THE GREATER GOOD
Sorry, Fox News, Trans Health Care Is Affordable
Fox News had a field day when it discovered Oregon’s Medicaid program covers transitional health care. But, it turns out, it costs taxpayers next to nothing.
When it comes to reporting on transgender issues, Fox News might as well replace the alphabet on their keyboards with buttons that say things like “sex change,” “taxpayers,” and “concerned parents.”
Last weekend, Fox News discovered that the state of Oregon’s Medicaid program has covered transition-related health care, including sex reassignment surgery (SRS), since January and that the medical age of consent in Oregon is 15. Put these two facts together and the sensationalist headline writes itself: “Oregon allowing 15-year-olds to get state-subsidized sex-change operations.” Other outlets followed suit, kicking up a fuss about “taxpayer-funded sex change[s]” and the dispersal of “state aid” to transgender teens.
But buried near the end of the Fox News report was the admission that transgender health care for all Oregonians who access it—not just the teens—may only cost $150,000 a year, according to an estimate from Oregon’s Health Evidence Review Commission (HERC). That figure is just a few thousandths of 1 percent of the billion-dollar Oregon Health Plan budget.
Providing transgender health care, it turns out, is a lot cheaper than some people want to admit.
Nico Quintana, the policy director for Basic Rights Oregon, an LGBT nonprofit that advocated for Oregon’s trans-inclusive Medicaid program, told The Daily Beast that the Fox News article, which relied heavily on quotes from a noted homophobic and transphobic physician, was “demeaning,” “reprehensible,” and sensationalistic.
Forget for a moment that the American Medical Association, the American Psychiatric Association, the American Psychological Association, and most major medical associations recognize that hormone therapy and SRS can be medically necessary treatments for gender dysphoria (PDF)—but science doesn’t seem to persuade the anti-transgender crowd.
If it’s money that Fox News viewers are actually worried about, there’s no cause for alarm: All available evidence to date suggests that the cost of providing transgender health care is low for governments and private insurers alike. Put down the pitchforks. Your taxes and insurance premiums are paying for far more costly and objectionable things than transgender health care.
Let’s start with the private sector. Employers and insurance providers tend not to comment on costs but, in 2013, the Williams Institute at the UCLA School of Law collected data from 34 employers that have trans-inclusive health plans (PDF). Of the 26 employers who disclosed specific health care costs, 85 percent reported no premium increases from adding the coverage in the first year. And of the 21 employers who shared data on employee utilization, two-thirds experienced no actual costs from implementing the coverage.
“Overall, we find that transition-related health care benefits have zero or very low costs, have low utilization by employees, and yet can provide benefits for employers and employees alike,” the report concluded.
The secret behind these low costs is low utilization. Transgender people might seem ubiquitous in the current Caitlyn Jenner-dominated media moment but the total population in the U.S. is actually quite small. A recent study places the national figure at 700,000, although that may be a low estimate. To put these numbers in perspective, the total number of transgender adults in the U.S. is comparable to the number of people who receive a knee replacement each year—a procedure that costs an average of $30,000, less than many estimates for a vaginoplasty.
When the initial pool of potential transgender employees is so tiny, the odds of an employer having to pay for dozens of costly surgeries per year are virtually nonexistent. The Williams Institute report estimated that between 1 out of 10,000 and 1 out of 20,000 employees utilized transgender health care, depending on company size—the smaller the company, the better the chances you have at least one transgender employee. These utilization rates are comparable to the 1 in 12,000 lifetime chance of being struck by lightning.
But with transgender people experiencing twice the rate of unemployment as the general population—due, in large part, to employment discrimination—perhaps the Fox faithful are concerned that they will be more of a burden on governments than they are on corporations.
That’s not so, either. According to the Transgender Law Center (TLC), seven states and the District of Columbia explicitly cover transition-related health care through Medicaid programs. Oregon, which began covering transition-related care in January, expects that only about 175 people—less than five thousandths of 1 percent of the state’s population—will access the state’s transition-related coverage in any given year.
If that estimate seems too low, data from further down the West Coast would suggest otherwise. The University of California system (UC) has provided transgender health care to its employees since 2005. UC managed to add the coverage without any increase in its premium and, by 2011, it had only paid for 28 procedures (PDF)—an average of less than six procedures a year among a body of over 150,000 faculty and staff.
San Francisco has also been providing transition-related care to government employees since 2001. The city initially estimated that there would be whopping $1.75 million in claims annually but a 2006 report found that there had been less than $77,000 in claims per year for the first five years.
The average additional cost of health care for each employee came out to less than a dollar per year, about a third of a single tall Starbucks latte—that is, it used to cost that much before the insurance providers decided to integrate the trans benefit with their standard coverage due to its “obvious affordability” (PDF).
But why was San Francisco’s initial estimate so high? According to the TLC (PDF), consultants who produce these estimates sometimes assume that all transgender people want surgery, that they will all seek the most expensive surgery, and that they will undergo a new surgery every year. None of these assumptions are true. A transgender man only needs so many penises, after all, if he even wants one in the first place.
Overestimates like these also seem largely responsible for the outcry over the provision of transgender health care to prisoners—another favorite Fox News punching bag. After a district court ordered the California Department of Corrections and Rehabilitation to provide SRS to transgender inmate Michelle Lael Norsworthy this year, a state spokesperson told media outlets it could cost up to $100,000, which the TLC, in turn, called a “gross exaggeration.”
Some right-wing outlets conveniently left that estimate uninterrogated and it became the most frequently-quoted dollar amount in media discussions of Norsworthy’s case. And along came the sensational headlines, like this Breitbart classic: “Sex Change Now Courtesy of the American Taxpayer.”
Even at $100,000, Norsworthy’s procedure would be a drop in the bucket for a state department that has a $1.5 billion budget for adult medical services. And Americans should probably be more concerned about any number of taxpayer expenses like, say, the billions of public dollars spent on NFL stadiums instead of a spare $150,000 for transgender Oregonians.
The small price tag of transgender health care comes with a lot of benefits, too, whether provided by a government or a corporation. From a public health perspective, trans health care improves mental health, saves lives, and it may save money long-term, especially if more providers start to cover it.
“Here’s the way I like to think of it,” said Harper Jean Tobin, the director of policy for the National Center for Transgender Equality (NCTE) before providing this explanation to The Daily Beast:
“Say that there’s a medical condition that a very small number of people have but that is very serious for those who have it. Say that there’s a proven effective treatment used for years and supported by all the major medical associations. Say that most members of the public don’t understand the condition or the treatment but doctors know that it works and that it not only improves patients’ health, it avoids life-threatening negative outcomes of leaving the medical condition untreated. It’s a no-brainer insurance should pay for that and that it will cost more in the long-term to be dealing with the symptoms and complications…than it does to provide the proven recommended treatment.”
According to the Williams Institute survey, the private sector also stands to benefit from trans-inclusive health care because it increases diversity and helps to attract talent. Sixty-two U.S. colleges and universities also cover hormones and surgeries for trans students, benefits that are quickly becoming marks of prestige in a competitive admissions landscape.
But if these benefits mean nothing to you, if you still take your transgender talking points from Sean Hannity, and if you still believe—in spite of all the evidence to the contrary—that being transgender is a mental illness, the available financial data is still the same. Talk is cheap but providing transgender health care may be even cheaper.