Solution Wanted 

A group of UA employees is working to convince the administration that insurance for trans faculty and family is a worthy fight

click to enlarge "This is a civil rights issue. It is about equality of access to healthcare," says Susan Stryker, director of the UA Institute for LGBT Studies.

Curtis Ryan

"This is a civil rights issue. It is about equality of access to healthcare," says Susan Stryker, director of the UA Institute for LGBT Studies.

Frustration is building among a group of UA employees over the exclusion of transgender-related care in the university's health insurance plan.

The transgender community and allies see a huge paradox.

Here's the progressive home of the first transgender studies program in the world; a university that supports gender nonconforming research and that, thanks to the Arizona Board of Regents, offers health insurance coverage for transgender students; and a place that long-ago added gender identity and expression to its nondiscrimination policy.

When it comes to health insurance exclusions, it's not just about individuals, there are parents of transgender and gender nonconforming children, who have had to pay for transition care out of pocket—care, such as hormone and psychological therapy, that's oftentimes life-saving for trans kids and youth, a demographic with astronomical suicide rates.

At least 41 percent of transgender people will attempt suicide at some point in their lives, compared to 4.6 percent of the non-trans population, according to 2015 statistics by the American Foundation for Suicide Prevention and the Williams Institute, which analyzed results from the National Transgender Discrimination Survey.

And that's the biggest fear for one UA employee whose 16-year-old child is a transgender boy.

"With a lot of the teens, it is a big mental health issue. As a parent, it is a huge concern," she says, asking to remain anonymous for her son's safety at school. "It is terrifying as a parent to know that you could come home someday and walk in when your kid just couldn't take it anymore."

To Susan Stryker, director of the UA's Institute for LGBT Studies and creator of the upcoming newly-created transgender studies degree, it's baffling that it has taken this long for the university to even acknowledge there's a problem. Stryker quietly began making waves more than two years ago, and was temporarily stonewalled, she says. "Only when we turned up the volume ... turned up the heat, did the university feel, 'We should move forward,'" Stryker says. "This is a civil rights issue. It is about equality of access to healthcare. They are out of compliance with their own diversity policy."

However, it's not entirely in the university's hands.

As a state entity, the UA is required to get its healthcare from the Arizona Department of Administration. The department's insurance clearly excludes, "Transsexual surgery including medical or psychological counseling and hormonal therapy in preparation for, or subsequent to, any such surgery," as Stryker points out.

She says the wording could suggest to entirely deny healthcare to transgender people, "because we can always be understood to be 'in preparation' for surgery, even if we don't want it, whereas if we have had surgery, any health care need 'subsequent to' it could be deemed related to transsexualism."

Helena Rodrigues, director of the UA's Human Resources Strategy and Planning, says the university is doing what it can to progress. For months, she has been meeting with employees affected by the healthcare exclusion, including parents of transgender children. Every single concern she hears about also reaches the ears of upper UA administrators and AZDOA. Rodrigues says the UA has to give the state info about how the exclusion is negatively affecting employees.

At a meeting in early November, the UA faculty senate passed a resolution "strongly" recommending that the university support health plan benefits for trans employees and their dependents.

On Nov. 25, a memo was sent to everyone involved on behalf of Andrew Comrie, senior vice president for Academic Affairs and Provost; Gregg Goldman, senior vice president for Business Affairs and CFO; and Allison Vaillancourt, president of HR, saying the university is working with AZDOA to "explore opportunities to amend our health insurance coverage options ... We will share updates and communicate our progress with you as we work to achieve change. We look forward to being able to provide health benefits that more fully meet the needs for our UA community."

But there are still critics who feel the university isn't doing enough. Rodrigues says that's fair.

"If you are the person being denied the coverage, or the parent of a child anticipating the need for this coverage, nothing can happen fast enough," she says. "We have invested a lot of attention. There is no doubt the university wants a solution."

Rodrigues is in constant communication with her counterparts at Arizona State University and Northern Arizona University. ASU is in a similar situation as the UA. In NAU's case, the school has its own health insurance plan—independent from AZDOA—and they already offer coverage for transgender care. "(NAU) has certain flexibility that we don't have," Rodrigues says.

AZDOA did not comment by press time.

If things remain static with the agency, detaching from the state-offered insurance is a solution that's been thrown around by some UA employees. But local transgender advocate and Pima County attorney Abby Jensen doesn't think it's the best path to choose. It could make coverage more expensive for other state employees, and it wouldn't fix the exclusion problem within other state-run agencies. Better to create an Arizona-wide umbrella of protection than continuing a piecemeal route.

Jensen hopes to collaborate with the AZDOA, so that the changes are done right from the start.

"We don't want to simply remove the exclusion for transgender care on the basis that is discriminatory, because then every time a transgender person files a claim, we have to prove that (an insurer) denied the same service to a cisgender patient," says Jensen, who is also the vice president and general counsel for the Southern Arizona Gender Alliance. "We want to go beyond, include a list of specific procedures and treatments that will be covered, so we don't have to fight every claim."

The Joint Legislative Budget Committee has the last word on whether the state-provided insurance should include transgender care or not, she says. Jensen, and everyone else involved, hopes to present the proposal for the JLBC to consider soon.

Jensen says it's only a matter of time until the federal government enforces healthcare anti-discrimination rules, and those changes begin to trickle down to every state. The U.S. Department of Health and Human Services is already working on it, using a provision in the Affordable Care Act that bans sex discrimination. It's been argued that "sex" also refers to healthcare exclusion based on gender identity. Even though this would only include insurance providers in the federal marketplace, it's still a big step forward that will pressure a domino effect with private insurers, Jensen argues.

Stryker wonders if what the UA wants is a lawsuit. She recognizes getting healthcare coverage for trans faculty is "bureaucratically complicated," and maybe having a third party decide what might be the best, in case there is fear of any political repercussions. She's aware that this is a state that about two years ago considered a bill that would have required transgender people to show an ID before entering a bathroom of the gender they identified with. "Litigation is a remedy of last resort," she says. "As long as they are moving in the right direction, that's good."

"It would be great to feel that my employer was actually committed to upholding its own diversity and nondiscrimination policies," she adds. "I think people at the top of the food chain in the university are wanting to do the right thing, but it is complicated. They can't figure out how to do the right thing, and maybe they wish the whole problem would just go away."

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