GenderLife Forum: The Information Exchange

http://www.innewsweekly.com/innews/?class_code=Ne&article_code=5603

AMA Supports Transgender Health Care GLAD Applauds Decision

by William Henderson
June 16, 2008

The House of Delegates of the American Medical Association, meeting in Chicago today, June 16, passed a resolution for "Removing Barriers to Care for Transgender Patients," which states “Resolved, that our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient’s physician.”
Getting appropriate medical care, from psychotherapy to hormone therapy to any range of surgeries, is a struggle for most transgender people due to prejudice, ignorance, and simple discrimination, said Jennifer Levi, director of GLAD’s Transgender Rights Project. [See GLAD Launches Transgender Rights Project, Issue 1744, Page 3].
“This resolution is hugely important, coming from the country’s most respected medical organization. Transgender people have to climb over so many barriers in order to get appropriate care, not the least of which is insurance coverage," said Levi. " The AMA resolution should help providers, insurers, courts and legislatures put gender identity disorder in its proper context – as a treatable health condition that insurers should cover without discrimination.”
GLAD’s work to challenge bias in health care against transgender people includes its current litigation of the U.S. Tax Court case, O’Donnabhain v. Commissioner of Internal Revenue, in which the IRS refused to consider deductible the medical expenses associated with care of treatment of Rhiannon O’Donnabhain’s gender identity disorder. "The questions that were raised in Rhiannon's case about the legitimacy of the GID diagnosis and appropriateness of its care and treatment are all answered in the affirmative by this AMA resolution," commented Levi. "This resolution firmly rejects the IRS's position that gender identity disorder is without a medical basis or that there is any question about the effectiveness of the established treatments for it."
The AMA's resolution and a Q & A about the resolution can be found on GLAD's Web site at www.glad.org.

And the APA? I wonder...

Thanks for posting this, Diana Lynn.

From the website of Roger Peele, M.D., D.L.F.A.P.A. a member of the APA Board of Trustees [1985-7, 1989-92, and 2001-present], as a member of two Work Groups, DSM-III, member of DSM-IIIR Task Force, DSM-IV Task Force, liaison to Steering Committee on Practice Guidelines, Committee on Psychiatric Diagnosis and Assessment,and also a member of the task force working on the DSM V:

ISSUES ALREADY BEFORE THE DSM TASKFORCE, INCMOPLETE:
"...
21. Sexual and Gender Identity Disorders:
A. Remove Gender Identity Disorder?
B. Remove Gender Identity Disorder as a psychiatric disorder, and include transsexual operation and medical care for people with gender variance in ICD-9-CM’s plastic surgery section.
..."

I don't know if this is on the American Psychiatric Association website or not, but Dr. Peele is on both the board of trustees and on the task force to create the DSM V.

Do you think this will have any effect on whether insurance companies cover GID or not?

And if insurance does become available for 'GID' what if GID is eventually no longer considered a 'mental disorder'? Would we all lose our coverage?

From NCTE. Contains the full text of the resolution.
June 17, 2008

NCTE Applauds the AMA Call for "Removal of Financial Barriers to Care for Transgender Patients"
The American Medical Association (AMA) passed a resolution yesterday calling for "public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient's physician." The declaration, known as Resolution 122, "Removing Financial Barriers to Care for Transgender Patients," was passed by the House of Delegates - AMA's primary decision-making body - at its annual conference in Chicago.

Resolution 122 affirms the effectiveness of medical treatment for transsexuals and the right to appropriate treatment. It also names as discriminatory the categorical denial of health insurance coverage for psychotherapy, hormonal and surgical treatments for transgender patients, and reiterates the AMA's opposition to discrimination based on gender identity. The full text of the resolution is below.

"America's physicians are saying that transgender people, like all others, deserve competent medical care based on what individual doctors and their patients determine is healthiest for each person," noted Mara Keisling, Executive Director of the National Center for Transgender Equality (NCTE). "Doctors and patients, not insurance companies, should be making those choices. We are so glad that the AMA has taken a leadership role against the rampant discrimination that transgender people have faced for so many years in receiving appropriate medical care and equitable insurance coverage,"

Health insurance coverage has been made into prominent national issue recently thanks in part to a three year campaign by the AMA. NCTE has prioritized ending health insurance discrimination against transgender people.


AMA RESOLUTION:

RESOLUTION 122
Subject: Removing Financial Barriers to Care for Transgender Patients

Whereas, Our American Medical Association opposes discrimination on the basis of gender identity; and
Whereas, Gender Identity Disorder (GID) is a serious medical condition recognized as such in both the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) and the International Classification of Diseases (10th Revision); and is characterized in the DSM-IV as a persistent discomfort with one's assigned sex and with one's primary and secondary sex characteristics, which causes intense emotional pain and suffering; and

Whereas, GID, if left untreated, can result in clinically significant psychological distress, dysfunction, debilitating depression and, for some people without access to appropriate medical care and treatment, suicidality and death; and

Whereas, The World Profession for Transgender Health, Inc. (WPATH) is the leading international, interdisciplinary professional organization devoted to the understanding and treatment of gender identity disorders, and has established internationally accepted Standards of Care for providing medical treatment of people with GID, including mental health care, hormone therapy, and sex reassignment surgery, which are designed to promote the health and welfare of persons with GID and are recognized within the medical community to be the standard of care for treating people with GID; and

Whereas, An established body of medical research demonstrates the effectiveness and medical necessity of mental health care, hormone therapy, and sex reassignment surgery as forms of therapeutic treatment for many people diagnosed with GID; and

Whereas, Health experts in GID, including WPATH, have rejected the myth that such treatments are "cosmetic" or "experimental" and have recognized that these treatments can provide safe and effective treatment for a serious health condition; and

Whereas, Physicians treating persons with GID must be able to provide the correct treatment necessary for a patient in order to achieve genuine and lasting comfort with his or her gender, based on the person's individual needs and medical history; and

Whereas, Our AMA opposes limitations placed on patient care by third-party payers when such care is based upon sound scientific evidence and sound medical opinion; and

Whereas, Many health insurance plans categorically exclude coverage of mental health, medical, and surgical treatments for GID, even though many of these same treatments, such as psychotherapy, hormone therapy, breast augmentation or removal, hysterectomy, oophorectomy, orchiectomy, and salpingectomy, are often covered for other medical conditions; and

Whereas, The denial of these otherwise covered benefits for patients suffering from GID represents discrimination based solely on a patient's gender identity; and

Whereas, Delaying treatment for GID can cause and/or aggravate additional serious and expensive health problems, such as stress-related physical illnesses, depression, and substance abuse problems, which further endanger patients' health and strain the health care system; therefore be it

RESOLVED, That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient's physician. (New HOD Policy).

The one thing that I think needs to be changed is the 1 year of RLE requirement before being able to qualify for SRS surgery.I know that someone can go to Thailand for SRS without RLE,and thats one way of getting around it.I know that before I go fulltime I'm going to get SRS first because theres too many risks involved otherwise,such as being denied medical treatment in an emergency,being discovered by accident along with an incomplete changing of all personal documents until thats done.Theres too many loose ends.Someone should be able to decide after a period of time on hrt if they want to go forward with SRS on there own, before RLE.It just has to be set up so any doctors/therapists/insurance companies are released from any type of liability in case the person has the surgery and for some reason finds out they made a mistake.I know it happens,but not often enough where it would be much of a problem.As I stated earlier in my post,I'm getting SRS and having my personal info changed before going fulltime regardless of what the SOC requirements are..

I agree 100%. I have said many times in different threads on this forum that requiring someone to live to live as a female in order to gain permission to fix their body is the height of abuse. I will say it again. IMHO that is a stupid hetero sexual male requirement. Live as a woman before you can alter your sex. That's pure BS. Why not require O'Bama to be a president before he can run for the office? Why not require a woman to adapt a child and prove she can be a competent mother before she is allowed to get pregnant? Personally I think we should require a person to be trans before they are allowed to write rules for Trans. Nuff said. My opinion only. Yours may differ and that's just fine with me if it does.

No on both counts.

1. Insurance companies are in no mood to increase spending on psychiatry. It is seen as very bad value for money, too few minds cured for too many expensive hours spent curing them. If anything psychiatric benefits will be cut, they definitely will not be increased.

2. DSM is a diagnostic manual not a treatment manual as the APA keeps telling us. Pathways to treatment have no bearing on whether GID stays or does not in the DSM. So says the APA.

3. Proven successful treatment will not be abandoned merely because one explanation of why it works is debunked. A different rationale will be found to replace GID just as soon as GID goes away. Actually however, mental illness GID may very well actually exist BUT NOT IN TRANSSEXUAL PEOPLE only in people like Sam Hashimi. HBIGDA SOC may still be appropriate but ONLY for DEtransitioners.

QFT.

It makes no difference to anyone but me what my genitals are, so why can I not have surgery today, before I'm full time? Sigh. Oh yeah, it's because I'm supposed to go through the hazing period, yeah, I forgot about that.


Anyway I'm still confused, does this mean that insurance companies today will start paying for SRS? Or does this only mean that the AMA is effectively encouraging the insurance companies to pay for it? If the later, this feels like nothing more than a token recognition of our issues. I'm hopeful, but I doubt we will see any change for quite some time... if ever, and even if they do for SRS, they'll never go for FFS - which in my mind for many people is far more medically necessary than SRS. And more expensive.