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Amid growing concerns over the lack of transgender voices in conversations about coverage plans, University of Michigan graduate employees met with human resources representatives and the MHealthy Advisory Committee Friday to urge the University to cover gender-affirming surgeries.
Members of the Graduate Employee Organization’s Trans Health Caucus discussed potential improvement to GradCare, a healthcare plan for University graduate students that covers most transgender surgeries yet deems certain ones, such as facial feminization surgery, as cosmetic and not medically necessary.
The conference was closed to the public, yet more than 50 GEO members and allies lined the hallways of Wolverine Tower holding signs of support that read “Are you ready to listen?” and “Our lives are not cosmetic.”
University spokesman Rick Fitzgerald said the goal of the conference was for members of HR to better understand the perspectives and experiences of the Trans Health Caucus’ members.
“One of the purposes of the special conference on Friday was to hear directly from GEO members about this topic,” Fitzgerald said. “The University acknowledges the courage and commitment of those who shared their stories Friday afternoon and these stories have helped to inform the process in a productive way.”
In April 2017, members of the Trans Health Caucus threatened to walk out of contract negotiations with HR due to inadequate trans healthcare coverage. Since, the Trans Health Caucus and HR have been engaged in a series of special conferences as part of the collective bargaining process to address the GEO’s demands.
In March 2018, the GEO also raised awareness about trans healthcare coverage by hosting a Trans Day of Disposability rally in the Diag. The conferences and rally put pressure on the University to adapt their policies related to gender transition procedures, but many Trans Health Caucus members said they still felt unheard and ignored by HR.
Ansel Neunzert, Rackham student and GEO member, stood outside of Friday’s special conference in support of the Trans Health Caucus. They said they hoped the conference would force University officials to acknowledge the experience of trans students when making decisions about healthcare coverage.
“I really hope that today they’re going to hear from a lot of trans people about the ways that this stuff impacts them, and get a sense of the fact that this isn’t an abstract discussion about the University’s bottom line — this is people’s lives,” Neunzert said. “I think it’s really valuable to get that first-hand information in a way that I don’t think HR and the MBAC (Medical Benefit Advisory Committee) have heard yet.”
According to Monica Lewis, Rackham student and chair of the Trans Health Caucus, the University agreed to convene every four months to discuss transgender healthcare coverage but has missed the deadline to arrange these meetings twice since April 2018.
“One of the major red flags that they weren’t taking this seriously was that there was a contractual deadline violation, namely literally the only stipulation in the contract that sets out rules for these meetings is that we have to meet every four months, and they missed the four-month deadline,” Lewis said. “In September, they missed the four-month deadline again. I think it was kind of over the summer of 2018 that we were like, yeah, this is not going anywhere and we’re going to have to get a little more aggressive with them.”
University spokeswoman Kim Broekhuizen said the University is still discussing the healthcare concerns with GEO.
“We have been meeting with GEO in good faith to discuss and review our transgender benefits,” Broekhuizen wrote.
Though asked about missing the four-month deadline for transgender healthcare, Broekhuizen did not comment on the allegation from Lewis.
To provide HR representatives with the medical background needed to participate in the special conferences, the University called two MBAC meetings in June and October 2018. The meetings, which were led by Philip Zazove, chair of Family Medicine at Michigan Medicine, aimed to discuss healthcare coverage with medical professionals and advise HR about what procedures to cover under GradCare.
Zazove did not respond to request for comment.
Lewis said the details of these meetings were not immediately available to the Trans Health Caucus, and the board members had little experience with trans healthcare before making their recommendations.
“The kind of people who were on this coverage review were primarily old-school physicians who don’t have any specialization in trans care whatsoever,” Lewis said. “So a bunch of cis people are going to meet behind closed doors and decide whether or not they feel these transition procedures are cosmetic and we don’t get any say in the matter?”
Fitzgerald said while the University is still in the process of negotiating more extensive transgender healthcare with the GEO, GradCare coverage includes many gender-affirming surgeries and is on par with most public institutions.
“The University’s coverage of gender-affirming services meets or exceeds that currently offered by the majority of our national peer institutions,” Fitzgerald said.
Lewis and Morgan Whitcomb, Rackham student and member of the Trans Health Caucus, said they took issue with how University officials seemed to exclude trans voices from the MBAC meetings and comply with insurance policies that do not cover gender-affirming surgeries.
According to MBAC meeting notes from June 2018 the Trans Health Caucus obtained through the Freedom of Information Act and given to The Daily, the Michigan Medicine plastic surgery team deemed facial feminization and chondrolaryngoplasty (Adam's apple reduction) medically necessary, but the insurance providers Blue Cross Blue Shield and Blue Care Network of Michigan identified them as cosmetic.
Whitcomb said the lack of trans people present in MBAC meetings contributed to this discrepancy.
“They don’t want to acknowledge that trans people are experts in their own healthcare,” Whitcomb said. “They have this disconnect of ‘Well, there’s like doctors have trained for this.’ The difference is they haven’t trained to be experts in trans care — they’re experts in other fields and they’re trying to apply that knowledge to a different community and problem without consulting the community.”
The Trans Health Caucus has received support from transgender students, allies and the Rackham Student Government since the first special conference in December 2017. In a November 2018 letter obtained by The Daily that GEO sent to MBAC with 419 signatures, the organization urged MBAC to “act with compassion to those over whom you currently wield significant power.”
On Dec. 13, 2018, the RSG unanimously passed a resolution in support of expanding GradCare coverage for gender-affirming surgery. 10 representatives were absent from the vote.
Friday’s special conference, which included a personal perspectives section where Trans Health Caucus members recounted their experiences with gender dysphoria, persuaded HR to cover fertility preservation under GradCare. Lewis said that while it was a victory for the Trans Health Caucus, the process to achieve it was a difficult one with more work to be done.
“It sucks that some people have to talk about suicidal ideation with HR representatives in order to get healthcare,” Lewis said. “And it sucks that that’s where we are at in the process, is that is talking about graphic descriptions of gender dysphoria with HR and MBAC. It sucks that that’s what it took, but if that’s what makes progress, hopefully we don’t have to do it again.”