For transgender people, getting health insurance to cover the transition from their existing sex to their identified sex can be a challenge. But for Jersey City workers, that will no longer be a concern starting on January 1.
Mayor Steven Fulop announced this week that the city will cover transgender-related healthcare, including surgeries and hormone therapy for city employees. The announcement was hailed by transgender-rights advocates, who said the city would be the first municipality in New Jersey and among the first nationally to add this type of coverage for workers.
The announcement reflects a growing move nationally to eliminate exclusions for the process known as gender reassignment, affirmation, or confirmation.
The American Psychological Association defines these terms as the alteration of transgender people’s bodies “through hormones, surgery, and other means to make their bodies as congruent as possible with their gender identities.”
In recent years, many of the largest companies have added coverage for transgender healthcare, and the federal government has signaled that it will bar most insurance plans from categorically denying gender-transition care. But even supporters like Fulop acknowledge that it’s a change that’s uncomfortable for some.
“Difficult decisions come across my desk all the time, and I could proudly say that this is not one of them,” Fulop said. “This is obvious and we feel this is the right thing to do. Transgender Americans face a unique injustice. The care they need — including gender-affirmation surgery – is as essential as heart bypass or cholesterol medications.”
The policy will apply to the city’s 3,500 workers, although Fulop and supporters expressed hope that other local government employers will adopt similar coverage. Fulop said he’s unsure how many employees will use the services, but city officials expect it to cost $100,000 to $500,000 annually.
While unusual in the public sector, transgender coverage is becoming increasingly common in the private sector. Two-thirds of Fortune 500 companies have transgender-inclusive healthcare, including New Jersey-based corporations like Johnson & Johnson, Prudential, Merck, and Chubb, according to advocacy organization the Human Rights Campaign.
Fulop announced the new policy outside of Jersey City Hall, flanked by two transgender women – longtime activist Barbra “Babs” Siperstein and Garden State Equality executive director Andrea Bowen. Fulop said the policy arose from a conversation with the activists about changes they would like to see.
Siperstein said: “This is a special day, and as a Jersey City native, it is great to be back in Jersey City.”
Siperstein said that covering the services shows respect for the fact that transgender people’s lives are similar to those of others.
“It’s all about respect — and transgender people, we live the same lives,” she said. “I’m a parent and grandparent. Why can’t we have respect?”
Fulop cited statistics that two in 10 transgender people have been refused healthcare, and one in three face significant delays in getting medical attention.
“If there is a valid reason for keeping things this way, I don’t think any of us have heard it, so today we are going to change that,” Fulop said. “As a mayor, I am proud of this new policy, and as a human being, I am certainly standing a little taller today.”
He added, “the fight for transgender rights is not done. In many ways it is just beginning. There will be more new policies, more education, more change to come. And after all that there still will be holdouts, people for whom the mention of transgender issues will always be uncomfortable.”
“Today, however, at least we are declaring for government in Jersey City, and hopefully the message goes far beyond this, we stand on this issue very tall. Government doesn’t exist to make us comfortable, it exists to let us be us.”
Bowen said that while the state is a national leader in protections for lesbian, gay, bisexual, and transgender people, “we’re shockingly lacking in provision of healthcare for trans people.”
She said that before her transition, “I had sort-of an existential cloud over my head. I knew I was a woman but I was living as a guy, and I sort-of felt myself slowly crumbling.”
“It was when I was able to get this kind of healthcare, this transition-related care, being able to go on hormones, being able to make my body look as I wanted it to look, I began to feel like the happier, fullest version of me,” Bowen said.
Bowen noted studies that indicate transgender people have better mental-health outcomes, including lower rates of suicide.
She condemned a state policy that excluded gender reassignment from individual health plans, including both those sold in the federally operated marketplace created through the Affordable Care Act, and those sold outside of the marketplace. This policy would be reversed for the ACA plans if a federal draft policy barring categorical denials of transition services is adopted.
“It’s wildly unfair,” Bowen said. “It will probably be illegal before too long.”
Bowen said her own New Jersey-based health insurance policy excluded transition-related care. But her doctor submitted the claim for her hormone medication under a code for other healthcare services.
“Not all doctors know how to do this, or know that that’s what should be done,” she said.