I am a fairly typical transgender woman who began transitioning in my mid-30s to live as my authentic self. I finally feel as though I am living the life I was always meant to.
However, life isn’t all sunshine and rainbows. Despite Hawaii being a generally safe and welcoming place to be transgender, I have been faced with significant adversity and discrimination when it comes to getting covered for some of the basic health-care needs associated with my gender identity and gender dysphoria.
In 2016, Hawaii passed House Bill 2084, which intended to prohibit health insurance companies from discriminating based on an individual’s gender identity and ensure that care associated with gender identity was covered. Since that bill was signed into law, health insurance companies have continued to deny much transgender care, particularly gender-affirming surgeries, calling it cosmetic or not medically necessary.
Peer-reviewed scientific research shows that surgical interventions that treat gender dysphoria can significantly reduce the anxiety, depression, self-harm and suicide rates that too often plague transgender individuals. Despite everything that we know as a society, it boggles my mind that health insurance companies can still in good conscience continue to deny so much lifesaving and medically necessary care and have such disregard for the laws we’ve already passed.
I am insured under HMSA, the largest health insurance company in Hawaii. Despite the 2016 law and supporting scientific evidence, my request for breast augmentation coverage was denied in April of this year as not medically necessary. I was forced to make the difficult decision to take out a 401(k) loan to finance the medical care that I so desperately needed while pursuing an appeal. It seemed like it would be an impossible fight that I would never win.
Everyone I spoke with in the community said they had never heard of the insurance company approving breast augmentation for a transgender woman.
I may be an ordinary transgender woman with no real power, but I am not one who will be pushed around, nor will I allow my rights to be trampled on. I know how important this care is for people and decided that I would not take no for an answer. After more than six weeks, countless hours on the phone, and much stress and anxiety, my breast augmentation request was finally approved by the insurance company. I am told that it might be among the first transgender breast augmentation requests to be approved, but hopefully it will not be the last.
Our understanding of the issues facing the transgender community has grown significantly in recent years. However, insurance companies have largely failed to keep up with the changing times and continue to discriminate against, and fail to provide basic health care coverage for, this already marginalized population. The approval of my breast augmentation appeal demonstrates the mounting pressures that advocates are putting on health insurance companies as we encourage them to get on the correct side of history. Our efforts are working.
I can see an unstoppable wave of change on the horizon, and it’s coming at us like a tsunami. Whether you are advocating as an ordinary individual like me or as part of a larger group or organization, each and every one of us is playing a critical role in what is so soon to be an epic victory for our state’s transgender community. We cannot afford to stop or slow down now. Change is imminent.
Breanna Zoey Connors holds a master’s degree in communications and advocates for transgender equity in health care.
