In mid-November, the largest insurer in Maryland, CareFirst BlueCross BlueShield, extended its coverage for transgender patients, removing language from its policies that said CareFirst would not pay for “treatment leading to or in connection with transsexualism, or sex changes or modifications, including but not limited to surgery.”
While insurers are increasingly starting to pay for gender-reassignment surgery and hormone therapy (as of 2014, the Centers for Medicare and Medicaid Services no longer ban such coverage, for example), many still do not—even though the American College of Physicians, the American Medical Association, and the American Psychological Association are just a few of the many organizations that consider gender-transition services to be medically necessary for transgender people.
In terms of necessity, a transgender person seeking transition services is “the same as saying if you have cancer, you need chemotherapy if you are going to survive,” says William Padula, an assistant professor at Johns Hopkins University’s Bloomberg School of Public Health. He’s not saying that being transgender is like a disease, he clarifies—just that hormone therapies and sometimes surgery are things people need to live a healthy life. And sometimes even to live at all: 41 percent of transgender people have attempted suicide at some point in their lives, compared to the national rate of 4.6 percent.