After a years-long campaign by the Graduate Employees' Organization to expand healthcare coverage for transgender members, University of Michigan health plans will expand to cover new procedures to treat gender dysphoria.
All U-M health plans cover genital surgery, mastectomy in female-to-male transition, hormone therapy and counseling when medically necessary to treat gender dysphoria. As of July 1, the plans will also cover certain facial feminization surgeries, Adam's apple reduction and facial hair removal. New coverage will apply not only to graduate students but will be available to anyone with a U-M health plan.
"We could not be happier to hear that U-M and Blue Cross Blue Shield have finally come around to see the trans community's perspective. Transition coverage is medically necessary, and it's incredibly rewarding to see people's minds change so much on this matter," said Monica Lewis, chair of GEO's Trans Health Caucus.
This expansion in transgender health care is historic. Based on conversations with the university, and to the best of GEO's knowledge, it is GEO's understanding that this is the first time a public institution has extended coverage for these procedures. However, speech-language therapy and transfeminine top surgery (augmentation mammoplasty) are not covered for transgender employees on any U-M health plan, even after this extension. Moreover, the requirements for accessing covered procedures remain a source of inequity in health coverage that GEO organizers seek to address.
In order to access this coverage, transgender patients are required to submit themselves to mandatory psychiatric evaluation (with either one or two therapists, depending on the procedure) and to an extended, unnecessary waiting period.
"These barriers obstruct medically necessary health care in a way that many trans people, myself included, find invasive, dehumanizing, and profoundly condescending," Lewis said. "We are excited to continue our advocacy work. Other medically necessary procedures remain excluded, but we hope to come to a similar point of understanding about how the current coverage still fails to meet the needs of trans people in many ways."
GEO laid out recommendations for new coverage to the university in an April 2018 conference. A review of coverage was initiated by the university's Medical Benefits Advisory Committee, with its first meeting held in June 2018. The MBAC meetings were closed to the public, information about the proceedings was withheld, and GEO was not permitted to attend. GEO's requests to interface with the panel were denied.
More than 50 Graduate Employees' Organization members and allies lined the hallways of Wolverine Tower in January holding signs to urge the University of Michigan to cover gender-affirming surgeries.
The inclusion of transgender voices in the review process was a central goal for GEO organizers, though requests for open MBAC forums were denied twice. After organizing efforts by GEO, the university responded by allowing transgender people to discuss their concerns with the MBAC chair and the associate vice president of human resources.
GEO has a long history of advocating for improvements to transgender health care. In 2005, GEO proposed coverage for many procedures, including facial feminization surgery and permanent hair removal, and the university denied both at the time. The conversation that led to this most recent extension of transgender benefits started in GEO's 2016-17 contract campaign. The union brought forward a number of proposals related to transgender health equity during bargaining, with little progress.
After the GEO membership authorized a walkout, the university responded with significant movement on many of their demands, including an agreement to hold a series of "special conferences" to discuss the coverage and accessibility of treatment services related to gender dysphoria. The walkout was called off and the GEO membership ratified the new contract, signed in May 2017. The first meeting of the special conference series on transgender health care was in December 2017, and there have been three more to date (the most recent of which was in January 2019).
