The Biden administration is using a Trump-era policy to approve the expansion of health care coverage for transgender Coloradans, forcing many of the state’s private insurers to cover gender-affirming care.
Former President Donald Trump’s 2018 policy allows states to redefine the essential health care benefits insurers are required to cover under the Affordable Care Act. On Tuesday, the Biden administration used it to approve Colorado’s request to add gender-affirming care among its health plans’ guaranteed benefits.
The move will force individual and small-group insurers to cover transition-related procedures, including hormone therapy, breast augmentation and laser hair removal, starting Jan. 1, 2023.
Federal officials and Colorado Gov. Jared Polis, one of two openly LGBTQ governors, said they hoped the measure would serve as a model to expand gender-affirming care in other states. The Biden administration also cited discriminatory barriers that transgender Americans frequently face when they seek transition-related care, often described as cosmetic.
“Health care should be in reach for everyone; by guaranteeing transgender individuals can access recommended care, we’re one step closer to making this a reality,” Health and Human Services Secretary Xavier Becerra said in a statement Tuesday. “I am proud to stand with Colorado to remove barriers that have historically made it difficult for transgender people to access health coverage and medical care.”
Medicaid covers gender-affirming care in more than a dozen states, including Colorado. But only a handful of states, including Massachusetts and Washington, have policies similar to the new Colorado measure, requiring many private insurers to cover transition-related care.
As a result, nearly half of transgender Americans — including 54 percent of trans people of color — say that their health insurers covered only some of their gender-affirming care or that they had no providers in network, according to a survey last year by the Center for American Progress. The report found that 46 percent of trans respondents and 56 percent of trans respondents of color were denied gender-affirming care by their insurers.
Dr. Alex Keuroghlian, the director of the National LGBTQIA+ Health Education Center at Boston’s Fenway Institute, who works directly with transgender patients, applauded the Biden administration’s new measure.
“What we’ve learned the hard way is that private insurers and employers won’t necessarily have these equitable policies around coverage of medically necessary gender-affirming care without the government enforcing such expectations,” he said.
Keuroghlian said that when Massachusetts similarly expanded coverage for transgender patients in 2014, he had to modify his schedule to keep up with the demand.
“We saw a remarkable increase in trans and diverse community members pursuing gender-affirming care because they didn’t have to pay out of pocket,” he said.
Many health insurance companies and lawmakers describe transition-related procedures as cosmetic, but many of the country’s leading health institutions say they are vital.
“In our mind, there is no debate,” said Dr. Jesse Ehrenfeld, the first and only openly LGBTQ board member of the American Medical Association. “These transition services and gender-affirming care for transgender patients are medically necessary. That’s what the science has demonstrated.”
Trans advocates have also long argued that transition-related procedures can help trans people more easily assimilate into society and avoid targeting.
“We are trying to eliminate trauma and discrimination in our lives,” said Lourdes Ashley Hunter, the founder and executive director of the advocacy group Trans Women of Color Collective. “And if that means that I need to get facial feminization so that when I go to the store or market I’m not being harassed and I’m doing so freely and safely, then so be it.”
The Biden administration’s approval of Colorado’s health care request aligns with the president’s campaign pledge to expand medical care for transgender Americans. It also follows the administration’s decision in May to reinstate federal discrimination protections for trans patients, which the Trump administration had rolled back.
Conversely, some states led by Republicans have tried to limit access to care for trans Americans.
In April, Arkansas became the first state to ban health care providers from providing trans youths with gender-affirming care, with legislators in favor of the measure arguing that they wanted to protect children from procedures they would regret later. Similar bills have been introduced in dozens of other states, including Texas.