Gender-affirming surgery and related treatments will now be covered for transgender state employees under state-provided health insurance after a 5-4 vote by the Group Insurance Board last month ended the ban on coverage exclusions.

Though the case for coverage has come to an end, benefits to state employees will take effect Jan. 1, 2019 after a process that took over two years.

According to an email from Mark Lamkins, spokesperson for the Wisconsin Department of Employee Trust Funds, the GIB approved removing the exclusion of transgender services in July 2016 based on new federal requirements under the Obama Administration’s Affordable Care Act that would take effect come Jan. 1, 2017.

But later that year, the State of Wisconsin challenged this requirement through a federal lawsuit in joining with Texas, Nebraska, Kentucky and Kansas, the Wisconsin DETF website states.

In December 2016, the insurance board met again for a re-vote to determine whether gender-affirming surgery and related treatments would be covered, Lamkins said in an email.

The board, according to Lamkins, agreed to reinstate the exclusion if and when four contingencies were met.

  1. A court ruling or administrative action enjoining, rescinding or invalidating the rules set by the federal Department of Health and Human Services.
  2. Compliance with state law that provides parameters for benefits of employees.
  3. Renegotiation of contracts maintaining or reducing premium costs for the state.
  4. A final opinion of the Wisconsin Department of Justice that the action taken does not constitute a breach of the Board’s fiduciary duties.

According to University of Wisconsin law professor Steph Tai, the contingencies were met, but the coverage only lasted a month before President Trump took office in January 2017, and Obama Care was repealed.

“Whereas the Obama administration was more accommodating to transgender folks, the Trump administration is not as much,” Tai said.

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Prior to the Aug. 22 vote, transgender advocates, UW Health and UW System officials alike were in full support of extending the coverage. On Aug. 8, UW Chancellor Rebecca Blank, among chancellors from five other UW campuses, addressed the GIB in a letter and asked the insurance board to reconsider the exemption, stating that the exclusion of coverage “jeopardizes our ability to attract top academic and research talent and puts us at a serious disadvantage retaining our LGBTQ employees.”

According to Tai, who as on the faculty committee that studied the necessity of this coverage for UW employees specifically, it was decided that UW needed to be a strong advocate for such matters.

Due to the lack of coverage offered to prospective and current employees, Tai said UW experienced recruitment and retention issues.

“People chose not to come here because their health care needs would not be covered. Recruitment for graduate students was also hard. That’s when the UW chancellors put out their letter,” Tai said.

The chancellor’s letter argues that universities in the UW system must already compete with peer institutions regionally and nationwide that offer coverage and health benefits for transgender faculty and staff.

When working to recruit prospective employees — the choice between an institution that offers full health care coverage and one that does not — transgender employees would opt for the former, the letter said.

“Importantly, the number of people who would utilize this coverage would be much smaller than the goodwill and recruiting impact this coverage would have for a broader range of sympathetic current and prospective employees,” the letter reads.

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Although state coverage has been reformed and extended now, Tai said that transgender individuals will not necessarily take advantage of the full range of surgeries and treatments now covered by state insurance. Because surgeries and related treatments were banned for so long, some transgender individuals may continue living their lives without taking advantage of these new options, but some people may consider it as it has become more affordable now, Tai said.

In January 2017, the GIB’s actuary, Segal Consulting, researched national trends and assessed the impact of transgender services in Wisconsin, Lamkins said in an email. Segal found that between two and five people out of 159,000 members in the state’s Group Health Insurance Program would be anticipated to need transgender-related services in any given year. The potential annual cost would be up to $250,000 of the state’s $1.3 billion non-Medicare premiums.

Included in an email from UW spokesperson Meredith McGlone, the UW Vice Chancellor for Finance and Administration Laurent Heller said, “as noted in the chancellors’ letter to the Group Insurance Board, providing transgender health insurance benefits will be a valuable tool in helping us attract and retain top faculty and staff. The financial costs of this coverage are vastly outweighed by our ability to compete for talented people and the positive impact these inclusive health benefits will have for our community.”

UW Health’s Chief Diversity Officer Shiva Bidar-Sielaff said UW has historically been a leader in LGBTQ+ advocacy and equality, with UW Health being recognized as a “Leader in LGBTQ+ Healthcare Equality” by the Human Rights Campaign Foundation.

This designation is a big deal for UW and prospective employees, Bidar-Sielaff said.

“This designation definitely helps attract employees to UW Health,” Bidar-Sielaff said. “We have been recognized worldwide for the policies and practices we have in place to create an inclusive environment for both employees and patients.”

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UW Health, specifically, is very involved in demonstrating the standards that are in place to ensure an inclusive environment, Bidar-Sielaff said.

Unisex restrooms, training for employees and now, the ability to have access to insurance for transgender employees are among the many policies and practices in place.

“Patients want to be cared for in a place that has these policies,” Bidar-Sielaff said. “And employees want to make sure they are working in an inclusive environment that has these standards.”