Okay everyone, I need you input! I have a project I'm working on for a local Trans health council. We are looking at many issues concerning trans people. My assignment is the insurance aspect of it.
So here's some of the questions I have:
1. Should there be coverage mandated to include gender identity treatments?
2. What levels of coverage if any, should be mandated?
3. What are the reasons that coverage is typically not included now?
4. What will be necessary for gender transition treatments to be covered?
5. If insurance co.'s eventually do cover or are mandated to cover gender transition treatments, should there be any waiting periods for coverage to begin?
6. If someone who is diagnosed with GID cannot afford an insurance plan that covers treatment options, should there be a mechanism available to make sure that individual is covered and treated in some way? If so, how?
7. Should an insurance co. have the right to refuse to cover GID related treatments?
8. If anyone can answer this, please do! How do larger corporations (like those with 100% ratings through HRC), successfully negotiate out exclusions of gender transition treatments so that they are covered in their health insurance plans?
9. Should whatever those mechanisms are, for negotiation, be made available and economically viable, to smaller group plans to help smaller business' become more diverse?
Well, that's probably enough for now. Please any and all thoughts are appreciated on each of these questions. However, in the interest of research, I would really like to avoid debate between us over these questions in this thread. We can open up other threads for that.
Thanks so much!
Dawn
Quote from: Dawn D. on February 02, 2010, 10:55:05 AM
1. Should there be coverage mandated to include gender identity treatments?
I think medical insurance should cover any medical procedure needed.
2. What levels of coverage if any, should be mandated?
SRS for sure, Mastectomies, therapists, hormones.
3. What are the reasons that coverage is typically not included now?
Expense and peoples fear of encouraging what they believe to be a corrupt idea instead of a medically necessary correction.
4. What will be necessary for gender transition treatments to be covered?
Not sure but perhaps a law like covering cancer screening is now.
5. If insurance co.'s eventually do cover or are mandated to cover gender transition treatments, should there be any waiting periods for coverage to begin?
Only if they want a therapists letter showing it to be necessary.
6. If someone who is diagnosed with GID cannot afford an insurance plan that covers treatment options, should there be a mechanism available to make sure that individual is covered and treated in some way? If so, how?
Same as others ore covered now for medical care,
7. Should an insurance co. have the right to refuse to cover GID related treatments?
Yes, if the refusal is because a person is mentally unstable or has health reasons making a procedure at higher risk than usual for others who transition.
8. If anyone can answer this, please do! How do larger corporations (like those with 100% ratings through HRC), successfully negotiate out exclusions of gender transition treatments so that they are covered in their health insurance plans?
Insurance companies offer lower rates for those who exclude transition related procedures.
9. Should whatever those mechanisms are, for negotiation, be made available and economically viable, to smaller group plans to help smaller business' become more diverse?
Well, that's probably enough for now. Please any and all thoughts are appreciated on each of these questions. However, in the interest of research, I would really like to avoid debate between us over these questions in this thread. We can open up other threads for that.
Thanks so much!
Dawn
Insurance companies offer lower rates for those who exclude transition related procedures.
That's not exactly true, its more like its not a basic covered expense, so it costs more. It's not a traditional exclusion. So at the current time its treated like a rider. Much like your standard renters insurance would not cover real works of art, and if you want them covered, its an additional rider on the basic policy. So its not a matter of costing less to exclude it, its costing more to include it.
The best way to do it might be through a rather high co-payment that a person could meet by using medical savings accounts that would be tax free (pre-tax) in same way that some things like glasses get covered in some policies.
1. Should there be coverage mandated to include gender identity treatments?
Yes. GID is and can be life threatening
2. What levels of coverage if any, should be mandated?
Because it is life threatening, any and all treatment should be covered.
3. What are the reasons that coverage is typically not included now?
Cost, I think. Businesses don't care about employees health. They only offer it to recruit new employees.
4. What will be necessary for gender transition treatments to be covered?
Everything from therapy through to SRS.
5. If insurance co.'s eventually do cover or are mandated to cover gender transition treatments, should there be any waiting periods for coverage to begin?
They should cover therapy following SOC rules. This would make it up to the therapist. Most insurance has a 90 waiting period.
6. If someone who is diagnosed with GID cannot afford an insurance plan that covers treatment options, should there be a mechanism available to make sure that individual is covered and treated in some way? If so, how?
This is one reason I feel we need a national health care. Right now I am in pain and can't be seen by anyone unless I pay out of pocket. Who can afford to see anyone.
This means that we would need something like Canada and England have.
7. Should an insurance co. have the right to refuse to cover GID related treatments?
No. It is a life threatening issues. Would they deny coverage for a heartache?
8. If anyone can answer this, please do! How do larger corporations (like those with 100% ratings through HRC), successfully negotiate out exclusions of gender transition treatments so that they are covered in their health insurance plans?
I think that they realized the true nature of GID.
9. Should whatever those mechanisms are, for negotiation, be made available and economically viable, to smaller group plans to help smaller business' become more diverse?
Yes. They then can hire qulified people that they might not see, because of health care coverage.
Tekla,
I don't doubt that you are correct for the technical part of that. Money wise it amounts to the same thing. Cost for including it for everyone would mean all rates would be higher but not as high for the individual needing it. I always thought that was sort of how insurance worked besides you pay an amount that added up to more than you spent overall. It was just available when you needed it whether or not you had it paid in full or not.
This questionaire is obviously aimed at people in America!
Quote from: Janet Lynn on February 02, 2010, 04:45:22 PM
Right now I am in pain and can't be seen by anyone unless I pay out of pocket. Who can afford to see anyone.
There has got to be a sliding fee clinic in your area. Also the Oregon Health Plan has a rolling enrollment for adults in OHP Standard, it takes about 6 months to a year to get in but everybody who is qualified eventually gets in. They don't come looking for you though, you have to ask. They recently cut some dental and vision services because of funding issues, but the health plan is a state priority and is still quite strong, covering most mental and physical problems.
My name is on the list and I am hoping to be selected. It would be nice to get some pain medications and maybe even HRT.
And I have not found anyone, but I will keep looking.
I wish you the best, it takes so long sometimes :(
My hope is that when whatever the national plan is surfaces that ohp will remain intact and under a lot less stress for those it misses, and it certainly will miss some. This health plan is really an exceptional project, and they ways the fund it are rather clever too. It really does make me proud to live here.
About the only way this is ever going to get covered for everyone (it is for several different groups already) is for the US to adopt a single-payer health care system, and that is not happening any time soon.
Hi all! Very interesting responses! Keep them coming! Thanks to you all for taking the time to think about this issue and make replies.
Dawn
It is a cosmetic surgery and should be treated as such. Switching genders remains a choice, the inability to mentally cope with one's birth gender is purely the whim of the individual. Those seeking to change themselves should be held fully accountable for costs of making it happen. Funding procedures for the sake of people's comfort of appearance will have no end. For the life of me I cannot fathom why transsexuals should have coverage but genetic males and females seeking common operations that greatly boost their self image should not. I will tolerate teenagers getting breast implants and liposuction paid for by third parties just as soon as I would transsexual operations, it boils down to the same thing: others should not be responsible for the dissatisfaction of one's insecurity in one's own appearance. If someone is that adamant on getting a free ride then sue your father for sending the wrong sperm to that egg, and then include your mother in on it for carrying you.
In my humble, yet very firm opinion :)
Quote from: inoutallabout on February 04, 2010, 03:06:56 PM
It is a cosmetic surgery and should be treated as such. Switching genders remains a choice, the inability to mentally cope with one's birth gender is purely the whim of the individual. Those seeking to change themselves should be held fully accountable for costs of making it happen. Funding procedures for the sake of people's comfort of appearance will have no end. For the life of me I cannot fathom why transsexuals should have coverage but genetic males and females seeking common operations that greatly boost their self image should not. I will tolerate teenagers getting breast implants and liposuction paid for by third parties just as soon as I would transsexual operations, it boils down to the same thing: others should not be responsible for the dissatisfaction of one's insecurity in one's own appearance. If someone is that adamant on getting a free ride then sue your father for sending the wrong sperm to that egg, and then include your mother in on it for carrying you.
In my humble, yet very firm opinion :)
Why aren't we allowed to troll trolls?
If you want this you should have to make your case for public option gender change in front of a Death Panel. Sounds only fair. >:-)
I sometimes think along those lines, usually when I'm using my health card for something expensive like bloodwork. I think: "Here I am getting $1500 in labs and somewhere in the state some little kid is going without vaccinations."
Well it's just not true. There is plenty for everyone, as we are proving here. It isn't easy but we are doing it, and without a sales tax...if we passed a state sales tax we'd be golden. Ohp is just an enhanced medicare, it's nothing special really or unique, but the importance the people place on it is. However, I wouldn't feel comfortable recieving such costly benefits unless things like prosthetic limbs, mastectomy reconstruction and so on were also available.
Quote from: Autumn on February 04, 2010, 06:33:24 PM
Why aren't we allowed to troll trolls?
I apologize that I do not share your views, but stating a legitimate and logical perspective in a non-aggressive manner does not constitute trolling. You may not agree with it, but slinging around insults over casual discussions is something I would consider more deserving of your own accusation. Name calling won't do much to change my mind either.:)
WE are not switching genders, we form our bodies to match our gender more closely. Inability to cope with GID is not a "whim".
whim
/ʰwɪm, wɪm/ Show Spelled Pronunciation [hwim, wim] Show IPA
–noun
1. an odd or capricious notion or desire; a sudden or freakish fancy: a sudden whim to take a midnight walk.
2. capricious humor: to be swayed by whim.
Quote from: inoutallabout on February 04, 2010, 03:06:56 PM
It is a cosmetic surgery and should be treated as such. Switching genders remains a choice, the inability to mentally cope with one's birth gender is purely the whim of the individual. Those seeking to change themselves should be held fully accountable for costs of making it happen. Funding procedures for the sake of people's comfort of appearance will have no end. For the life of me I cannot fathom why transsexuals should have coverage but genetic males and females seeking common operations that greatly boost their self image should not. I will tolerate teenagers getting breast implants and liposuction paid for by third parties just as soon as I would transsexual operations, it boils down to the same thing: others should not be responsible for the dissatisfaction of one's insecurity in one's own appearance. If someone is that adamant on getting a free ride then sue your father for sending the wrong sperm to that egg, and then include your mother in on it for carrying you.
In my humble, yet very firm opinion :)
The issue I have with it being seen as completely cosmetic is that unlike a boob job or a nose redo the SRS can actually have an effect on more than just you feeling good about yourself--it also helps you get a job, reduces the visibility of the transperson and thus gives them a safer existence, and most teenagers wouldn't commit suicide over having too small of breasts.
Liposuctions and stomach stapling, in certain circumstances, IS covered if the person's weight is deemed a risk to their health and wellbeing. Without it those overweight people wouldn't be able to work or move around comfortably (thus effecting quality of life) and no one would walk up to a bedridden 500-lb man, a prisoner of his own body, and tell him it is purely cosmetic.
Without the surgeries, or at least hormonal treatments, MTF FFS and FTM top surgery, many of us would have a much, much harder time assimilating into everyday culture...there are no laws protecting hirees on how they look and if you look like a man in a dress many employers won't want you as a part of their company image. Genital surgery, however, generally doesn't effect your ability to work, so if they choose to not cover anything that would be it.
As far as it being a choice and being 'unable to cope with your chosen gender'...pumping myself full of antidepressants and other medications to make myself forget that I'm living my life as someone else is not coping. And, treatment for that depression and those medications are insured. Why not cover what can 'cure' the problem, thus improving quality of life, instead of just medicating someone into a mild coma or risking them hurting themselves (which would be more costly to the insurance company as well)?
Okay, before this gets out of control, let me remind everyone that I specifically asked that this thread not become a forum of debate. And, I am not going to aim this at a particular person. After all, I love a good debate as well as the next person. However, this is a research project. I'll accept and consider ALL opinions relating to the questions I asked originally. So please, if you feel you must enter into debate, would you kindly create a new thread for it?
Thank you all so much for your consideration and participation!
Dawn
Lordkat, thanks for the definition, a better choice of wording may have conveyed my view better. Perhaps... "state of the individual."
Quote from: Christian >.> on February 05, 2010, 04:02:08 AM
The issue I have with it being seen as completely cosmetic is that unlike a boob job or a nose redo the SRS can actually have an effect on more than just you feeling good about yourself--it also helps you get a job, reduces the visibility of the transperson and thus gives them a safer existence, and most teenagers wouldn't commit suicide over having too small of breasts.
Liposuctions and stomach stapling, in certain circumstances, IS covered if the person's weight is deemed a risk to their health and wellbeing. Without it those overweight people wouldn't be able to work or move around comfortably (thus effecting quality of life) and no one would walk up to a bedridden 500-lb man, a prisoner of his own body, and tell him it is purely cosmetic.
Without the surgeries, or at least hormonal treatments, MTF FFS and FTM top surgery, many of us would have a much, much harder time assimilating into everyday culture...there are no laws protecting hirees on how they look and if you look like a man in a dress many employers won't want you as a part of their company image. Genital surgery, however, generally doesn't effect your ability to work, so if they choose to not cover anything that would be it.
As far as it being a choice and being 'unable to cope with your chosen gender'...pumping myself full of antidepressants and other medications to make myself forget that I'm living my life as someone else is not coping. And, treatment for that depression and those medications are insured. Why not cover what can 'cure' the problem, thus improving quality of life, instead of just medicating someone into a mild coma or risking them hurting themselves (which would be more costly to the insurance company as well)?
I feel prescription coverage could be provided, even coverage for doctor fees and bloodwork. The part where I have the largest objection is that I do not feel it should be the job of government to provide healthcare for what I still feel are cosmetic procedures. I believe if one is contributing to a third party via work or privately, then heck yeah. You pay a bill each month specifically for that purpose, that's fine. If taxes were raised appropriately for federal healthcare, as in one is contributing towards it, then I'm on board. As far as giving people a free ride, I will always stand against it.
People who need actions regarding their weight should be responsible for it. There's plenty of preventative measures to gaining weight, once again I feel that other taxpayers should not be responsible for the decision of someone to let their weight get out of hand. Even diabetics and people with a predisposition towards such can manage, I worked in the fitness industry for years and can personally attest to that... I've seen some amazing things happen with will power, education, and consistency. Regarding mental treatments, I still feel that keeping a level head and a balanced, realistic view about life is the best method towards not only alleviating that, but also for maximizing one's appreciation and outlook on life in any situation. People say, all the time, "be happy with what you've got and don't let what you haven't got drag you down." Why doesn't anyone follow that?
Self image can be crucial to mental health, especially in severe cases of dysphoria such as gender dysphoria. However, that does not make transsexuals the only humans that can greatly benefit from cosmetic procedures. The fact remains that the body of a transsexual is physically stable and functional, even if the owner doesn't want that body. Semantics regarding already being this gender or that gender will always be a controversial subject. While one may feel like the opposite gender and greatly desire to be, one is still making a journey from one to the other. The justification may be factual, or it may simply be a crutch, I'm not to say either way. I know I hold a personal stake in it just as everyone else on these forums does, but that doesn't blind me to my opinions and I won't contradict myself purely for my own peace of mind or that of someone else.
Personal financing and/or saving up for the operations is the only way I feel SRS should be handled in my country. If one wants to be something badly enough, then they can work hard for it. It's easy to let others shoulder the bill, but I don't feel it's a morally sound concept by any stretch of the imagination.
Now, that's that for my take and I still stand by it firmly. If I'm incorrect, perhaps gaining wisdom with age and/or seeing my culture change to fit a different mindset will get my mind on the right track.
Post Merge: February 05, 2010, 12:48:32 PM
And um, I just saw your post Dawn. I'm sorry for getting things off topic, consider me both apologetic, and dismissed:D
Being cis-gender and heterosexual is very much a choice. Period
1. Should there be coverage mandated to include gender identity treatments?
I agree that it should cover things that are needed.
2. What levels of coverage if any, should be mandated?
I do think much of it should be covered. A few things on case by case I think.
3. What are the reasons that coverage is typically not included now?
I think many still see at as they did in the past. So they feel offering coverage would compromise their views on many things.
4. What will be necessary for gender transition treatments to be covered?
Kinda out on that one. However I think it should be more updated then this 1950's system.
5. If insurance co.'s eventually do cover or are mandated to cover gender transition treatments, should there be any waiting periods for coverage to begin?
I believe the wait should be very short. A letter from a therapist and verification it is real.
6. If someone who is diagnosed with GID cannot afford an insurance plan that covers treatment options, should there be a mechanism available to make sure that individual is covered and treated in some way? If so, how?
I believe we need a better system all around. I think the current bill is a bogged down pos in America. However nothing? That just isn't acceptable anymore.
7. Should an insurance co. have the right to refuse to cover GID related treatments?
Yes, but only if it is a major health issue. As in at that time that procedure would cause more harm then good. However it would need to be a major issue not a minor one.
8. If anyone can answer this, please do! How do larger corporations (like those with 100% ratings through HRC), successfully negotiate out exclusions of gender transition treatments so that they are covered in their health insurance plans?
Dunno the answer to this one.
9. Should whatever those mechanisms are, for negotiation, be made available and economically viable, to smaller group plans to help smaller business' become more diverse?
inoutallabout - I think you compromised yourself in other ways to stick by your views.
Quote7. Should an insurance co. have the right to refuse to cover GID related treatments?
Yes, but only if it is a major health issue. As in at that time that procedure would cause more harm then good. However it would need to be a major issue not a minor one.
8. If anyone can answer this, please do! How do larger corporations (like those with 100% ratings through HRC), successfully negotiate out exclusions of gender transition treatments so that they are covered in their health insurance plans?
Who gets to decide if it is a major health issue? If the insurance does then it will always be a major health issue, which it is. A major health issue is what should be covered.
As an aside, I talked to my insurance company. They did say that the company has the
option to exclude gender associated treatments. Those treatments are included in the basic plan and excluded later, not added as a rider.
I know that the VA health system has afforded me reduced treatments. As the only information I was able to discover to take to my VA primary health physician was from the Boston VA, it facilitated opening of lots of doors. I was lucky that my physician interned at the Boston VA.
The following is an excerpt from a document on the Transgendered American Veterans Association website:
http://www.tavausa.org/Management%20of%20Transgender%20Veteran%20Patients_7.08.pdf (http://www.tavausa.org/Management%20of%20Transgender%20Veteran%20Patients_7.08.pdf)
"PATIENT CARE MEMORANDUM-11-046-LM July 2008
MANAGEMENT OF TRANSGENDER VETERAN PATIENTS
1. PURPOSE: To establish guidelines for the safe, ethical, and appropriate management of
transgender individuals within VA Boston Healthcare System. This policy applies to any
individual who self-identifies as transgender (an umbrella term, see definitions below) seeking
care at any VA Boston Healthcare System facility. This policy applies irrespective of the
veteran's status with regard to gender revision surgery and therefore includes those who have
had gender revision surgery outside of VHA, those who might be considering such surgical
intervention, and those who do not wish to undergo gender revision surgery but self-identify as
transgender.
2. BACKGROUND: Nationwide, there is a VA prohibition against providing gender revision
surgery or sex reassignment surgery (SRS). However, VA Boston Healthcare System has a
number of transgender patients seeking 'usual and customary' treatment. Some transsexual
patients have completed or are en-route to full transition from one gender to another. This
transition often takes years for a patient to fully complete; some never fully complete the
transition. Moreover, other transgender individuals prefer to live outside the traditional
boundaries of gender which may not necessitate surgical interventions or other elements of
transition. Thus, VA Boston Healthcare System cares for transgender patients who present at
multiple points on this transition continuum, including individuals who are not seeking SRS.
Therefore, transition status cannot be a prerequisite for providing appropriate healthcare.
3. POLICY:
a. When a transgender veteran presents for health care at any VA Boston Healthcare System
facility, including specific male or female health issues, the veteran will be provided health
care, consistent with VHA policies for all patients. Health care will be delivered to that
veteran, based upon that veteran's self-identified gender, recognizing that unique health
issues are associated with some transgender patients.
As an example, a male-to-female transsexual will be referred to as "she" in all contacts and
documents irrespective of appearance and/or surgical history. It is appropriate for such
treatment to occur in women's health clinics and in women's housing for residential and
inpatient programs. If the veteran is taking hormone therapy, there may be increased
medical risks for blood clots, breast cancer, pituitary and liver problems, as well as
cardiovascular disease. Moreover, there may be screenings that are appropriate to conduct
(e.g., prostate exams) or not to conduct (e.g., pap smear) that are not typical procedure for
staff in women's clinics. However, appropriate screenings to address these issues will occur
and are the responsibility of the provider to monitor.
b. Veterans will be addressed, and referred to, on the basis of their self-identified gender (e.g.
"she" for a male-to-female transgender individual), regardless of the veteran's appearance
and/or surgical history. Computerized documentation of gender should also be consistent
with the veteran's self-identified gender, including salutations on computer-generated letters
to patients. Transgender veterans are encouraged to request this documentation change."
Basically they have to treat you as a human being, but no re-routing of the plumbing. Patience with the VA staff learning to treat you properly is a good thing.
The VA does help with the treatments because I cannot afford traditional insurance and health care through my current job. The occasional person looking at my chart and addressing me by my birth gender is ok.
Quote from: LordKAT on February 11, 2010, 02:37:33 AM
Who gets to decide if it is a major health issue? If the insurance does then it will always be a major health issue, which it is. A major health issue is what should be covered.
As an aside, I talked to my insurance company. They did say that the company has the option to exclude gender associated treatments. Those treatments are included in the basic plan and excluded later, not added as a rider.
I'd say major would be at that moment it would do more harm then good. We are talking about it hurting your system in way the body can't repair, instead of a possible clot a guaranteed to happen unless you take drug A for a month. Things along that line.
You missed my point. They will still get treatment but they need to clear something up so it is safe for them to do so. There are a ton of procedures out there that ask you to wait or something similar if it is going to hurt you more then help you at that moment. Sometimes it is something insurance should cover in these instances. Sometimes it is not because the issue was person caused all the way down the road and can be cleared by them through effort.
Ya, depression blows but it isn't an excuse to do half the crap people do to themselves. Such as getting fat enough to need a stinking cut off valve in their throat to save their life from over eating.
Quote from: Korlee on February 11, 2010, 06:58:59 PM
I'd say major would be at that moment it would do more harm then good. We are talking about it hurting your system in way the body can't repair, instead of a possible clot a guaranteed to happen unless you take drug A for a month. Things along that line.
You missed my point. They will still get treatment but they need to clear something up so it is safe for them to do so. There are a ton of procedures out there that ask you to wait or something similar if it is going to hurt you more then help you at that moment. Sometimes it is something insurance should cover in these instances. Sometimes it is not because the issue was person caused all the way down the road and can be cleared by them through effort.
Ya, depression blows but it isn't an excuse to do half the crap people do to themselves. Such as getting fat enough to need a stinking cut off valve in their throat to save their life from over eating.
Actually I didn't miss the point. I did believe it needed clarifying. I don't consider having to quit smoking before getting hormones to be a major health issue. I still did it and was glad insurance was willing to help by covering chantix. Skipping paying for it just because I smoked and wasn't forced to isn't the issue. The addiction still exists now.
Some weight issues are due to things other than "overeating". Why refuse to treat that issue.
Quote from: LordKAT on February 12, 2010, 03:26:18 AM
Actually I didn't miss the point. I did believe it needed clarifying. I don't consider having to quit smoking before getting hormones to be a major health issue. I still did it and was glad insurance was willing to help by covering chantix. Skipping paying for it just because I smoked and wasn't forced to isn't the issue. The addiction still exists now.
Some weight issues are due to things other than "overeating". Why refuse to treat that issue.
I didn't think it needed more added to it because I thought most people outside of insurance companies? Had a different rating system for what would be considered a major health issue. A major issue that stops treatment usually means loss of life, an organ, something that is huge from starting a new treatment because of a previous condition. Something that makes such a huge liability you'd be pressed to even get a doctor to okay it without insurance.
Smoking is something that can cause harm in the long term or not. My father and his father were chain smokers but never got a thing. My father still has not had a thing from it. While it would hamper treatment it isn't going to make you keel over and die from combining the two.
I disagree with them covering the smaller thing that was and is within that persons control because they lacked self control or restraint. That person should have to fix that on their own then be able to move on.
I meant it more along the line of an issue they caused themselves. Not from someone being big boned, or an imbalance in body regulation. My aunt has something like that. I forget what it is called off the top of my head but she can't control it. Anyways, I was just citing it as an easy example.
However I can see with you I shall need to tag and check every post before hitting submit. If I can get over my lazyness.
It is my job, and also my private inclination, to respond to questions regarding decisions by providing an impact analysis of the decision itself.
Quote from: Dawn D. on February 02, 2010, 10:55:05 AM
1. Should there be coverage mandated to include gender identity treatments?
Paychecks and benefits must be reduced to compensate for the added cost of health insurance. If jobs can be moved to a region with comparable talent at lower cost, then each such measure will increase that effect. Further costs include compliance (man-hours of lawyers to determine what the law actually requires and how to comply with regulation and to document that compliance, a considerable sum) and liability (the cost associated with lawsuits from groups such as HRC and from individual employees).
Given that transsexuals are extremely rare (1:4e4), it probably won't hurt much, but on the same token, support will be fairly lean when money is already tight.
Quote from: Dawn D. on February 02, 2010, 10:55:05 AM
2. What levels of coverage if any, should be mandated?
Same answer; mandate what you will, business practices will adjust accordingly to survive competition.
Quote from: Dawn D. on February 02, 2010, 10:55:05 AM
3. What are the reasons that coverage is typically not included now?
Politically, garnishing an innocent man's wages to pay for a medical condition that he does not have tends to reduce his willingness to vote for your party. If the beneficiary tells him that he is a criminal or oppressor, his votes shift further. If his taxes increase, and wages decrease, during a recession or depression, further. If he has young children and a mortgage, further...
Economically, see above.
Quote from: Dawn D. on February 02, 2010, 10:55:05 AM
4. What will be necessary for gender transition treatments to be covered?
If a given transsexual employee is highly productive, and demonstrates this clearly, they could negotiate for expanded health insurance as part of their employment package on an individual basis.
(NB: The heavily-tattooed and multiply-pierced Sociology-graduate at the cash register, telling me about 'gender theory' and arguing for tax increases, is not 'highly productive.' The slightly-bearded girl who writes
rockin' code and designs motherboards is 'highly productive.')
On a collective basis, however, the current and foreseeable economic conditions suggest that most transfolk will, over the coming decade, be rather more concerned with food and housing than with transition.
Quote from: Dawn D. on February 02, 2010, 10:55:05 AM
5. If insurance co.'s eventually do cover or are mandated to cover gender transition treatments, should there be any waiting periods for coverage to begin?
Goes to cost.
Quote from: Dawn D. on February 02, 2010, 10:55:05 AM
6. If someone who is diagnosed with GID cannot afford an insurance plan that covers treatment options, should there be a mechanism available to make sure that individual is covered and treated in some way? If so, how?
The resulting mechanism would increase personal taxes (cost of living, requiring higher salaries) and corporate taxes (lower profit margins). The effects are as described above, proportional to costs associated, and affect the entire economy in the theater of operation (including all local businesses and private household economies).
Quote from: Dawn D. on February 02, 2010, 10:55:05 AM
7. Should an insurance co. have the right to refuse to cover GID related treatments?
Insurance companies are private corporations in a market, offering a service in exchange for a profit. Like any other human being, the insurance company owners must have the power to refuse business. Deviation from this principle incurs the costs described above.
Quote from: Dawn D. on February 02, 2010, 10:55:05 AM
8. If anyone can answer this, please do! How do larger corporations (like those with 100% ratings through HRC), successfully negotiate out exclusions of gender transition treatments so that they are covered in their health insurance plans?
No idea.
Quote from: Dawn D. on February 02, 2010, 10:55:05 AM
9. Should whatever those mechanisms are, for negotiation, be made available and economically viable, to smaller group plans to help smaller business' become more diverse?
Diversity is a mechanism as outlined above (labor cost, compliance, liability) without any benefit that I am aware of (no increase in productivity) and carries with it the 'silent fear,' the effect of speech-suppression measures used by the corporation to protect against lawsuit. As a result, it serves as a strong incentive for offshoring. In essence, it serves to increase diversity in a shrinking workforce.
The common thread in these observations is that each benefit comes with both a direct cost, paid in taxes, a series of indirect costs involving lowered wages, reduced benefits, and reduced employment figures, and finally a series of political repercussions involving voter alienation and economic emigration. The voters must decide if they can afford these costs, on top of other costs already incurred for similar measures, as a time when debt is already high.
In summary, everything has a cost, including other people's money.
- N
[Edit: As a postscript, as the original poster has asked us for "any and all thoughts" but has asked us to refrain from debate, I will not offer surrebuttal for this post. Rebuttal, however, may prove useful to the original poster.]