as positive, or agrees that hormones and surgery are proper treatment for those who identify as transgender. The leader of MassResistance, a nonprofit conservative advocacy group in Waltham, called the proposed ordinance “a sad example of science fiction over science.”

“The medical community has always considered ‘gender identity’ confusion as a mental health issue,” said Brian Camenker, executive director of MassResistance. “Attempting to ‘treat’ someone with sex hormones or body mutilating surgery may please the political activists but only makes things much worse for the individual.”

Carly Burton, deputy director of the statewide lesbian, gay, bisexual, and transgender rights group MassEquality, said the issue is a simple matter of treating all employees fairly. She said more than 200 private employers nationwide also provide coverage.


Burton, who worked with city councilors to craft the policy, said it would be an important step, though not a revolutionary one, for Boston to adopt such a policy, noting the city already has in place policies requiring equal employment opportunities and access to public accommodations for transgender people.

“We have just wanted to make sure that transgender city employees . . . have access to comprehensive health care and coverage just like any other employee in the city of Boston,” Burton said.

Jeremy C. Fox can be reached at jeremy.fox@globe.com. Follow him on Twitter @jeremycfox.