It was announced on December 19, 2012 by the Oregon Insurance Division of the Department of Consumer and Business Services that private health insurance companies could no longer discriminate against trans policy holders.
Transgender advocates have been lauding the regulations, which prohibit denying coverage of hormone therapy, hysterectomies, mastectomies, and other medically-necessary treatments for gender dysphoria and sex-reassignment surgery. Even though many of these surgeries are already protected for non-trans policy holders, the law now specifically prohibits denying coverage for a surgery because the recipient is trans. The regulations also expand mental health services to include trans policy holders.
Being transgender is considered a mental health disorder known as Gender Identity Disorder in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) – a highly controversial decision. On December 2, 2012, the APA announced that it would be removing Gender Identity Disorder from DSM-V and replacing it with Gender Dysphoria. The difference is that GID focuses on whether a person feels their birth sex and gender are in alignment, and GD focuses on the anguish caused by being unable to make the alignment between sex and gender. For example, a person who might be diagnosed with GID doesn’t necessarily suffer from dysphoria if they have access to gender reassignment surgery, but a person who might be diagnosed with GID could suffer dysphoria if they’re prevented from getting medical treatments and surgeries to change their sex to suit their gender.
In the US, payment for health care treatment by insurance companies, Medicare, and Medicaid relies on the diagnosis of a specific disorder categorized in the DSM-IV. Some say the “disorder” should be struck because it inappropriately stigmatizes trans identities, much like homosexuality was until 1973, and some say it’s necessary in order for trans people to receive the health care they need, such as gender reassignment surgery. The American Psychological Association seems to agree that it is not being trans that causes the requisite distress or disability that qualifies a psychological state as a disorder, but rather the social stigma, discrimination, violence, and difficulty obtaining access to health care that trans people face.
For more information on what being trans means, you can visit the APA’s website on sexuality and gender identification.