Last week, I brought up a question many individuals had asked me: why don’t insurance companies have to cover medically necessary transgender surgery? The easy answer is they don’t legally have to, but I feel it is more important to understand the history that led to this lack of coverage.
In “Transgender History Part One” I examined the origin of transgender identity and healthcare in America. The short of it is that the first widely known trans woman, Christine Jorgensen, found a warm welcome in the public eye in the nineteen-fifties. She was able to transition because Dr. Harry Benjamin, an endocrinologist, took interest and worked to help her be her authentic self.
Her public transition introduced to our culture the idea that there is more to gender than what is between our legs. This is a powerful idea that let many people finally understand the pain and confusion they felt about their own body. Those people then sought help from Dr. Benjamin and after a number of years treating these patients, he went on to develop a healthcare model for transgender patients in the nineteen-sixties. Unfortunately the original model was incredibly limiting, erasive, and sexist. It required trans women to always put on makeup, wear dresses, talk in a high pitch, and be as hyperfeminine as possible to get treatment.
The sixties also gave rise to second-wave feminism, which broaden the scope of first wave feminism to include a liberation of sexuality, freedom of body autonomy, and gender equality laws. First wave was concerned with voting and ownership rights, while second wave was looking at the more nuanced issues of expanding personal freedoms and rights. While Christine Jorgensen was given a warm welcome, she was one person, she wasn’t the whole trans movement. Because of that, culture and feminism hadn’t really digested how they would feel about this. I’d venture at this point that most cisgender people didn’t care or have an opinion, and it stayed that way until the late seventies.
This all changed in 1979 with Janice Raymond’s book “Trannsexual Empire.” She took the position that trans women are patriarchal stereotypes of what it means to be a woman, who metaphorically rape women’s bodies and appropriate their space. While she was by no means the first person to hold anti-transgender views, her book became the bible for modern day trans-exclusionary radical feminists or TERF for short.
Looking back at how the original model of healthcare was for transgender women, it makes sense that she came to this view, because in a way she was right, but not in the way she intended. She aimed her criticisms at trans women, instead of at the medical establishment which required trans women to be caricatures. Tragically, we suffered the consequences of this misdirection, because instead of it changing the criteria of our treatment as it could have, it alienated, invalidated, and stereotyped the trans movement then and to this day.
To really understand the consequences and to answer the original question I posed, transgender healthcare was routinely covered by insurance prior to her book. In the beginning of the eighties, based solely her work, the government determined transgender surgery was controversial. They used her work to justify that position and insurance companies in turn excluded covering it by citing that. This ruling lasted without question for the next thirty years and is what continues to influence our lack of coverage today.
So, what changed after thirty years?
The answer to that starts in the early nineties with the emergence of third-wave feminism, which expanded cultural ideas of what gender can be. Judith Butler and Kate Bornstein fired some of the first shots, and from them and many others we gained an understanding that there are many ways to live authentically. This is when the term transgender was popularized and when both transgender individuals and feminists were able to criticize and change transgender healthcare for the better.
The most recent Standards of Care for transgender individuals came out in 2011 and no longer held us to sexist notions nor encouraged us to hide. Without those restrictions we started to gain a voice as a movement and to be understood as authentic. That is why we have seen such dramatic strides in the last five years, why Laverne Cox was on the cover of Time, and why a judge in Minnesota ruled a trans surgery ban was unconstitutional.
That’s the simple history and it omits the thousands of activists that worked through the years for a better life for themselves and others. While I think surgery bans will become illegal in all states, I hope and encourage companies to include the coverage before all that, because this surgery is provably necessary, effective, and affordable.