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Manchester aldermanic panel: City should pay for transgender health care

New Hampshire Union Leader

October 04. 2016 10:42PM

Reader Poll

  • Should NH cities and towns cover the cost of transgender health care, including sex change surgery, for municipal employees?
  • Yes
  • 8%
  • No
  • 89%
  • Ambivalent
  • 3%
  • Total Votes: 2339


MANCHESTER — Members of an aldermanic committee voted Tuesday to recommend that transgender health care services — such as sex change surgery — be covered by city health insurance.

Human Resources Director Jane Gile went before the Aldermanic Committee on Human Resources and Insurance Tuesday recommending the city ask health insurance provider Anthem to “remove all transgender exclusions or limitations of coverage for all health services related to gender transition from the templates of the city’s medical benefit plan” — thereby allowing Manchester to offer the health benefits to municipal employees as soon as next summer.

Committee members voted 3-2 to recommend to the full board the exclusions be removed. Voting in favor were Aldermen Pat Long, Ron Ludwig and Tom Katsiantonis, with William Shea and Keith Hirschmann opposed.

“I don’t think the taxpayers should be paying for this,” said Hirschmann.

Gile told city aldermen that Anthem will remove the exclusion for gender identity disorders and sex change surgery from its coverage offerings — both fully and self-insured plans — in accordance with ACA Section 1557, nondiscriminatory provisions of the Affordable Care Act.

Section 1557 prohibits most insurers from discriminating on the basis of sex — including gender identity — when providing health coverage. Discrimination on the basis of gender identity includes:

• Blanket exclusions on any transition-related health care services;

• The denial or limitation of coverage for services used for gender transition when those services would normally be covered when treating a non-transition related health condition;

• The refusal to cover treatment that is typically associated with one particular gender, because an individual identifies with another gender or is listed as having another gender in their medical records or on a personal form of identification.

Self-insured plans like the one offered by Manchester can opt out of this provision, but Gile feels other federal rules may apply.

“I think there are other federal laws that might kick in if we choose to keep these exclusions in our plan,” said Gile.

The Age Discrimination Act of 1975 prohibits “covered entities from discriminating on the basis of race, color, national origin, sex or disability” when providing or administering health-related insurance or coverage. In a memo to city aldermen, Gile states the rule prohibits a covered entity from “broadly excluding coverage for transgender services including gender reassignment” and related services.

Hirschmann asked that the request be tabled until Gile could provide additional information.

“This is for transgender services,” said Hirschmann. “If a person wanted liposuction because they felt they are too heavy, do you have to provide it? If they want breast augmentation, is that covered?”

A motion to table the request was not seconded at the committee level.

Gile estimates the cost to add transgender services to the city health plan to be between 80 cents and $1.10 per member, per month.

The request is expected to go before the full board for a vote later this month.

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