Historic campaign for trans benefits kicks off

photo of Gabriel Haaland by Luke Thomas, Fog City Journal

A group of LGBT labor activists is launching a nationwide campaign to push unions to bargain for transgender health benefits for their members.

Pride At Work, in collaboration with the Transgender Law Center, the National Center for Transgender Equality, and the SEIU Lavender Caucus, plans to ask labor groups, including local labor councils and state labor federations, to pledge to include trans benefits in future contract negotiations.

The effort is historic -- and badly needed: Gabriel Haaland, co-chair of Pride At Work's Transgender Caucus, estimated that fewer than 10 percent of all union contracts mandate health insurance benefits for transgender people.

The organizing effort will kick off in March with actions and educational programs in at least 10 cities.

Some unions already recognize the importance of the issue -- SEIU, for example, endorsed the idea of including trans benefits at a recent national convention. And transgender employees of the 2.1 million-member union are covered.

But "we're asking, how does that get implement at the local level, as a bargaining priority," Haaland said.

A growing number of private-sector employers, including Google, Office Depot and Kaiser, cover a broad spectrum of care, including gender-reassignment surgery.

San Francisco made national headlines in 2001 when the city agreed to cover the health costs of transgender employees, and the right-wing nuts of the world went crazy. Headlines announced that the city's taxpayers would soon be underwriting "sex-change operations."

As a result, however, local health-care providers that contract with the city began to train their staff on trans sensitivity and began to develop protocols for treating trans patients.

In reality, most trans benefits are fairly inexpensive -- hormone treatments, for example, are not terribly costly. And the very concept of organizing around trans issues and pushing benefits in union contracts can help bring a historically underserved and marginalized community into the political discussion.

"It's just as it was in the past with gay and lesbian issues," Haaland said. "A lot of people don't even realize that they know trans people. And when trans workers realize that this is happening, it gets them more involved in their unions."

Even in San Francisco, trans people face huge obstacles at work. A 2006 study by the Transgender Law Center and the Bay Guardian found that three out of four trans people in the city lack a full-time job -- and more than 90 percent earn less than the area's median income.

The organizing effort came out of a January, 2013 National Gay and Lesbian Task Force "Creating Change" conference in Atlanta, where Pride at Work members brought in transgender leaders from around the country for discussions on political issues and strategies. The issue of benefits was at the top of the list.

"Not just the issue but the process itself was historic," Haaland said. "We went out and asked community leaders what they wanted, and this is where we ended up."



Anyone is entitled to healthcare, but elective surgery is a no-no. Health plans rarely pay for cosmetic surgery in any event.

Posted by anon on Feb. 11, 2013 @ 2:27 pm

Jason Grant Garza ... yes, everyone is entitled to HEALTHCARE if you can GET the LAW enforced ... however, if you are the Department of Public Health in San Francisco you can BREAK the LAW and NO ONE knows WHO enforces it.

Watch this VIDEO to see DPH and CRIMINAL FRAUD http://www.youtube.com/watch?v=7cP3jCmJFRo

then watch the SHERIFF (DPH'S lapdog) inform me that there is NO RETRAINING ORDER ... http://www.youtube.com/watch?v=uk7xpxL8QjI and tell me to go back ( cup of poison)

so that DPH can BREAK the LAW again .. http://www.youtube.com/watch?v=VFd-KtS8Zss

and NOW months later still trying to get another appointment with the GREAT SHERIFF to followup on his CUP OF POISON and still no appointment ... wonder why???

Yes, the ILLUSION is GREAT and where is the CONCERN ???

Keep looking at YOUTUBE and KNOW you are NEXT ... ENJOY the LIE.

Oh, and this is NOT the first time ... go to http://www.myownprivateguantanamo.com to see a signed settlement agreement and confession by CCSF and the INSPECTOR GENERAL for FEDERAL MEDICAL LAW VIOLATION ... then CCSF left its INNOCENT VINDICATED VICTIM for DEAD (me) ... go ahead and look UNLESS you'd rather believe the LIES ....

and the settlement (years later) did not come from the "GOODNESS and KINDNESS" of the city attorney after committing FRAUD and TESTILING in FEDERAL COURT to have my case dismissed ( C02-3485PJH ) years before THEY signed the CONFESSION admitting FAULT and GUILT. Why would they lie in court and sign a confession years later ... RIGGED is as RIGGED does ... what was the CONSEQUENCE ????

Rights are NOTHING if NOT enforced ... what a FARCE for it has started again ... go to YOUTUBE and watch NO ONE enforce MEDICAL LAW ...

Posted by Jason Grant Garza on Feb. 12, 2013 @ 7:21 am

Gender reassignment is not "cosmetic surgery."

Posted by tim on Feb. 11, 2013 @ 2:33 pm

Working Americans are being pushed into serfdom at an alarming rate while organized labor stands by idly and negotiates the rate of our surrender. Our house is on fire, yet labor can find resources to work on immigration or something important like transgender health benefits, but which are both objectively orders of magnitude less important than putting out the raging fire of the class warfare imposed debt peonage thing.

Posted by marcos on Feb. 11, 2013 @ 3:11 pm

Have any concept of what trans people go through. Imagine if you were born into the wrong body, if every day you realized you were a man but your body was female (or vice versa). This isn't cosmetic or about getting laid more; it's about dealing with very deep-rooted psychological issues that can, and often do, lead people to substance abuse and even suicide. Seriously: The cost of trans health benefits is minor. There are, at most, a handful of people who have used their city benefits for gender reassigment surgery. But for the people involved, it's a huge deal.

Get over your biases. They aren't pretty.

Posted by tim on Feb. 11, 2013 @ 4:15 pm

I do not buy this idea that just because a guy wants to wear woman's clothing, that that is somehow my problem. If they want to pay to alter themselves, then fine. If they get sick,. I'll consider paying towards it.

But don't tell me I have to pay to fund someone who hasn't figured out who he is, who he wants to shag, or how. That is discretionary - it's not like having cancer.

Posted by Guest on Feb. 11, 2013 @ 5:03 pm

Just because a man wants to wear women's clothing doesn't mean he's transsexual and in need of surgery. There's a big difference.

I mean, are you serious with that comment?

Posted by Guest on Feb. 11, 2013 @ 5:51 pm

higher premia for my own insurance? Convince me. Show me how that is in my interests, as someone who is quite happy with the body and gender I have.

Posted by Guest on Feb. 11, 2013 @ 6:00 pm

Do you insist on someone personally proving to you the medical necessity of every medical intervention?

Posted by marcos on Feb. 11, 2013 @ 7:25 pm

of healthy, happy people who take care of each other is a basic human aspiration?

Posted by marke on Feb. 11, 2013 @ 8:11 pm

I am free to decide that I don't want to pay for that.

Posted by anon on Feb. 12, 2013 @ 7:58 am

to provide your own healthcare.

Posted by marke on Feb. 12, 2013 @ 9:21 am

healthcare. It's asking me to pay for elective, cosmetic care for others that I have an issue with. If a TS wants to pay for his/her own transformation, I am all for it. Just not on my dime.

Posted by Guest on Feb. 12, 2013 @ 9:49 am

as several other comments here have shown. And everyone paying for their own healthcare outside of the price controls of shared costs would mean astronomical prices -- unless you're advocating a single payer system? Perhaps you'd like me to review your medical records and see which things I don't want to pay for, which things I consider elective? (Or maybe I can "elect" to up your antidepressants so you don't spend all day trolling this site, which will "cosmetically" make you a more attractive person?)

Posted by marke on Feb. 12, 2013 @ 9:59 am

no tits are both making free choices. They health is not at risk if they do not make those changes.

You are arguing that a TS should have cover for a tit change but a regular woman should not. I see no difference between the two cases.

It is for a doctor to decide what medical care is necessary, and life-saving treatments are very different from discretionary, elective treatments.

Posted by Guest on Feb. 12, 2013 @ 10:13 am

And your proof that these procedures are not live saving is what, exactly?

Posted by marcos on Feb. 12, 2013 @ 10:22 am

of dying or getting sick if she doesn't have it.

Ditto nose jobs, tuck jobs and so on.

Posted by Guest on Feb. 12, 2013 @ 10:36 am

How about answering the question instead of answering a different question that nobody asked you?

I don't pretend to understand the 'whys' of medical necessity but I don't have to for there to be a medical necessity that you've not come close to undermining.

Posted by Guest on Feb. 12, 2013 @ 11:14 am

doesn't necessarily save your life or your health. Cosmetic surgery is neutral or worse for your health, which is why most health insurance plans I have seen do not cover them.

Ypu seem to be arguing that we should have different rules for, say, breast alteration surgery depending on whether the woman wants to stay a woman rather than to look like a man.

I oppose that kind of discrimination in healthcare.

Posted by Guest on Feb. 12, 2013 @ 11:54 am

But I bet that you have no problems with Viagra being covered under insurance plans, huh?

Ain't no medical necessity for sex, right?

Posted by Guest on Feb. 12, 2013 @ 12:07 pm

Wanting to have bigger or smaller tits addresses no such diagnosis.

Posted by Guest on Feb. 12, 2013 @ 12:23 pm

People don't need to be able to get it up and fuck to survive, that is merely cosmetic.

Posted by Guest on Feb. 12, 2013 @ 12:39 pm

The species can survivie perfectly well if people never change their appearance.

Posted by Guest on Feb. 12, 2013 @ 12:48 pm

ED is not a disease.

Posted by Guest on Feb. 12, 2013 @ 12:53 pm

Me wishing I was a woman is not.

Posted by Guest on Feb. 12, 2013 @ 1:10 pm

Whatever they call gender dysphoria these days is also a treatable medical condition.

Posted by marcos on Feb. 12, 2013 @ 5:52 pm
Posted by anon on Feb. 12, 2013 @ 6:04 pm

Gender Identity Disorder is classified as a medical disorder by the ICD-10 CM and by the DSM-IV TR. The upcoming DSM-5, however, will remove the diagnosis and replace it with a related diagnosis called "Gender Dysphoria."


Posted by marcos on Feb. 12, 2013 @ 9:42 pm

booted off the DCCC. I'm happy the poor dear has landed on his feet and found a whole new cause to join in with his SEIU "organizing."

Posted by Lucretia Snapples on Feb. 11, 2013 @ 4:20 pm

HI Tim,
I want to thank you for your interest in this topic. It's so exciting that you are offering the opportunity to discuss such important issue for transgender people who are struggling for healthcare in the face of discrimination from the public at large and insurance providers.

Here is some background information from the Center for American Progress to help some of the folks who have questions about the issues...

What are the health care needs of transgender people?
Transgender people require much of the same medical care that is provided to nontransgender people. Transgender people need acute care when they are sick and preventive care to keep from becoming ill, including services that are traditionally considered to be gender specific—such as Pap smears, prostate exams, and mammograms. Transgender patients may require a mix of such screenings. Medically necessary preventive screenings for a transgender woman, for example, may include both a mammogram and a prostate exam.
Transgender people who use medical treatments as part of gender transition also require access to many of the same services that are regularly provided to nontransgender people. The same hormone therapy used in gender transition, for example, is provided to patients with endocrine disorders and to women with menopausal symptoms.
Are services related to gender transition medically necessary?
Yes. Major expert associations agree that transition-related medical services, including mental health services, hormone therapy, and surgery, are medically necessary for many transgender people. The American Medical Association; the American Psychological Association; the American Psychiatric Association; the American Academy of Family Physicians; the American Congress of Obstetricians and Gynecologists; the Endocrine Society; the National Association of Social Workers; and the World Professional Association for Transgender Health have all issued public statements to this effect. According to these expert associations, determination of the medical necessity of any particular transition-related service for an individual patient properly rests with medical providers, not insurance companies.
Do insurance plans usually cover care for transgender people?
Unfortunately, despite significant advances, many insurers continue to rely on outdated assumptions about transgender people to justify discriminatory transgender-specific exclusions in their policies.
Still, the trend of offering nondiscriminatory, comprehensive coverage for transgender people is growing. An increasing number of health insurers are offering plans without transgender-specific exclusions, and many are also including affirmative statements of coverage for treatments needed for gender transition.
Some of the insurers offering inclusive plans include Aetna, Blue Cross Blue Shield, Cigna, Kaiser Permanente, and UnitedHealthcare. Many employers are also offering comprehensive coverage to their transgender workers. Currently, more than 25 percent of Fortune 100 employers, including Kraft Foods, Microsoft, and Nike, offer equal coverage for their transgender employees.
What are transgender-specific exclusions?
Many health insurers specifically target the transgender population for denial of services provided to nontransgender people under the same plan. In some instances these exclusions apply only to surgical treatments while permitting coverage for other benefits, such as mental health services and hormone therapy. In many cases, however, the exclusions are sweeping, excluding, for example, coverage of any “services, drugs, or supplies related to sex transformation.”
Transgender-specific exclusions are unacceptable on both medical and ethical grounds. They arbitrarily target transgender people for discrimination by forcing them to pay out-of-pocket for the same medically necessary services provided to nontransgender people.
As discussed above, many medical services needed by transgender people during transition and at other points in their lives are part of the course of care required for other medical conditions and are routinely covered by health insurance plans. Hormone therapy, for instance, may be utilized for patients with low testosterone or estrogen levels or other endocrine disorders. Preventive care services such as pelvic or prostate exams are an important part of an overall health regimen for all individuals, while various surgeries and reconstructive procedures are commonly covered for treating injuries and intersex conditions, or for cancer treatment or prevention.
Moreover, insurers frequently expand such exclusions in practice to deny transgender people coverage for basic services that are unrelated to gender transition. Take the outrageous example of a transgender woman in New Jersey who was denied coverage for a mammogram on the basis that it fell under her plan’s sweeping exclusion for all treatments “related to changing sex.” It took a two-year appeal process and intervention from the Transgender Legal Defense and Education Fund before the insurer agreed that the exclusion had unfairly prevented her from receiving medically necessary care and reimbursed her for the mammogram.
Are insurers being honest when they classify transition-related care as “experimental” or “cosmetic”?
No. The idea that transition-related care is experimental or cosmetic reflects assumptions that are out of step with medical knowledge. For more than half a century, medical professionals have researched and provided care to support gender transition that is safe, effective, and necessary for many people. The American Medical Association has specifically rejected classifying transition-related care as either experimental or cosmetic, and the U.S. Tax Court has likewise held that transition-related care is not cosmetic.
If transgender exclusions are removed from a plan, does it then have to cover any service provided to a transgender patient?
No. Removing transgender exclusions simply recognizes that coverage determinations and benefits design must be based on medically and actuarially sound principles, rather than on outdated assumptions. Removing transgender-specific exclusions also does not prohibit plans from denying coverage for services that are not medically necessary, that are experimental, or that are comparatively more expensive than other treatments.
If exclusions for transition-related care are removed from an insurance plan, does that create a new set of benefits that must be covered?
No. Eliminating discriminatory benefits exclusions does not mandate coverage for a new set of services in addition to those already covered by a given plan. Removing these exclusions guarantees that transgender people will be able to get equal coverage for the same medically necessary services that are covered for nontransgender people. The only requirement that would be placed on insurers is common sense: They must base their coverage determinations on sound medical and financial grounds rather than on arbitrary discrimination against transgender people.
Will removing exclusions for transition-related care increase costs?
No. The California Department of Insurance released an economic impact assessment in April 2012 comparing the costs and benefits of a California law prohibiting insurance discrimination against transgender people. The Department concluded, “the benefits of eliminating discrimination far exceed the insignificant costs,” and that there was an “immaterial” impact on premium costs.
Actuarial projections of the cost of removing exclusions frequently employ incorrect assumptions about cost and utilization. In 2001 the city of San Francisco, for example, removed transgender-specific exclusions from the coverage it offers to its employees and introduced a rider for medically necessary care related to gender transition. To meet the high cost projections, which were based on faulty expectations of a large number of transgender people requiring numerous surgical procedures, the city charged $1.70 more per month for each enrollee. Over the next several years, the city experienced a net surplus resulting from the premium increase: From 2001 to 2006 San Francisco collected $5.6 million in excess premiums and paid out only $386,417 on 37 claims. As a result, the rider was dropped and the city affirmed coverage for medically necessary transition-related care as part of its core benefit package.
Other jurisdictions covering transition-related care have had similar experiences. In 2011 the city of Portland determined that the cost of offering equal coverage for transgender employees would only amount to .08 percent of the city health insurance budget, and the city now provides these benefits to its employees.
Are there benefits to removing transgender-specific exclusions?
Yes. Removing transgender-specific exclusions improves the health of transgender people. The California Department of Insurance assessment found improved outcomes for some of the most significant health problems facing the transgender population, including reduced suicide risk, lower rates of substance abuse, improved mental health outcomes, and increased adherence to HIV treatment regimens. Removing exclusions is also important for employers, as it helps attract and retain a diverse and talented workforce, increases employee comfort and productivity, and eliminates time wasted on time-intensive appeals and negotiations regarding reimbursement for health care services.
Right now, arbitrary and outdated insurance exclusions are preventing transgender people from accessing the health care they need to be safe, happy, and whole. But it doesn’t have to be like this. All it takes to help end insurance discrimination against transgender people is a simple change that doesn’t impact the bottom line, but that makes a world of difference for transgender people.

Posted by Gabriel Haaland on Feb. 11, 2013 @ 4:33 pm

But what about Marcos' point that this is a tangential issue motivated primarily by Gabriel's experience which has almost ZERO impact on the larger working class? Why are progressives far more motivated by tangential, emotionally-laden issues like this vs. making sure the working class is taken care of first?

Posted by Lucretia Snapples on Feb. 11, 2013 @ 5:08 pm

another example of what Marcos has shown is a self-defeating obsession with trivia.

Hey, if someone wants to change their sex, then fine. But is it not my problem, nor my financial liability.

Posted by Guest on Feb. 11, 2013 @ 5:38 pm

I did not say that it was tangential, it is integral. However it only impacts a few hundred thousand people in the US. It is like the labor and nonprofit left are trying to figure out how to make themselves as irrelevant as possible to most folks by ignoring the big ticket issues that are driving most all of us to the risk of debt peonage and focusing on very narrow issues.

Of course all of this health care should be provided. There are a lot of things more broken about the health care system and health care finance that organizing around would make labor relevant to tens of millions. But the cultural notion prevalent on the labor and nonprofit left is that the most vulnerable come first because they fear that if anyone else got anything, we'd just ignore them and move on. Serious insecurity. Sorry folks are insecure, but that is not a justification for condemning tens of millions to debt peonage and Obamacare.

Posted by marcos on Feb. 11, 2013 @ 6:08 pm

Democrat majority in Congress, let alone a majority of the people. Even so, the very idea of it led to the successes of the Tea Party. Non starter.

Posted by Guest on Feb. 11, 2013 @ 6:20 pm

The Senate Finance Committee cut a deal that killed the public option.

The ACA will be the death yet of the Democrat Party.

Posted by marcos on Feb. 11, 2013 @ 7:16 pm

Congress listened. But for that, there would be no Tea Party. Great job.

Posted by Guest on Feb. 12, 2013 @ 7:59 am

Go figure.

If you were a corporate mouthpiece trying to cover the fact that your boys have democracy beat all hollow, wouldn't you also simply claim that it is the will of the majority that is being served when politicians scramble for corporate favor?


1 Progressive ideas are not popular

2 Only corporations pay tax

3 Social Security adds to the deficit

4 Poor people here are actually quite wealthy.

5 Rent control represents newcomers subsidizing those already here.

6 Only whiners show up at public meetings

7 Progressives have situational ethics

8 Progressives ignore pressing problems while promoting pet projects.

9 Anybody who thinks the police must have proper civilian oversight is a "cop hater."

10 San Francisco "exceptionalism" is behind pro-democratic intitiatives

Posted by lillipublicans on Feb. 12, 2013 @ 8:21 am

the Dem's nixxed the public option. And then lost the house in the mid-terms anyway.

Posted by Guest on Feb. 12, 2013 @ 9:07 am

"The people," in the best of the Reaganist tradition, were the insurers, pharma, hospital chains and medical device makers. No flesh and blood human being persons need apply.

Posted by marcos on Feb. 12, 2013 @ 9:39 am

were outraged with the idea of the extra costs and the idea of "death panels" deciding who to treat.

Posted by Guest on Feb. 12, 2013 @ 9:52 am

that drew less than 15,000 people were eerily similar to the Million Man March, the March on Washington, or the numerous anti-Vietnam and Iraq War demonstrations.

Aren't you advocating "death panels" for transgendered people?

Posted by Eddie on Feb. 12, 2013 @ 10:27 am

adolescent girl who wants a nose job so she can get more dates.

Posted by Guest on Feb. 12, 2013 @ 10:37 am

drew nearly half a million people.

I think you err when you dignify the Tea Partiests by such a comparison.

Posted by lillipublicans on Feb. 12, 2013 @ 3:22 pm

I was contrasting the paltry attendences of Tea Party events with those with real mass appeal like the ones I listed. I picked the Million Man March because I just recently watched "Get On The Bus" for the first time.

Posted by Eddie on Feb. 12, 2013 @ 3:43 pm

The million man march had it's 15 minutes of fame and then vanished.

Posted by Guest on Feb. 12, 2013 @ 3:46 pm

The Democrats lost the mid term 2010 elections because Obamacare was a kick in the groin to the base who got abandoned in favor of the insurers, pharma, hospital chains and device makers. The Democrat base was demoralized and demobilized while the Republican base was angered. That's how election results turn.

Posted by marcos on Feb. 13, 2013 @ 6:49 am

when the elft lose an election to the political center and then claim that they only lost because they were not left-wing enough!

That's like Romney saying he would beaten Obama if only he had been more right-wing.

Do you ever listen to yourself?

Posted by anon on Feb. 13, 2013 @ 7:44 am

Nothing wrong with Marcos' analysis.

The Tea Party is an astroturf movement funded by the Koch brothers and their friends.

Posted by Eddie on Feb. 13, 2013 @ 8:12 am
Posted by anon on Feb. 13, 2013 @ 8:35 am