Gendercast Episode 36: Trans-Inclusive Healthcare, Trans Justice Project at Basic Right Oregon

Gendercast Episode 36: Trans-Inclusive Healthcare, Trans Justice Project at Basic Right Oregon



this is Jesse this is Shaun and welcome to gender cast our trans masculine gender query join us as we discuss our journey through gender expression trans masculine culture identity and navigating the binary in our communities welcome to gender cast episode 36 I'm actually on location at a presentation and the presentation is actually in occurring at the new Ingersoll gender Center space in a place on Capitol Hill neighborhood in Seattle a few sort of LGBT organizations have gotten together and are sort of cohabitating some space and ingersoll just opened their space up so special thanks to Ingersoll for allowing us to come in and record this presentation and episode 36 is going to be a live recording of a presentation that happened in Seattle probably about a month before this is airing and the presentation is by a couple folks from basic rights Oregon which is an Oregon LGBT advocacy group presentation is going to be focused on a toolkit they came out with called the benefits of equality a blueprint for inclusive health care for chant transgender workers so they're going to be talking a lot about how they've gotten inclusive healthcare within a lot of organizations and some insurance inclusions and sort of the process that they took the flow of the presentation we'll talk about sort of some of the ways that they came to organize around their actual trans justice project which is within basic rights Oregon then how they came to do some of this organizing around healthcare Tosh and Joe will give a presentation that sort of follows along a PowerPoint that they're referencing but please have the benefits of equality toolkit out in front of you because they're gonna be referencing that a lot and so we'll make sure to create a link to that you can just download that online and then there'll be a video about half an hour in and we'll play the audio to that video and that's a video that they used in their campaign and then at the end of the presentation we'll actually have live questions from the audience members and them answering the questions and those will be included so please enjoy Josh and Joe coming up right now I'm Tasha and trans justice program manager at basic rights Oregon I've been working with basic rights Oregon since 2007 and I got to be around for the beginning of the trans justice program and actually the evolution of the trans justice work that we've been doing through basic rights in Oregon so I'm really excited to be here sharing with Washingtonians and I'm Joe LeBlanc I'm the development coordinator at basic rights Oregon and I'm also a member of the trans justice working group which is something that we will describe in a little bit we're glad to be here to talk about the work that we've done also my preferred pronoun is he and Tosh as they or their name so just try to keep us flowing in the the right direction that way we want to give an overview about the trans justice program of Bro what does this program look like how does it work what are our strategies for moving this care this is what we're gonna talk about tonight and so basic rights Oregon's trans justice program our objective is to increase the safety and well-being of transgender Oregonians through policy victories our work focuses on three main areas ending healthcare discrimination particularly within insurance plans increasing the safety of trans Oregonians who are in jail and prison in the state and implementing our state's non-discrimination law which includes gender identity and public accommodations employment and housing our trans justice working group which is kind of a leader in this area in that our trans justice working group is comprised of Volunteers of the transit and gender non-conforming and allied group it's been around for how many years would you say you know three or four years now going with Tasha's numbers there where basic rights Oregon selected community leaders that were really invested in this work to be at the forefront of the decisions as far as what interests what issues were facing the community the most and healthcare kind of rose to the top as far as being the number one issue the three points that Tosh just mentioned along with the prison system and fighting our non-discrimination laws this particular group we're designing and implementing the strategies to win inclusive healthcare that's our main priority right now and the working group members we shape empower the work from the strategies with legislature education to volunteer recruitment to event planning I mean we're all over the place in how we form what this program looks like we pretty much design what Tasha's workplan looks like and the fact that we actually have a budget and we allocate what part of the budgets gonna go to the various pieces that we're working towards thanks Joe our strategies for winning care I want to describe but first I want to share a little bit more about the history of the program and how the working group came to be and why we function with this model that's pretty unique for a statewide organization of any kind doing advocacy to mix paid staff and volunteers in this way so as Joe mentioned the working group has been around since before the trans justice program has been around at bro 2008 our board was looking at creating a strategic plan a five-year strategic plan from 2009 to 2013 in creating that plan they did a lot of community outreach and wanted to focus particularly on communities who had not been historically represented in mainstream LGBTQ organizations and in Oregon and around the country I would say that's communities of color and trans communities so there were specific community input sessions excuse me that were conducted in relation to the strategic plan and I was actually on staff at the time and was able to help organize what we called the trans focus group where we brought together a bunch of community leaders to talk about what issues do you want to see basic rights take on as a policy and advocacy organization and what we heard from trans folks is were really loud and clear listen basic rights has been fairly inclusive there's been a lot of times when issues have come up that have not seen the greatest trans inclusion but what you really need to do as an organization to show your commitment to the trans community and to truly serve the trans community is to work on policies that impact trans people primarily and so the the board heard that feedback and prioritized that in our strategic plan so when we said about creating a program we knew that had to come from community input and the trans justice working group was convened at that time I was a member of the group as a volunteer and we actually did listening sessions in Eugene in Portland we did an online survey and we got feedback from over a hundred trans we're gonna ins they're partners in phase around what types of action they wanted us to take what areas they wanted us to focus on health care criminal justice and implementing the state's non-discrimination law were the three priorities that rose and that's why they are the three priorities of the program so the working group has remained that kind of community core of the work that we do and it's really unique in what we're trying to do blending again staff that are paid with volunteers that are using their time and and using this working group as a pipeline to staff so myself I was a working group member before I was a full-time staff member Joe and Sasha who's in our communications department are all on staff now originally coming into the organization through this group we're also building trans leaders to be part of other organizations because we we want to build a strong base to work with basic rights Oregon but we also want to equip trans folks with skills to lead in all areas of organizing and progressive politics so it's really strategic important and it keeps us accountable to the communities are serving to use this model and the strategies that the working group has developed alongside staff are educating legislators and union leaders to lay the groundwork for statewide wins in the long term so we know there are many paths to health care and however we get there we need to have the support of people who are elected officials folks who are in the labor movement which has been a huge ally historically to the LGBT community and specifically in Oregon has a really long history of a lying with Pro LGBT work we're also working with businesses and state agencies to remove exclusions from plans and immediately increase access to insurance for trans folks so what that means to us is not only do we work at this big picture level of ultimately working towards a statewide change statewide laws and regulations but in the meantime we need to make sure that as many people have access as soon as possible so we do individual support with folks in their universities or businesses to actually remove exclusions from those health plans and working with state agencies to make that happen quickly and all of this is developing and centering the leadership of trans Oregonian so as said part of the strategy of the program is to build the skills and leadership of trans folks and invest in a community that historically has been not invested in by a lot of large LGBT advocacy organizations there are all these ingredients in all of these ways that we can seek change and for us again it's businesses it's looking at state laws it's looking at administrative solutions and it's looking at state agencies all right so we handed out our handy dandy toolkit that we developed with helping some of those businesses to advocate for trans inclusive healthcare this is what our nice visual is of benefits of equality the toolkit that we've given to lots of businesses and it's available online we have copies here as well but on this particular screen we're talking about the winds because that basic rights Oregon we love to win it's kind of like a tagline that should go before everything we do but so as a result of the work that we've been doing we have 53 thousand more Oregonians covered compared to where we started in 2011 200 policymakers educated on health care that includes legislators includes how many folks from the criminal justice program 120 managers and staff at the Department of Corrections in Oregon which we believe is the largest of its kind that's happened in that capacity on top of that we have our groundbreaking toolkit and we have the video that was released that's called the faces of trans health care and which we'll be showing that in a little bit which is also available on our website and on YouTube so if you're going to YouTube you're able to title that it'll be able to view it for those at home our insurance division bulletins which was a huge win for us recently they basically put it out there that it was a part of public accommodation that it covers care through most private insurers that now basically anyone who has a private insurance policy in Oregon is no longer relegated to being excluded with seeking medical medically necessary health care so any service that's that is appliable to a cisgender person or a person who is non trans a trans person now has access to it so there's no more outright discrimination for those policies which doesn't cover everyone because we have a lot of folks within our communities who don't have insurance as well as folks that don't have private insurance in the state of Oregon as well as federally coupled plans which are exempt so we still have a lot of work to do we have the Oregon Health Plan that also exists so just in general it's like the tip of the iceberg so we're not finished working by any means and we're using these victories to leverage to get more victories to happen so recently we had a settlement that was for state employees Esquivel case to where now oregon state employees now have access to trans inclusive healthcare and then we're extending the Oregon Health Plan coverage it to be extended in 2014 which is another great progressive win and then we're looking forward to the Affordable Health Care Act to remove pre-existing conditions in 2014 which will also apply to trans folks so we have our large Oregon businesses removing exclusions last year the top of the list is 14,000 employees are now covered as a result of Oregon Health and Sciences University OHSU is a huge employer in Oregon they're leading the way with this as well as the Port of Portland with adding over 700 employees Stowell Reeves which is a law firm over 800 employees and Davis rights remain over 400 employees these were all just wins within the last year so on top of the city of Portland adding trans-inclusive healthcare on top of the dcbs which is our insurance division having us win the state adding this win these are all like all steps towards victory so we're going with trying to get businesses on board trying to get unions on board schools all the avenues are leading to this huge moment to where we're hopefully that it will no longer be an exclusion with any insurance policy next we want to dig a little bit more into what I suspect a lot of folks are interested in our kind of big policy victories with the insurance division and going through a little bit of what Joe just said we kind of try to break it down as simply as possible for a very bureaucratic legalese bill and what this bulletun does is it applies to most private insurance regulated by Oregon law so it doesn't apply to any type of public insurance Medicare Medicaid in Oregon which is the Oregon Health Plan or to people who live in Oregon but are insured through a business or corporation that is not Oregon based it also does not include employers who are self-insured typically employers over 500 employees can create their own health plans that are then administered by large insurance companies but don't fall under the purview of our insurance division so this is about a third of folks who are insured in Oregon who are covered under this bulletin the bulletin also does not mandate coverage of any specific procedures or services so it says that any service that is provided by one of the plans and oversees must offer the same access to care for everyone so if a plan is covering hormone therapy for people who are not transgender that plan must cover hormone therapy for people who are transgender and then that would similarly apply to surgical procedures and we know many of the surgical procedures that trans people seek are routinely covered for people who are not trans in other situations and it does ensure that insurers can't categorically exclude trans patients from coverage dropping or denying people from plans simply because of their gender identity we know this is going to end nationwide in 2014 when the Affordable Care Act is implemented because pre-existing conditions will no longer be a basis for dropping people but we're just getting a little bit of a head start on that and again this is really written and stated in a way that's about equity and coverage so not talking about specific medical procedures but talking about whatever is offered by a plan must be offered to all and it enforces existing insurance mandates around sex specific cancer screenings mammograms pap smears prostate exams being covered regardless of the gender marker on file it's actually my favorite part of the bulletin is that it says something like the gender marker on file should not be relevant to this type of care for patients which we know is a huge issue for trans folks and just accessing these routine screenings employers who are really large and self-insured over 500 employees or even larger and governed by ERISA which is federal insurance regulations our insurance division in the state of Oregon cannot oversee the Oregon Health Plan which is our Medicaid in Oregon we've made some progress in as well with our partners transactive education and advocacy which works primarily with trans children in youth beginning in October 2014 the Oregon Health Plan is going to cover mental health care for trans related diagnoses for both youth and adults so previously this care has been excluded any mental health appointment if you're an Oregonian and you have gender identity disorder on your chart that appointment will not be covered by our Medicaid that will be changing also puberty blockers for youth who are under 18 will be covered by the Oregon Health Plan starting in 2014 October 2014 it does not yet cover hormone therapy at any age so again we're talking about puberty blockers not about supplemental hormones does not cover any type of surgical care or other transition-related care that folks might seek so there's a lot of work to do in this area and this is actually one of our major focuses of this year is working to remove exclusions from our public insurance in the state strategies for winning what I actually want to talk about now I do want to give folks a chance at this point to ask questions because that's kind of the brief overview of our program and what it looks like what strategies we're using broadly this second part of the presentation is about here's how we make the case here's how we have worked with these businesses here's how we've worked with our state agencies here are the messages that we know really work and to actually share with you a very similar presentation to what we do with all these decision-makers we're talking to you so that you all can understand how we're making these changes so the question is for businesses who have inclusive care are their utilization rates and were there individuals asking for coverage so the answer is for the businesses we listed because they are so new they do not have utilization rates in this piece of the presentation we talk through some of the existing utilization rates and in our toolkit we have gathered at the time of the toolkit printing as much utilization data as we could possibly find and there's a lot more now almost a year later and we're actually updating the toolkit but for those specific employers typically we don't see utilization data come from employers or municipalities until at least a year and usually two or three years after they've implemented the benefits and then in terms of folks asking for the care most of those businesses did have internal advocacy and that is something that we found is really effective that there were either trans-identified people requesting services or in a lot of cases allies allies who are not trans saying this is care that my transgender co-workers should be able to receive and it makes me you know have a less positive experience at work when I know that my co-workers are being discriminated against in this health plan so we actually see the business work the advocacy within your employer or school as a really important place for people who are not trans to actually take action because it is so risky for trans people to come out in their employer and then be asking for specific medical care it's very much it's a really big leap to take so a lot of these cases were not individuals asking for the care but allies saying is these discriminatory exclusions should be removed so the question is with the businesses who removed exclusions are they including SRS facial feminization services that it would be more difficult to justify cysts or not trans people receive them regularly those policies all do cover SRS what we know is that the boilerplate language for quote unquote inclusive insurance plans often excludes facial feminization surgery tracheal shaves services that are medically necessary so what we have tried to do in our advocacy with the specific language that folks use in their plans is to really use the standards of care that have been updated and are a lot more flexible but also really give power to the patient and their physician to determine what's medically necessary so the ideal language would be something along the lines of this type of care for gender transition is covered in accordance with medically necessary procedures as determined by a patient's position so that somebody can have their physicians say facial feminization surgery is medically necessary and have that covered so our strategy is the more we get into listing out procedures the more procedures will be excluded and that shouldn't be a decision that's in anybody's hands besides an and their doctor but unfortunately there's a precedent that's been set by a lot of plans that you know we were adopted five ten years ago and have exclusions for those procedures that you're mentioning the question is whether any places are covering facial hair removal and I honestly don't know the answer to that yeah again this is really how we've made the case the way we made the case the way we continue to make the case for inclusive care is using really three main messages one that this care is medically necessary many many Medical Association's have issued formal resolutions stating that this care is something that trans folks need to have access to secondly that's affordable to provide this coverage the businesses and municipalities who have removed exclusions have found no cost increase whatsoever and third that it's a matter of basic fairness so the types of exclusions that exist in insurance plans are so blatantly discriminatory towards transgender folks that it's outright discrimination the question is do we have cost data and the answer is yes in the toolkit and we're gonna talk about a little bit of it also there are a lot of resources we're gonna be putting into a new version of the toolkit that we'll be releasing within a month specifics on page 35 of the toolkit if you're holding it or going to download it the way we talk about medical necessity that there are dozens of organizations that have stated this care is medically necessary and those are organizations like the American Medical Association the American Psychological Association last year the American Psychiatric Association and the American College of Obstetricians and Gynaecologists even the IRS has said that transition-related care is an expense that is tax-deductible and the list kind of goes on so what we're seeing here is that medical bodies like the AMA and the APA which I don't think anyone can claim are bastions of progressive thinking really coming into understanding that this is not really an option for some trans folks right to access this care of course not every trans person and not every transition is the same this is something that is so clear now that these insurance exclusions are absolutely outdated to medical experts and what they're saying now today in 2013 we also know that there are extremely high rates of medical issues faced by trans folks so the National trans discrimination survey that was released by the National Gay and Lesbian Task Force shout out the National Center for transgender equality this has given us numbers for what we know is happening right so 41% of trans folks who took the survey and it was a little under 6,500 trans people in the u.s. who took the survey 41% of people had attempted suicide 88% of folks who do not have access to insurance delayed preventive care its 28% of folks overall so almost 30% of trans folks whether or not they have any access to health insurance are delaying preventive care for fear of discrimination which is huge in almost 50% of people postponed seeking medical care altogether because of discrimination we know that treatment for a lot of issues equals paying out-of-pocket but particularly transition-related care trans people are almost guaranteed to have to pay out-of-pocket for there are also some other less we can't put concrete numbers here but a social stigma low self-worth depression and substance abuse are huge issues because of pervasive transphobia and particularly you know for trans people who don't have access to transition-related care there are extremely high rates of depression and substance abuse and from a purely logical perspective depression and substance abuse are some of the highest cost to our medical system and it actually is a cost savings to everyone and literally saves the lives of a lot of trans people to have access to the care they need so it's not just the right thing to do but it makes sense to provide the care so it's affordable to provide coverage we always like to say no jurisdiction employer municipality who has adopted trans inclusive health care has ever found the cost to be prohibitive so a couple of the case studies we like to use the University of California system which is a huge system and began covering care in 2005 they have about two hundred and thirty two thousand enrollees so not a small number I believe that's like 20% of the population of the entire state of Oregon 28 surgeries related to gender transition were performed in the first five years so between 2005 and 2028 surgeries relating to transition were covered under this plan those are the numbers we could get from the University of California system to protect the confidentiality of the folks accessing those services but what we know is that that's an extremely low cost and utilization rate but an extremely high impact for the people who access that care another case study is the city of San Francisco the City and County of San Francisco in 2001 removed exclusions from their plan they are probably the most famous example and well-known example of this when they first did it they said this is probably gonna cost us some extra money we want to make sure that we have the money to cover this so let's put a dollar 70 surcharge on it per employee per month they did that for a couple years revisited and found that they had gathered four point three million dollars in premiums and paid out a hundred and fifty six thousand dollars in benefits so the reason the percentage is not in this presentation is because I'm not very good at math but I don't think that it takes a lot to understand that the difference between four point three million and 156 thousand is huge in 2007 a couple years after that they revisited it again and said this actually doesn't worry any surcharge at all there's no reason for a surcharge to happen here and they've continued to say that up until today so now going on twelve years of having this care it has not been a cost factor for them and it's in a place like San Francisco which is such a hub of safety and friendliness that would be a place we'd expect if any if any place is gonna have a lot of trans folks asset accessing care it's gonna be San Francisco and we're just not seeing that happen in the city of Portland they removed exclusions of 2011 and anticipated that their costs increased would be 76 cents per employee per month that for them is a premium impact of less than a tenth of a percent so point zero eight percent is the premium impact for their overall health plan costs and we know that this is too high and they're actually moving towards doing the same thing in San Francisco and declaring it not a cost expense at all also an Oregon Multnomah County removes exclusions from their health plan in 2010 they have affirmed a similar cost to the city of Portland less than $1 per employee per month but we know that again that is too high and there's actually no additional cost the reason that they haven't been able to give us specific utilization data is that in fact so few people have utilized the benefit that they are worried it would violate HIPAA and therefore patient privacy to share those numbers which tell us we can only ascertain it you know one person per year accessing this benefit which again not a huge number of people but an incredible incredible impact for those people so this is also a matter of basic fairness our name is basic rights Oregon and that's a really important part of what we do right so all of this needs to be underlined by the fact that we're talking about procedures which by and large are covered for non transgender people the bottom line here is I think even for things that maybe we don't see is typically covered for people who aren't transgender right and we talk about surgical care there are some procedures which are very common and so much are very uncommon but the bottom line in our medical care system is that medical necessity is determined by doctors and patients and this should be in the hands of doctors and patients not in insurance companies and the language that they're putting into plans so that's a really important point to affirm is that the standard for medical necessity in this country is between doctors and patients not what language is an insurance plan and the medically necessary treatment should be available for everyone and again it takes many times to say this for folks to absorb it who are not familiar with the issue it's difficult for people to fathom that these these exclusions could be so discriminatory but we really need to underline for folks that there's literally a sentence or a paragraph in a plan is excluding a specific community from receiving access to care and that's unprecedented discrimination and insurance plans which we know are not very friendly to anybody this this is a specific type of that's happening we also highlight about the fairness issues here that a lot of businesses are seeing this be true for them as employers so that more than 25 percent of Fortune 100 companies cover this care and there's dozens and dozens of businesses who know that this is the right thing to do for their employees and actually it's a competitive thing to do for their employees a lot of great information has come from the Human Rights Campaign Corporate Equality Index this is the index that rates employers on their LGBT friendliness and the Human Rights Campaign took a really important step in including transition-related care after a number of years of having this Corporate Equality Index they added transition-related care as a requirement for business scoring one hundred percent since they did that the number of businesses who cover transition-related care has increased as more than doubled so it was 80 something before they added this requirement and now it's in the 200s at least so that's a huge shift that's happened recently and next up we talked about how as an employee or as an ally or as an advocate for your city your school or union how you start the conversation first thing you need to determine who are the business decision makers who is the person that can say okay we need to go and talk to our insurance company it's an HR person is it a City Council that basically deems what is put forth or can someone just create like an executive order I mean there's so many different ways in each city is different each business is different and it really depends if you're self-insured versus if you're federally mandated I mean there's so many different ways to go at this so it's important to figure out who the person is that makes that decision then you make your case you talk about all the different things that we just mentioned how it's medically necessary how there is no cost associated with it and then it's a matter of basic fairness giving them all the details as far as the different companies like Nike like you know those really progressive organizations like the City of Seattle as well as being sure to connect and give context and commit to really making a difference and really trying to get rid of the exclusions because it's that discriminatory practice that's keeping them from having the best and brightest employees and citizens and we also have all of this stuff that I'm going over right now in the toolkit basically telling you exactly what I'm telling you but also filling in a lot of details because we've had folks that have done exactly what we're talking about and this is like the best practices so folks who have accessed the various systems with their employees with their unions and this is the way that they've got it done so you kind of have a roadmap on how to be able to do this for yourself it covers how you talk with an insurer trying to get the right people on the phone because as we all know talking with the insurance company on the phone is a great way to pass some time but definitely getting that person who will have the information and who can direct you to the right spot and asking precise questions specifically like what what our earlier questionnaire had asked like does my policy cover facial surgeries what is excluded so I mean a lot of times it's it's written specifically like any item that's directly related to transgender or to SRS is not covered and it's that basic it doesn't even have to be you know couched and a bunch of legalese like that's how most folks would deem it like oh they must not really be excluding you as a person no it's that basic because I'm trans I cannot have this access and so we definitely have a frequently asked questions piece in the toolkit so we definitely recommend folks to utilize those questions how to get the conversation rolling with your insurance provider also addressing cost that's definitely one piece that comes up all the time because people think that because we're adding things or removing exclusions that folks are just going to use up every service that's possible because every trans person goes about their transition the same way right because everyone wants every surgery that's available because that's exactly how they want to live their lives but that is not the case most folks you know choose not to have surgery for a variety of reasons that may not be their path to transition so it's really just a matter of and it's not like these surgeries are happening every year like I'm gonna go for Top surgery every year so you need to cover this so I mean it's just a matter of trying to figure out how those differences apply and really putting it back into the hands of the patient instead of the insurance company you can talk about companies who have removed exclusions again we're talking about people like Walt Disney but crafts I mean these are like in to shion's embedded in our in our country you know which is kind of interesting when you think about it because this is like cosmetic surgery or anything that's newfangled but it's not these these corporations have had it already in place and these are main states throughout the country and so the cosmetic issue comes up all the time too because folks are like oh well I want to have my nose job covered if the no the nose job versus whatever other surgery is that the American Medical Association the IRS I mean when we talk about those bastions of progressiveness I mean these are mainstays with medical professionals saying this is medically necessary not leaving it up to someone who you know works at an insurance company to decide what those determining factors are and so we continuously go back a fourth saying it's medically necessary care it's not just about the surgeries that also are medically necessary but it's also about sex specific care like mammograms prostate exams because everyone just wants to go out and get those done so you definitely want to have your insurance company be able to cover those expenses for you just going to do preventative maintenance on your body regardless how you identify I'm going back to the summary we're talking about figuring out who are the decision-makers for you to make this happen and your corporation in your city in your in your school as well as assessing your insurance policy really figuring out what language they use to add these discriminatory practices as well as talking telling people your story talking about why it matters to you and how important it is to really affirm that it's medical necessity that you're talking about and we have found with anything I think with most folks in the LGBT community sharing our personal stories is how people realize what it is that we are about and how this affects us it may be considered something that's really an experience that they haven't gone through but when you talk about how I really just want to go to have an ob/gyn visit and have it covered because I happen to have a male marker my gender really shouldn't dictate that this should be covered because I'm really trying to take care of my body I'm not trying to create medical fraud against the insurance company for getting this done and it's not a good time so let's just try and take care of our bodies and also just talking about ways that not having that access really affects you as a person I mean it affects everything because when you don't have access that you spend money that goes into everything else you're having to fundraise to be able to take care of medical necessity how can you you know focus on your job how can you you know it just feeds right into housing and other discriminatory practices this becomes this ever ever ending circle of discrimination that you really can't get out of just because you don't have the access for medical care and so next we have the video that we've put together with folks like myself and eight or nine other folks that are talking about their stories as either trans or gender non-conforming folks and we also have some allies that are in the video as well talking about why this medical care is necessary for them and how we should go about removing those exclusions so this this video was actually the brainchild of the trans justice working group and really created so that there would be a resource to show to folks to help them understand the issue in less than ten minutes to go over the basics to talk about the impact that this has on trans people and we really wanted to prioritize the voices of folks who are specifically impacted which is why the majority of the video is people who are impacted and then our allies are our state treasurer and the past president of the Oregon Medical Association just to make really clear the the levels of support that exist for this now I want to ask people what questions you have what kind of I know a lot of you in the room are doing this work and really want to open up the floor for the rest of the time we have together to be as useful to you all as possible I'll just give folks the mic for the other questions for that one I'll try to summarize and saying the question is for perspective on the chicken and egg whether trans folks coming out and asking for this care is what's gonna move this versus allies really stepping up in addition to in the LGBT movement the success we've seen around particularly marriage equality has come a lot from personal story sharing from gay and lesbian and bisexual folks who are impacted by marriage equality some of the biggest changes have occurred through allies through parents saying I have a gay child through somebody saying like my brother or my sister can't get married and that that makes a huge difference I think with this issue because we're talking about trans people going to their employers probably having to come out as trans and then saying this is the type of medical care I want therefore I am Telling You very personal things about my body from a place of integrity I just don't feel you know having doing this work for the last three or four years that it's proper or right to put the impetus on trans folks right but there is a need for people to put a face to the issue so that's part of the reason we made this video is like asking trans identified people to speak to their experiences and that we have actually found that that has moved some employers so we've used videos like this or stories that maybe aren't coming from an employee at X company but I give a personal perspective of here's a trans person telling you how this feels to us right ideally trans people would be able to have the safety to take the lead on these issues in the workplace in my experience that's been rare I'm so glad to hear there's a chorus of allies where you are that chorus is missing most places and that course does make a difference most places so my kind of perspective would be if you're finding that allies aren't moving and there aren't trans people who are feeling safe to share or feeling like they want to share that they're in that company perhaps using some of the you know videos that are on YouTube the trans people speak I am trans people speak project by Massachusetts trans political Coalition also has like dozens of videos of different trans people telling their stories and those could be really effective ways to humanize the issue in the absence of trans individuals but I totally hear that dilemma some of our employers can actually be allies and they get surprised by the restrictions that are placed on them I work for Seattle Public Schools they've supported my transition and entirely I filed a discrimination complaint against them in September and I also against my Union and Group Health Cooperative two months went by and and I hadn't heard anything but the HR director sent me an email apologized for not contacting me sooner and he had gone to the legal department of the district and they said clearly this is discriminatory and we can't defend against it if anybody brought complaints to us we would lose and they recommended the district hire a private law firm to try to get the exclusions removed they sent letters to Rupe health and the union and all the health care providers for the district and all of them said no we don't believe it's discriminatory he sent a letter to the State Insurance Commissioner asking him to rule in the legality and the Insurance Commissioner said it's not in my jurisdiction and this is like shocked my HR director and the attorney from the private firm how do we get a handle on this we have these state agencies that are really difficult to make them change but I think what happens is you create allies by coming out I think it may be the only way it happens so just to follow up on the issue of the responsibility of allies to help move this process forward I'm a union member I'm on the Executive Board of the Martin Luther King County Labor Council and I can tell you that there's that there is kind of a vicious cycle that develops in the labor movement because even the best intentioned union leadership sometimes do not bring up these issues spontaneously and they don't bring them up because they don't think that they have members who are interested in them and then the members seeing that the leadership is not bringing up the issues say wow this union is not very friendly to my to my interests and they become intimidated bringing out the issues themselves in my mind it's the responsibility of the people who have positions of power and influence to open the door and to say yes we want to hear about the members issues there are union leaders who might try to block that or their union leaders who might not want to move on issues because they believe that they have other legal responsibilities the main responsibility should be on the leadership to make it clear to their members that in a democratic union they want to hear from from the members and they want to address members concerns going along with some of the procedures is for example with as far as official surgeries there are no in-network providers here in Washington State they're in San Francisco Thailand Chicago various places Montreal getting this coverage would have to have some sort of provision for out-of-network providers that's a really important point I think in the way that we've kind of successfully addressed that point that there are a lot of types of care I think particularly looking at like brain surgery for instance there's not a great brain surgeon in every city in the country right and when folks have like specialized medical conditions there's usually a provision for travel and insurance plans that's certainly not the case across the board when we're talking about transition-related care particularly surgical care it can be really comparable to a lot of less common medical conditions where folks do need to go to specialists and that's kind of the way we make the case is finding places in an insurance plan where they have specialist coverage or travel and saying you should cover transition-related care in accordance with how you cover these other conditions so equally give the same amount of travel reimbursement that you give for this other thing to transition-related care give the same amount of wide berth for finding a specialist who's in the northwest region or on the west coast of the country you know or whatever provisions they have and again not all insurance plans have that but I think it's a really important point and that's kind of how we've addressed it is talking about this is specialized care that should be comparable to other types of specialized care thank you what an amazing presentation I'm thinking at a time somewhere many years ago when suddenly we looked around and in once the space of one summer it looked like every insurance company had put that language in of exclusion so it happened so quickly and it's been war practically ever since now you're offering these wonderful tools we know they're there but you put them together a powerful way so my question is this when you go in to whoever it may be and you present the medical answer the evidence based the cost issues and the other statements and the video if you can show it are you seeing results happen fairly quickly what what's the timeline what's the blow back it used to be we're going directly to our our lawyers what's what do you see now thank you for that question we actually are not seeing folks go to their lawyers as much which is great not that I have anything against lawyers but you know just really understanding that there's a path so what we've tried to do with the toolkit is just take all of this knowledge that so many trans people so many allies have been through this and we're just putting that knowledge all into one place to say here's how you have the conversation here's the questions you need to ask but we've found really great reception from a lot of companies with that kind of guidance we work with with municipalities as well we just talk them through and give them the tools to do it so they don't feel like they have to call their attorneys so they're having their hands oh I just need to call our insurance company ask what we have covered figure out what we don't have covered and then add what's not covered to the plan no lawyers need to be involved actually in that process right it's that simple so we try to really break it down and also connect people peer to peer so there's been times when you know we've had the HR person at Multnomah County who's just amazing and has a really strong grasp you know of what transition-related care looks like he's administered it to folks who worked in Multnomah County and we've just had him in touch with other HR professionals at companies who are looking to move this care how that peer-to-peer conversation that I can't pretend to have because I'm not an HR person I'm just make people feel that he is like this isn't this kind of out there thing this is something that dozens and dozens of businesses have done that we're now getting into almost half a dozen municipalities with the city of Seattle and Berkeley so recently there's a path here it's not something you have to call somebody special about I think one story that comes up similar what you were just saying like we did a legislative briefing for I think three folks in Salem and one of the legislators was how do they get away with this this is outright discrimination and this is a non trans person older white male who just had that light bulb moment this is blatant discrimination what language are they using how are they couching it no it's this right here well that's not right and to have him like bang his and to really see it that way because he had folks that were trans in front of him talking about their experiences of not being able to receive medical care thank you so much for this incredible presentation tonight I had a question for you about when the city of Portland provided care looks to me based on sheets handed out that there was what were lifetime maximum and I wanted to know if those lifetime maximals were problematic or appropriate because they seem kind of low and if you're having the problem now of you know having coverage but it being inadequate so the question about lifetime maximum is a good question I think that most people can agree there shouldn't be lifetime maximum homes on any type of service that you need medically but that's what insurance plants have put into place what we've done when working with businesses and municipalities if they have lifetime caps we ask them to do a comparable lifetime cap to the other caps they have right what we recommend is no lifetime cap we don't again like I don't think there should be a cap on anything because everyone has a different path in every type of medical care they access and that includes trans people so ideally I think lifetime captured generally not good for anyone in the case that an employer has previously established caps on other types of care we ask them to take into consideration do in an equitable way we can't ask them to remove it fully when they have pre established caps in their plan been unlikely if there are pre established caps in a plan for other types of services that they would put transition-related care in or rather remove the exclusions without a cap so it's really negotiating around that and trying to make it as high as possible about the caps do you have data on like what an average cap is or what that tends to look like or the number of companies that have caps anything like that that is a really good question and I don't have that data I do know that the typically recommended cap is 7 like me 75,000 lifetime that seems to be one that a lot of companies use but with all the new businesses and all this momentum over the last year or two I think it could be really productive to figure that question out I feel as we do this advocacy the more that we can and again it's not always possible but the more that we can help folks understand that each trans person is an individual and each person will have an individual journey those decisions should be between a doctor and their patient about what a person is accessing out of putting putting a cap on that actually undermines a doctor's ability to provide the best medical care to their patient that's the kind of language we want to use around this but again it's not always possible so the highest cap possible would be ideal I think a closer to ideal cap would be a hundred thousand one hundred and fifty thousand a year to really ensure that the entire scope of coverage as a person needs particularly if somebody's looking at you know things like facial hair removal looking at what could the maximum cost be and making that the cap knowing that very few people will access every service so the question that I have is it sounds like you mentioned the standards of care the W Pass standards of care but a lot of what you're talking about to me sounds much more like informed consent so what has been your experience working with providers I know that there's mental health providers and then some here locally and then working with some medical providers and trying to implement more of the informed consent model in the latest version of the standards talks about informed consent has that come up in your conversations and what what does that look like part of our work has been talking to people about the new standards of care because a lot of folks don't know that that's what exists and typically when a business is looking at an inclusive plan or removing exclusions from their plan they will look for an inclusive plan and those inclusive plans usually are haven't been updated right in the last year or so with the new standards of care so we try to actually walk people through that say this is what these mean and I think very strongly advocate for informed consent we're working out of Portland which like Seattle has a lot of trans friendly medical providers who are very into informed consent and are having conversations with each other and that's one thing we're trying to increase as well what we're finding is you know as advocates we can talk to people and we should talk to a lot of people but folks will listen most loudly sometimes to their peers so we're actually trying to build momentum in Oregon for medical providers who are successfully using informed consent to talk to other medical providers and say look this is work I've been doing this for X number of years with X number of patients these are the results I've seen you should consider doing this to you and again there's those peer-to-peer conversations are just really really effective so I think that's a thing that can be really powerful is just getting the folks to talk to each other about why informed consent is important and that it works and it's not this it's not out there it's not out there thing it's something that works that people are using and just makes sense so I know the new Oregon Health Plan was a huge win but I know you all wanted more can you just talk a little bit about what's next yeah what's next with the Oregon Health Plan and part of it for us a big part of it actually is gathering personal stories of people who are personally impacted by exclusions whether they are trans identified people who are on Oregon Health Plan which we know trans people and especially trans people of color are disproportionately accessing Medicaid in all states because of discrimination so that actually is really important to make sure that folks are represented in the issues they're actually experiencing but we want to kind of gather those stories from trans individuals and their partners and families to say look we're on Medicaid this is the impact that it has for these exclusions to exist for my partner or my sibling or my child or myself and really bring those voices to the forefront in addition to that we're trying to look at all of the medical research that's out there because a lot of Medicaid decision makers are using evidence based research models evidence based research takes funding and resources that haven't been put into looking at trans people's health unsurprisingly so there's not a lot of evidence-based research out there for these big you know decision makers to look at so we're trying to figure out what is out there what we can use and actually it's ideally solicit more evidence-based research from the medical community so that the language decision-makers are speaking is being spoken back to them in numbers from the medical community I have a question about our reimbursement we actually have inclusive coverage at the University of Washington we're working with a network that doesn't take insurance and they are very adamant about not taking insurance so we're having a lot of our students having to pay it lately up front for their surgeries with then they build the insurance with the expectation of getting a percentage of the allowed amount so have you guys worked at all with like getting reimbursement ahead of time and potentially working with providers on relaxing their insurance policies we have not worked much on that we have worked to advocate against reimbursement which I'm sure you know is very challenging thing to do so we typically advocate against reimbursement with providers I think part of is kind of unspoken and spoken within the trans community as we know a lot of surgeons particularly for many many years have been getting paid out of pocket right with no insurance plans covering this that landscape is changing so quickly and I think that really interacts with reimbursements right just overall we need to get this momentum in to providers as well this momentum that's happening with exclusions being removed so I think that's a really important thing and the way we're kind of addressing it is feeling that the more we build inclusive insurance plans that's gonna result in medical providers who are willing to do that on a more relaxed basis and then those medical providers will receive essentially receive business that drives that away from others so the standard will have to become that folks are having more relaxed acceptance of insurance and reimbursement policies as providers so our strategy for that has been creating the momentum but that's honestly something I think there's a lot more work to do so that wraps up episode 36 our presentation from Tosh and Joe from the basic rights Oregon trans justice project talking about their new toolkit the benefits for equality a blueprint for inclusive health care for transgender workers thank you so much to Tasha and Joe for being willing to have the gender cast mic with them throughout their presentation and allowing us to share this with the rest of the country in the world the good work that they've done copyright 2012 gender caste our trans masculine gender query all podcasts content and information related to these podcasts are the property of gender cows producers and may not be used without the written consent tack gender caste at gmail.com for written permission I'm just into this world why what the world might see isn't always me Cavan sided as a boy drama break free he doesn't wanna take over my body or my soul he just wants to share this body make me whole coz the girl this one of does he is only half of me I am not the one born under this golden stop beneath the surface you will find the million thought that crossed my mind I am born into this world brand new start with knowledge small takes time to learn at all time to live leaving all the different I'll find the peace of my differences make us who we are what we know some of us are scared to let it show let's be nifty now it's time to the pole I am not the only one on another Golden Sun beneath the surface you will million thoughts that I cross my mind

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