A state insurance policy that prohibits discrimination could increase access to gender confirmation surgery

Implementing a statewide insurance policy that prohibits discrimination based on gender identity or gender expression could increase access to surgical care for gender confirmation, according to a new study from The Ohio State University Wexner Medical Center and College of Medicine.

The research examined the impact of California’s Insurance Gender Non-Discrimination Act, which prohibits insurance companies from refusing to cover the cost of necessary medical care based on a patient’s gender identity or gender expression. The policy applies to all health plans in the country.

The analysis included 25,252 transgender and gender diverse patients in California as well as in Arizona and Washington, which did not implement similar insurance policies. The researchers found a 12.1% increase in the likelihood of patients undergoing gender confirmation surgery in California compared to those in Arizona or Washington. The results are published today in the Journal of the American Medical Association.

Adrian Diaz, MD, a general surgery resident and senior author of the study, said. According to the study, at least 1.6 million Americans identify as transgender or gender diverse with about 60% expressing interest in gender confirmation surgery.

This research has the potential to have a significant impact on the transgender and gender-diverse community because it demonstrates the power that state legislatures have to implement non-discriminatory insurance policies and improve access to gender-affirming surgical care.”

Dr. Adrian Diaz, MD, general surgery resident and senior author of the study

Studies show that without access to gender-affirming surgical care, patients have higher rates of HIV infection, depression, substance abuse, suicidal ideation, and unemployment.

“With the recent national trend of states passing restrictive state-level policies that limit access to gender affirmation care, we felt it was important to understand the impact of preventive and non-discriminatory state-level policies that have already been implemented. This type of research helps inform legislators States have potential policies that can create a more equitable health care environment within their states,” said Dr. Anna Schoenbrunner, MD, a plastic surgery resident at Ohio State’s Department of Plastic and Reconstructive Surgery and first author of the study.

The researchers note that their findings were similar to what happened after the implementation of the Women’s Health and Cancer Rights Act in 1999, which mandated insurance coverage for breast reconstruction and symmetry procedures after a mastectomy. After the law was passed, a study found that benefit from breast reconstruction increased 31% in the year of implementation and 36% the following year in states where there was no prior legislation mandating insurance coverage.


Journal reference:

Schoenbrunner, A.; et al. (2023). The association between California’s insurance gender non-discrimination law and the use of gender confirmation surgery. gamma. doi.org/10.1001/jama.2023.0878.

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