Just a Symptom

There was an article in the San Francisco Chronicle on Thursday that I found very interesting, and because it is getting play around the Internet, I thought I’d comment on it.

The short premise of the fairly short story is that LGBT organizations are behind large employers in providing adequate and appropriate health insurance for their trans employees. It is true but also misses the point.

First some context.

1. Kudos to HRC and NCLR who really have done an admirable job trying to stay ahead of this by providing the best they can for their staff. Other really great examples by the way, are the American Friends Service Committee and the Unitarian Universalists Association. [There may be others I am forgetting.]

2. Since November, NCTE has been co-convener of a working group of folks trying to address this issue, specifically but not entirely as it relates to the LGBT movement. And I have personally spoken with quite a few fellow executive directors. NCTE has been providing technical assistance to other organizations as they try to do the right thing. And we will continue with the working group and the technical assistance until all trans employees have appropriate coverage. And then we will continue until all trans people (employed or not) can access adequate health care [see # 6 below].

3. There are a lot of others working on this as well, including, but not exclusively trans people and others who work at these organizations. I would venture to say that most, if not all LGBT organizations have this issue on their radar and are trying to do the right thing.

4. We all should expect our organizations to do the right thing on this, but we also need to remember that it simply is not easy—especially for small organizations, and all LGBT organizations are small organizations from an insurance perspective.

5. Everyone –LGBT organizations, the San Francisco Chronicle and probably most trans people reading this — think that the issue is only about paying for transition-related surgical procedures, when in reality, trans people, even with insurance, often have non-transition-related care denied as being transition-related. That has even happened to NCTE staff members. The issue, it seems to me, is that insurance companies, who immorally see their job as being primarily about denying payment for as much as they can, see trans people as easy targets for denial.

6. An even bigger issue that may be more to the point is that most trans people will not be able to access adequate healthcare until most people in the U.S. can. Universal healthcare is certainly coming to America and NCTE will continue to work to insure that we don’t see trans exemptions based more on old stereotypes than on currently accepted medical realities.

With that context in mind, my critique of the article is a restatement of their subtitle

They said:

While large companies expand health benefits for transgender employees, the majority of LGBT rights groups say they cannot afford insurance that covers transition-related expenses. [Emphasis mine]

I think it would be more accurate as the following:

While large companies expand health benefits for transgender employees, the majority of LGBT rights groups, like other small employers, are struggling to do the right thing.

I’m confident that we will get there. This is not the first time the movement has faced this kind of issue. There was a time, for instance—and it is still a challenge—when HIV positive employees couldn’t be adequately covered or covered at all. It took a bit to figure it out, but it got figured out. And, importantly, it didn’t take a while because the organizations were dragging their collective feet, but rather because the insurance industry makes it hard in many ways obvious and obscure. One big way, by the way, is that most employers can only make changes to their policies once per year, so that definitely slows things down.

At NCTE we are very hopeful that the LGBT movement will continue to resolve this important issue and we will continue to work with our allies to make that happen.

Here is a link to the Chronicle story.

Be well,


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