Insurance must cover ‘cosmetic’ procedures deemed medically necessary for trans folks in Hawaii

Insurance must cover ‘cosmetic’ procedures deemed medically necessary for trans folks in Hawaii

In spite of it being Pride Month, Republicans aren’t making it easy for LGBTQ+ folks and allies to have many recent wins to celebrate. One victory comes to us thanks to Democratic Gov. David Ige, however, as he signed not one, not two, but three pro-LGBTQ+ bills into law to help protect and serve queer folks in Hawaii, as reported by the Los Angeles Blade.  

The legislation includes SB 2136, which mandates that neither gender identity nor expression can be used as reasons to include someone from jury duty. SB 2670 codifies that the state’s LGBTQ+ commission will be permanent, and perhaps the biggest news is HB 2405, which mandates insurance providers require that health plans provide clear details about which gender-affirming services are covered and that they cannot ban such treatments when deemed medically necessary. 

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“Collectively, these three bills are critical in supporting the LGBTQ+ members in our communities,” Ige explained in part, adding that they’re meant to help “identify social and community issues” more smoothly and to prevent discrimination. He added that he wants Hawaii to be an “inclusive” community for all.

The health care bill deserves a closer look for a few reasons. Some insurance companies (in this case serving Hawaii, but also elsewhere in the U.S.) categorize gender-affirming treatments as “cosmetic,” such as voice therapy, laser hair removal, and even facial feminization surgeries—meaning that they’re generally not covered. But these treatments can be legitimately life-saving, and it’s essentially a blockage on low-income trans folks if they can’t access them on account of these services being “cosmetic.”

Here’s a hypothetical scenario. A trans-inclusive plan might cover, for example, chest reduction surgery. Great! But if they don’t provide related care, like those that might impact one’s voice or face, trans folks can become uniquely vulnerable to being “outed” or perceived as “different” by strangers, as well as by potential bosses, landlords, neighbors, and so on. Now, this is nuanced and complex because no one needs any kind of surgery or treatment to be “really” trans—people are trans because they are trans, period.

No one needs to do or say any particular thing to be “fully” or “truly” trans. But when it comes to individual needs and preferences, it’s completely valid and reasonable that a person seeking gender-affirming care might feel confused, stuck, or forced to pay exorbitant money in order to exist safely in this world. Is this fair? Of course not. But we’re (obviously) not going to get everyone on board with the complexities of gender identity and gender expression overnight, and even if we could, trans folks still deserve this life-saving care. 

Ige signing the bill into law is a great step forward in giving trans folks the care they need. Insurance is (unfortunately) confusing for many people, but it’s no small issue for the trans community. In this case, if medical professionals agree it’s medically necessary, insurance companies won’t be able to brush off the very important gender-affirmation aspect of care—meaning trans folks will come a little closer to finally getting full respect and humanity both in the health care system and outside of it.

It’s especially meaningful, of course, when so many conservatives are pushing legislation to take rights and protections away from trans folks. Whenever Democrats can stand in opposition, we must. 

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