Last week, transgender North Carolinians and their families spoke out against the decision by state officials to deny coverage of treatments for transgender people from the NC State Health Plan.
Now, at least one member of the health plan’s board of trustees — the only one other than state treasurer Dale Folwell yet to respond to Policy Watch inquiries — is speaking out on the issue and urging a change.
“The core issue for me is that we have a group of State Health Plan members who have reached out to us for help,” said Kim Hargett in an interview with Policy Watch. “The goal of the state health plan is to help our members. At this point, it warrants looking for ways to help them.”
Hargett, a teacher at Marshville Elementary School in Union County, is one of two members of the board appointed by Gov. Roy Cooper.
Folwell, a conservative Republican and former state lawmaker, is chairman of the board by virtue of his office. Gov. Cooper’s state budget director, Charlie Perusse, is also an ex officio member. The other members are all appointed by Folwell or the General Assembly, whose GOP majority continues to contend that transgender identity does not exist, but is the result of improperly treated mental illness.
That position is at odds with the view of the mainstream medical community, from the doctors who actually work with transgender patients to the American Medical Association and American Psychiatric Association. The APA recognizes gender dysphoria not as a mental illness but as “a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify.”
More than 40 years of research into and treatment of transgender people experiencing dysphoria has led psychiatric and medical professionals to conclude the most effective course of treatment is gender transition — aligning one’s life socially and sometimes physically to better match their gender identity. Not all transgender people choose to medically transition, but for those for whom it is judged necessary, medical experts agree it can be life-saving.
That’s why Blue Cross/Blue Shield of North Carolina, which administers the State Employee Health Plan has, since 2011, recognized dysphoria as a serious medical issue and covered treatments related to transition, including hormone therapy and gender confirmation surgery. That’s in line with many private health plans, Medicare and the federal employee health plan.
The trustees of the state health plan voted to begin covering treatments for gender dysphoria at the end of 2016 in order to comply with federal anti-discrimination laws.
Folwell, then the incoming state treasurer, strongly disagreed with that decision. He and the plan’s trustees allowed that coverage related to gender dysphoria to expire at the first opportunity — not renewing it for the 2018 plan year and making no move to remove the blanket exemption for gender dysphoria treatment for 2019 plan year.
Hargett disagrees with that decision. She was also troubled by Folwell’s statement to Policy Watch on the issue last week, she said.
“The legal and medical uncertainty of this elective, non-emergency procedure has never been greater,” Folwell said in the statement. “Until the court system, a legislative body or voters tell us that we ‘have to,’ ‘when to,’ and ‘how to’ spend taxpayers’ money on sex change operations, I will not make a decision that has the potential to discriminate against those who desire other currently uncovered elective, non-emergency procedures.”
“Sex change operation” is not a term used by medical professionals treating transgender people, insurance companies or the LGBTQ community. It is widely considered offensive both because of its technical inaccuracy and because a wide array of procedures — not just one operation — are utilized in gender transition.
The exemption for treatments of gender dysphoria doesn’t just prevent surgical procedures. It prevents coverage for hormone therapy used by transgender people who choose not to have surgery, doctor or therapist appointments related to that therapy and other treatment related to dysphoria.
“I did want to say that I disagree with the language used in that statement,” Hargett said. “The language we use is important. And I want the state health plan’s language to show that the concerns are being heard. I have so much respect for the people who have had the courage to come speak before the Board of Trustees on this issue. It took guts. It took courage.”
“We need to respect the basic humanity of everyone,” Hargett said. “And if we want to recruit and retain the best employees, we need to show that respect and draw larger circles, show that we value and respect everyone. Words are important in doing that.”
Hargett said she respects Folwell’s point about costs, but said those are calculations that have to be made with all health coverage. A blanket exemption that only impacts one statistically small group of people covered by the health plan doesn’t seem primarily based in either science or economic concerns, she said.
“I’m a public school teacher,” Hargett said. “We realize that everything is political.”
“I think the lens by which you view subjects, view issues, is whether or not you have any personal connection,” Hargett said.
Hargett, 53, said she knows transgender people and has had them as students. That makes a difference to the understanding of the issues, she said.
“The younger generation — they know transgender people, they know they have transgender friends and family members,” Hargett said. “They just don’t seem to have a voice, it seems. Or it’s not weighted as much. Sometimes our legislative bodies and appointees to boards tend to skew a little bit different than the population.”
“I dare say that ten years from now, this will not be an issue at all,” Hargett said. “The younger folks — they don’t even understand why this is a controversy.”
In the meantime, transgender people relying on the state health plan for coverage have to hope their willingness to talk about their lives and their health needs and the testimony of medical professionals make an impact on the board of trustees. If not, January 1 will begin another year without the health coverage many of them need.
“I’m just speaking for myself,” Hargett said. “I can’t speak for any other board member. But I am hopeful there will be more discussions on the board and that we will get there. I am hopeful that there will be pathways to find ‘yes’ as opposed to looking for roadblocks, reasons to say ‘no.’”
“I, at least, am in agreement that we need to be supporting our transgender members and their transgender family members,” Hargett said. “So that’s one board member, at least.”