A young trans friend of mine in the Hollywood film industry, a union member, spoke to me recently about a conversation she had when she asked an individual representing the Motion Picture Industry Health Plan about health care for herself. She began with the most basic question; will they pay for hormones? The answer was a flat and simple no.
Page 63 of the Active MPI health plan states that "gender change" is excluded from coverage. Some of us would argue that we aren't "changing" so much as "restoring" genders, but let that be, for now. On her own, my friend found that that there was another plan available to union members, an HMO, that did indeed cover all aspects of trans health care including Gender Reconfirming Surgery with an excellent provider in Arizona.
Even then, she found she had problems with representatives of the provider depending on where the offices were located. The Hollywood/Los Angeles office was helpful and knowledgeable, while other offices seemed perplexed, as if she were requesting something no one had ever heard of before.
If you are a trans person seeking health care, you are no stranger to this. In spite of a groundbreaking state law in California that prohibits insurers from excluding trans-related care from health plans, many insurers still push back against providing it, subtly, or not-so-subtly.
The odds tend to be with those insurers, since trans people are somewhere below five percent of the entire population by some estimates, often too intimidated to ask for what we need, and most importantly, the broader culture is ignorant about us and are often hostile to the very idea that we exist.
It's perfectly legal for MPI health plan to exclude "gender change" since the plan is negotiated through collective bargaining and subject only to the federal rules of ERISA, and not that particular California state law.
There are also multiple back door ways that The Plan will pay for the basic HRT needs of trans persons if one finds a creative doctor. One also has a feeling that The Plan is perfectly aware of this, but chooses not to act. So what's the problem?
Here's the thing.
The media-enhanced perception of those in the Heartland is that Hollywood is a bubbling hotbed of Liberalism and political correctness; in truth, the Industry is far from diverse in terms of the stories it tells or the people it employs. Recent surveys revealed this was true even in terms of the world's biggest "minority"; women. Film and TV crews are far more diverse than they were in 1970, but The Industry has a dauntingly long way to go in hiring more women, African-Americans, Latinos, Latinas and Asians.
LGBT people are somewhat well-represented on shows by actors and in a few departments but there are other good-paying crew jobs where many of us keep our identities quiet lest we lose work due to prejudice; it's a business of networking and personal referrals. My young friend is remarkable and rare for being proudly and openly trans. To their credit, the Amazon show Transparent has made an effort to hire trans people in many positions, but they are currently the exception rather than the rule.
Trans people are in the headlines and trans characters are showing up more often in scripts as major characters. What has now begun to happen to trans people, as it has to so many other groups historically, is that the broader culture now thinks we're interesting. Hollywood, America's Dream Factory, is now selling advertising and profiting while telling our stories. It's no small irony that they are doing this while denying our very existence with two words excepting us from our own health plan.
Unlike anyone else in the LGBT community, people like me who work in The Industry pay into the health plan, yet are not officially covered for our specific needs. The vague, trite argument that some have against us is that we "choose" to be the way we are. I disagree with that argument, but let's suppose it were true; I also pay for the coverage of people in my health plan who "choose" to be obese, use recreational drugs, smoke tobacco, drink to excess and participate in extreme sports, and they are not excluded.
Others argue that Gender Reconfirming Surgery is wildly expensive and that it will drive up costs. Basic Male-to-female surgery rarely costs in excess of $40,000, with all hospital expenses covered. Breast reduction surgery for Trans men is far less, although phalloplasties can be expensive, and little has been done to improve methods for it. In contrast, one trip to an ER based on a chest pain can easily cost over $100,000.
The number of people requesting these surgeries is likely to be extremely low, given the small numbers of our population and the fact that many trans people never get these surgeries for any number of reasons. Hormones, by the standards of other drugs The Plan provides, are relatively inexpensive and not likely to be a huge cost driver.
I am reminded of another issue that The Plan had in the past. The Plan used to adamantly refuse to pay for birth control; perhaps they considered this another "choice" issue back then. It was so bad that women with other reproductive issues could not even get innovative therapies containing hormones due to The Plan's hard line when it came to estrogen.
Then, at some point, someone noticed that they were covering Viagra. Someone pointedly, and tellingly asked if the sexual health and pleasure of men was more important than the reproductive health of women, and The Plan quickly and quietly began to pay for birth control. I don't think I'm being cynical if I wonder aloud if some of the original prohibition had something to do with the gender of the decision makers.
So dear, crazy, grumpy, stingy, unpredictable Hollywood, my hometown and employer; please do the right thing and make sure that the trans people working on your shows about trans people (and all people) have their lives and identities honored with appropriate health care, as is their right as covered workers.
Maybe we can have another Viagra moment.