Cosmetic to critical: Blue states help trans health coverage

PORTLAND, Ore. — For most of her life in New Mexico, Christina Wood felt like she had to hide her identity as a transgender woman. Six years ago she moved to Oregon, where she had readier access to the gender-affirming health care she needed to live as her authentic self.

Once there, Wood, 49, was able to receive certain surgeries that helped her transition, but electrolysis, or permanent hair removal, wasn’t fully covered under the state’s Medicaid plan for low-income residents. Paying out-of-pocket ate up nearly half her monthly income, but it was critical for Wood’s mental health.

“Having this facial hair or this body hair, it doesn’t make me feel feminine. I still look in the mirror and I see that masculine person,” she said. “It’s stressful. It causes anxiety and PTSD when you’re having to live in this body that you don’t feel like you should be in.”

That is likely about to change. Oregon lawmakers are expected to pass a bill that would further expand insurance coverage for gender-affirming care to include things like facial hair removal and Adam’s apple reduction surgery, procedures currently considered cosmetic by insurers but seen as critical to the mental health of transitioning women.

The wide-ranging bill is part of a wave of legislation this year in Democratic-led states intended to carve out safe havens amid a conservative movement that seeks to ban or limit gender-affirming care elsewhere, eliminate some rights and protections for transgender people and even bar discussion of their existence in settings such as classrooms.

More than a half-dozen states, from New Jersey to Vermont to Colorado, passed or are considering bills or executive orders around transgender health care, civil rights and other legal protections. In Michigan, for example, Democratic Gov. Gretchen Whitmer last month signed a bill outlawing discrimination on the basis of gender identity and sexual orientation for the first time in her state.

“Trans people are just being used as a political punching bag,” said Rose Saxe, deputy director of the American Civil Liberties Union’s LGBT and HIV Project. “Denying this health care doesn’t make them not trans. It just makes their lives much harder.”

Gender-affirming care includes a wide range of social and medical interventions, such as hormone treatments, counseling, puberty blockers and surgery.

Oregon’s bill would bar insurers and the state’s Medicaid plan from defining procedures like electrolysis as cosmetic when they are prescribed as medically necessary for treating gender dysphoria. It also would shield providers and patients from lawsuits originating in states where such procedures are restricted.

Access to procedures such as electrolysis is also necessary as a matter of public safety, said Blair Stenvick, communications manager for the LGBTQ+ advocacy group Basic Rights Oregon.

“Facial hair can be a trigger for harassment,” Stenvick said, and being able to present as a woman “helps folks to not get targeted and identified as a trans person and then attacked.”

The bill sparked fervent debate, with hundreds of people submitting written testimony both for and against it and an emotionally charged public hearing last month. The Democratic-controlled House is expected to vote on the bill Monday over Republican opposition before it heads to the Senate, which is also dominated by Democrats.

Shield protections similar to what is being proposed in Oregon were enacted this year in Colorado, Illinois, New Jersey and New Mexico, and other bills are awaiting the signatures of Govs. Jay Inslee in Washington and Tim Walz in Minnesota. California, Massachusetts and Connecticut passed their own measures last year. They largely bar authorities from complying with subpoenas, arrest warrants or extradition requests from states that banned gender-affirming treatments.

Meanwhile a measure passed last month by lawmakers in Maryland would expand the list of procedures covered by Medicaid, and Democratic Gov. Wes Moore said he plans to sign it.

Lawmakers in Nevada’s Democratic-held Legislature are pushing to expand gender-affirming health care and develop policies regarding the treatment of transgender prisoners, among other things.

The bills face an uncertain fate under Republican Gov. Joe Lombardo. Lawmakers have just over a month to vote on them before the legislative session ends in June. Regardless of their outcome, an open debate over transgender health care protections in the important swing state promises to further heighten national attention on the issue.

Some opponents of gender-affirming health care say they’re concerned that young people may undergo certain physical transition procedures that are irreversible or transition socially in settings such as schools without their parents’ knowledge.

Advocates for gender-affirming health procedures counter that they can be a matter of life or death.

Kevin Wang, medical director for the LGBTQI+ Program at Swedish Health Services in Seattle, said such care alleviates depression, anxiety and self-harm in patients with gender dysphoria. Studies show transgender people, particularly youth, consider and attempt suicide at higher rates than the general population.

“These are not aesthetic procedures,” he said.