Column: Gender affirmation act would prevent discrimination

Across the United States, transgender lives are under attack from their local governments, but Hawaii is headed in a different direction. If it becomes law, the Gender Affirming Treatment Act, House Bill 2405, would prohibit insurance providers from discriminating against transgender patients seeking gender-affirming treatments or surgeries. These lifesaving protections are long overdue.

Transgender people in Hawaii continue to face discrimination from private insurers when seeking medically necessary care even though the law and medical opinion are on our side. Transgender residents should be protected from categorical or blanket gender-affirming treatment denials by Act 135 (2016), but private insurers created a loophole with their own definition and policies about the meaning of medically necessary care, medical necessity, and cosmetic treatments. Essentially, the insurers ignore the majority of medical research around gender-affirming care and say certain treatments or surgeries are categorically cosmetic when that is simply untrue.

The majority of leading medical institutions agree that gender-affirming treatment is life-saving treatment for us as transgender people. And according to UCLA’s William’s Institute, there are approximately 8,000 transgender adults in Hawaii; we’re your friends, neighbors, coworkers and ohana.

The discriminatory loopholes insurers created cause significant harm to us as one of the most vulnerable communities in Hawaii due to historical and systemic discrimination. For transgender people who do not receive affirming care, care that cisgender people receive, the costs are our mental health, well-being, and even our lives.

Despite the positive progress of the Gender Affirming Treatment Act at the Legislature, private insurers continue to try to undermine the anti-discrimination protections of the bill. Multimillion-dollar for-profit insurers in the state have the nerve to claim in testimony that there are additional “costs” to stop discriminating against us. They pretend their decisions and unsubstantiated policies aren’t deadly and still show up at Honolulu Pride as “allies.” These insurers ignore all of the research that demonstrates there are zero or very minimal (e.g., $0.01) “costs” for providing gender-affirming care. And they ignore that the bill is simply stopping them from discriminating.

Further, during this legislative session, insurers have updated their gender identity services policies to make them more discriminatory. For instance, one insurer changed its policy language from gender confirmation to genital confirmation surgery and now requires pre-certification for hair removal. These language and policy changes invoke the ignorant and transphobic ideology that harms transgender people.

While we are not surprised by these tactics — Washington state saw a similar underhanded response to their Gender Affirming Treatment Act (2021) from insurers — we know we don’t deserve this kind of cruel treatment. We also know if insurers treat us this way, they will also treat other people seeking medical care however they want even if it is hateful and discriminatory.

Fortunately, we have many strong supporters. Mahalo to the organizations and community members who have gotten the Gender Affirming Treatment this far at the Legislature. Organizations such as the Hawaii Health and Harm Reduction Center, the Democratic Party of Hawaii, Hawaii Public Health Institute, Af3irm Hawaii, North Shore Koolau Diversity Collective, and several religious organizations demonstrate the power of community organizing together.

We also thank the collaborative leadership of Sens. Rosalyn Baker and Karl Rhoads and Rep. Ryan Yamane. We especially thank Rep. Aaron Ling Johanson for introducing the House version and Sen. Chris Lee for introducing the Senate version of the Gender Affirming Treatment Act. We hope, that if the bill passes the Legislature, the governor will sign it into law.

We believe everyone deserves health care and we think that House Bill 2405 is a step toward recognizing that truth for transgender people now. We invite you to join us as we fight for the health care that we need as transgender people in Hawaii by supporting House Bill 2405.