Kalani Bright has already had to pay more than $34,000 for sex reassignment procedures after losing a three-year battle to have her health insurance cover them.
Now the 42-year-old transgender woman is due to undergo another voice surgery, but her insurance still won’t cover the costs as it is considered cosmetic rather than medically necessary.
“It’s really frustrating and it puts you in a mental state where you see what your issues are,” Bright said. “Because you spend years talking about it, you feel like you’re not going anywhere.”
She is one of many transgender people who could benefit from a bill passed by the Legislature and awaiting Governor David Ige’s approval.
Hawaii passed a law in 2016 which prohibits insurance companies from discriminating against transgender people. However, advocates say insurers still refuse to cover gender confirmation procedures claiming they are cosmetic and not medically necessary.
House Bill 2405 would close the gap by prohibiting health insurance providers from applying “cosmetic or general categorical exclusions” to prescribed gender confirmation treatments or procedures.
The measure lists examples including hormone therapies, hysterectomies, mastectomies, voice training, feminizing vaginoplasty, masculinizing phalloplasties, metoidioplasties, breast augmentations, masculinizing chest surgeries, facial surgeries, thyroid chondroplasties of reduction, voice surgeries and therapies, and electrolysis or laser hair removal.
The bill would also define the process for appealing a denied application due to medical necessity. It also obliges health insurers, mutuals and health insurance organizations to provide applicants with clear information on coverage.
Two of Hawaii’s major insurers, Kaiser Permanente and the Hawaii Medical Service Association, said they support the intent of the bill, but called for technical changes due to concerns the new law could potentially increase the cost insurance and premiums.
In previous written testimony, HMSA Assistant Vice President Matthew Sasaki said the additional procedures would cost the insurance provider $7.7 million.
HMSA did not respond to a request for comment on its position after the Legislative Assembly passed the bill. Kaiser said he supports the final version.
“We are proud to offer gender-affirming services that ensure respectful, equitable and inclusive care for all of our transgender and gender-diverse patients and members wherever we provide care,” the insurer said in a statement. sent by email.
Representative Aaron Ling Johanson, who sponsored the bill, said it was an important step towards equity in care.
“It is important to ensure that in gender-affirming care, insurers cannot inadvertently or consciously discriminate,” he said, calling the procedures “an important and essential part of care. gender and a person’s successful transition”.
Ige has until June 27 to announce his intention to veto.
Jen Jenkins, a transgender rights advocate who helped draft the measure, said “the goal is to prevent insurers from describing things as cosmetic.”
However, Jenkins fears that insurers are no longer finding loopholes such as adding administrative burdens that could discourage transgender people from seeking treatment. This means either more paperwork or steps that could delay proceedings.
“The fight for trans health and health care in general will probably never end under capitalism, but this (bill) is a great way to bring people together and signal that Hawaii is different and moving in a direction different than other states,” Jenkins said.
A constant fight
east hawaii considered an LGBTQ-friendly state compared to many others. But D. Ojeda, the main national organizer of the National Center for Transgender Equalitysaid it was still common for transgender people to have to fight to have their procedures covered.
Ojeda cited “misinformation and misunderstanding of what these health services mean for trans people.”
Ojeda said health coverage for these gender affirmation procedures is vital to the mental health of the transgender community.
“Surgical care not only improves mental health, it improves your own body, and it also improves the quality of our lives,” Ojeda said. “When we don’t have access to gender-affirming care, it can lead to deadly situations like suicide and also violence. If people know we’re trans, there’s a level of violence that goes with, so surgical care in particular is key to our livelihood.
Last year, Breanna Zoey Connors said she considered suicide after being denied coverage for various gender-affirming services, such as breast augmentation, tracheal shaving and other products for the face. The 38-year-old noted that her care provider said her surgeries were not medically necessary.
“It was just awful at one point, yeah, I didn’t want to live anymore,” said Connors, who took a second job as an Uber driver to help cover the costs.
After months of resistance, Connors said she was able to get HMSA to cover the costs of her breast augmentation and some facial procedures late last year, and is now working on getting her insurance to cover her facial electrolysis procedure.
She also said many transgender people might feel too intimidated to push back against insurance companies.
Connors acknowledged that the new bill isn’t perfect.
“It won’t solve all the problems with insurance companies,” she said. “There’s a lot of anticipation, but the intention is to give trans people the coverage they need (and) to put an end to these nonsensical denials.”