Transition process of transgender person from male to female.
According to the Human Rights Campaign Corporate Equality Index, the of employers worldwide that “provide at least one transgender-inclusive healthcare coverage plan” rose from 49 in the 2009, to 278 in the 2013, and are now at 647 this year.
There are names on the list one might expect by perceived progressive companies like Apple, Facebook, Google, and LinkedIn. There are also other businesses on the list perceived as more conservative such as Campbell Soup, Exxon Mobil, or Marriott.
Of course, removed from this list of employers will be the U.S. Armed Forces. As was reported last month, Trump officially banned transgender people from serving in the military. His ban also orders that the Pentagon stop paying for gender reassignment surgeries (except in cases that are already in progress).
Yet, clinical transgender services are now truly available. NYU Langone Health in New York offers transgender surgery services. The services include plastic and reconstructive surgery, urology services, adolescent medicine, psychiatry and mental health, vocal surgery and voice therapy, gynecology and reproductive endocrinology, and gender and health education. The number of services for support and care underscore the complexity and cost associated with transgender surgery.
In Chicago, The Center for Gender Confirmation Surgery at Weiss Memorial Hospital states on its website that it is “one of only a handful of centers in the country that offers a comprehensive approach to gender confirmation surgery.” The site also confirmed that the number of insurance plans that offer coverage for gender confirmation surgery is increasing.
Of course, for employers who are self-insured, the issue of healthcare coverage is a matter of dollars and cents. It is also a matter of delivering great benefits to employees. With the latest U.S. Military news, covering transgenders is now a larger public relations, or perception issue.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Still, the reason that companies want to provide healthcare benefits is to have happy, healthy productive workers. Plus, a great health benefit can help employers attract and retain the best employees. And, offering health coverage to more types of people can expand the pool of candidates.
It is important to understand the number of transgender persons in the U.S. for two purposes:
- the potential cost to a health plan should a person be covered; and
- the percent of people a company may eliminate as candidates for employment.
According to The Williams Institute at UCLA School of Law, “approximately 0.6 percent of adults in the United States, or 1.4 million individuals, identify as transgender.” According to a Rand study, Assessing the Implications of Allowing Transgender Personnel to Serve Openly, 1,320 to 6,630 of 1.3 million active duty service members may be transgender. This is between 0.1 percent and 0.5 percent of all personnel.
The cost of transition is around $150,000 for a litany of services. This estimate is based upon a price list from The Philadelphia Center for Transgender Surgery.
Many, if not most, employer health plans do cover costs for more widespread ailments like heart disease, diabetes, and colorectal cancer cases. There are 30.4 million people in the US who have diabetes according to the CDC, which is 9.4 percent of the US population. CDC stats also show the following:
- In 2014 (the most recent year numbers are available) 139,992 people were diagnosed with colorectal cancer.
- Every year about 735,000 Americans have a heart attack. According to Millions Heart (a CDC site), heart disease and stroke cost the nation an estimated $316.6 billion in health care costs and lost productivity in 2011. By 2035, according to the American Heart Association, heart disease costs for the U.S. will exceed $1 trillion.
In reality, the cost implication of providing health coverage for transgenders is minuscule compared to other chronic diseases. It seems that overall cost is not the issue, especially when 0.1 percent to 0.5 percent of a workforce may make a claim for these services
It is a PR issue and human rights issue for major employers. That’s why more employers have removed transgender exclusions from their health insurance contracts.
Some U.S. workers would never work at a company that covers transgenders. But for others in the workforce, they would never work at a company that excludes coverage to transgenders.
Employees have to feel good, or at least OK, about where they work. So, will the U.S. military be better off with a purge of between 0.1 percent and 0.5 percent of personnel? Are companies better off taking a stand and automatically vetting their candidate pool?
The issue is clearly not the total cost of covering transgenders at companies or the military compared to other chronic diseases in America.
Meanwhile, we are at 647 and counting.
Illustration: Sudowoodo, Getty Images
