-- Right-gender expression requires initial surgical correction of anatomic differences plus a lifetime of hormonal treatment.

-- Transsexuals have a unique health maintenance schedule (mammograms, pap smears, prostate screening, etc).

-- Transsexual health care records must be handled carefully in order to preserve privacy.

Unfortunately transsexuals are medical orphans;  the vast majority of health care programs specifically deny medical care for transsexuals.  They definitely prohibit any procedure that would contribute to right-gender expression, but often the prohibition extends to denial of even usual coverage.  Federal programs such as Medicare, Medicaid, and the Veteran’s Administration exclude transsexuals.

Justification for the exclusion centers around the Old Paradigm concept that transsexuality is a choice, so the surgery is elective & cosmetic.  (Even though both the American Medical Association and the American Psychiatric Association have ruled that it’s not.)  In addition religious extremists demand wrong-gender expression from transsexuals;  insurance denial promotes that end.

As a result transsexuals rank at the top of all minorities in mortality (including suicide) and in complications resulting directly from health care unavailability.  They rank lowest in quality of life and appropriate health maintenance.

Enter the current health care reforms.  Is there any hope for transsexuals?

FEDERAL HEALTH CARE REFORM
People who have insurance don’t want any changes;  people who don’t have insurance want access to medical care.  Insurance companies want tax dollars to pay the premiums for universally mandated insurance;  the general population is fed up with insurance companies.   There’s no doubt health reform is a volatile subject.

Heretofore the wealthy upper-half have dictated American health care policy.  The Haves have ignored the Have-Nots.  Health care has been a privilege of the upper-half.

Current initiatives for health care reform on the federal level (as passed in the House & pending in the Senate) are all based on making health insurance mandatory for the entire population.

EXCEPT most health insurance specifically excludes transsexual care.  Will health insurance discrimination continue?

The word “transsexual” appears nowhere in any of the 2000 page federal reform bills.  Both the House & Senate bills mandate NO exclusions from coverage.  …And then specifically exclude abortions and cosmetic surgery, just like before.  Congressional testimony has suggested that “Medical Necessity” will continue to be the basis for coverage.

That’s ominous.  In the past the same wording has resulted in transsexual exclusion.  Transsexuals may end up paying for mandatory insurance that excludes them from coverage.

Even so, religious extremists have voiced outrage about even the remote possibility of allowing right-gender expression among transsexuals--reform bills have been labeled "tranny-care" in the national press, as if allowing transsexuals in medical offices were some sort of scandal.  Transsexual exclusion may end up a price that the political majority pays for passage of the bills.

Advocates have therefore taken a “wait & see” attitude.  It’s better to pass the bill now and deal with coverage later.  Any mention of transsexuality in connection with the bill will almost certainly result in a specifically stated exclusion.

COLORADO HEALTH CARE REFORM
In the past three years Health Care Reform has also been a hot topic in the Colorado Legislature.  In January of 2008 a Blue Ribbon Panel released their recommendations—mainly a financial analysis of the various options.  On 21 April 2009 Governor Ritter signed the Colorado Health Care Affordability Act which taxes hospitals & providers to expand insurance coverage for about 100,000 previously uninsured (out of a total of 792,000 uninsured;  one-fifth of the state).

Should health care coverage come from a single source or from expanding current insurance coverage to the entire population?  The question was hotly debated throughout 2009, but foundered on a catastrophic budgetary shortfall.  The issue has been put on hold due to the actions being considered on the federal level.

Governor Ritter is working on a series of “Building Blocks” for health care reform based primarily on recommendations from the Colorado Department of Health Care Policy & Financing (HCPF). 2009 saw such initiatives as legislative controls on insurance premiums, electronic medical records, and mandatory coverage for bowel cancer screening & autism.  Various groups continue to lobby for inclusion of THEIR issues in the program.

Of course transsexuals would like to add their pleas to the long line of other supplicants.  However the term “transsexual” has yet to appear on any of the myriad of reports and forecasts—in spite of the high mortality in transsexuals of all ages, but particularly in adolescents.

Recognizing the power of the religious extremists, transsexual care is likely to fall outside the scope of coverage through the Colorado implementation of federally mandated insurance, if that ever happens.  Transsexuals would probably remain medical orphans in an America with “universal” health care coverage.

Given the events of January 2010, meaningful federal health care reform is unlikely.  How long will it take for Colorado legislators to re-engage?

The best and most humane response by Colorado would be inclusion of transsexuals in the CoverColorado emergency healthcare program.  CoverColorado provides coverage for people with lifelong conditions that aren’t covered by any other means. 

…And that change could be implemented immediately, to meet an immediate need.