This Week in the Mercury


Tuesday, June 28, 2011

Sexual Politics: Fight For Your Right to Healthcare

Posted by Sarah Mirk on Tue, Jun 28, 2011 at 11:59 AM

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Welcome to my weekly column about LGBT, reproductive rights, and gender issues. Previous columns are here and here. If there's a topic you think I should cover, let me know!

In an ideal world, Alec Esquivel’s ovaries wouldn’t make headlines.

The details of the transgender law clerk’s reproductive organs would be known to only Esquivel and his doctors. But, instead, Esquivel has decided to sacrifice his confidentiality, thrusting his most private parts into the limelight to fight for his right to healthcare.

Esquivel, an Oregon state employee, filed a lawsuit against the state last week, arguing that the public employee insurances’ blanket ban on covering sex change operations violates the state’s own anti-discrimination law. A worker shouldn't have to make their medical history a public spectacle just to get the state to follow its own damn laws, but good on Esquivel for being brave enough to come out and hit the state government where it hurts the most: Its budget.

If the state doesn't agree to change its insurance plan to one that covers every employee equally, they could be paying for a lot more than the cost of just one sex change: The lawsuit seeks $250,000 in damages.

Just two weeks ago, Portland city council unanimously voted that city insurance should cover sex changes for transgender employees. Now here is a perfect example of what will happen when employers aren't so forward-thinking. Workers will sue.

"I'm sharing a lot of stuff about myself that most people would rather not share," says Esquivel. "But sometimes you have to do some education and having a real face, a real person, makes it easier for people to see that discrimination is a real problem that affects real people."

As the complaint spells out, "Esquivel experienced increased anxiety, distress, and lack of sleep from the incongruity between his felt gender identity, which was now fully expressed outward as male, and his internal female reproductive organs."

Esquivel has been living as a man since 2001, when he moved here to "escape from Nebraska" (as he puts it). He's legally changed his name, his gender, his birth certificate. For a decade, he has been diagnosed with Gender Identity Disorder, with the recommended treatment of getting a sex change. But the state's insurance providers—Providence and Kaiser—explicitly ban coverage for "all services related to sexual disorders or dysfunctions" including sex changes and hormone therapy.

So since 2001, Esquivel has been paying for the treatment for his diagnosed, mainstream-doctor-recognized disorder, shelling out thousands of dollars for hormones and a breast removal operation. But when the insurance companies refused to cover his hysterectomy this year, Esquivel decided it was time to sue. Not only does he not have the cash for the doctor-prescribed surgery (which can cost anywhere from $10,000-20,000), but he wants to change a state insurance policy that clearly violates the state's anti-discrimination law.

There’s no excuse for Oregon insurance not covering doctor-prescribed treatments just because it deals with icky body parts. In a state where laws explicitly ban discriminating against employees based on their sexual orientation and gender, the only reason sex changes aren’t routinely covered is that insurance companies are three years behind those wild and crazy radicals at the American Medical Association, which decided in 2008 that Gender Identity Disorder is a disorder like any other and should definitely be covered by insurance.

This is likely a first-of-its kind lawsuit. LAMBDA legal, which is representing Esquivel, notes that courts have recently ruled that denying medically necessary gender-transition care to transgender prison inmates is discriminatory, but it looks like Esquivel is the first transgender state employee to step up and demand equal healthcare.

I hope it sends a clear message that we've entered the era where public agencies only have two options regarding transgender employees: Treat Gender Identity Disorder as a genuine diagnosis and cover it with insurance like you'd cover any other disorder, or get sued.

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