Due to inadequate transgender care services, the Graduate Employees’ Organization — a union representing graduate student instructors and graduate student staff assistants at the University of Michigan — is fighting for transgender health care coverage by raising awareness at their Trans Day of Disposability rally and putting pressure on the University Human Resources to take part in health care negotiations. Through these negotiations, GEO hopes to achieve more transparent information and health care coverage from at least two providers for the transgender community in Ann Arbor.
GEO’s Trans Health Caucus has been meeting with Human Resources in special conferences to address trans health care coverage under GradCare, a health care plan exclusively available for graduate students, including instructors, staff assistants and research assistants. Though GradCare covers transgender surgeries in general, it deems specific genital surgeries as cosmetic and refuses to cover those expenses. According to Jill Seale, a Transgender Resources and Retention Coordinator at Portland State University, obtaining proper treatments is imperative for a transgender individual’s wellbeing.
“Let me be clear, these procedures are not cosmetic; they’re medically necessary,” Seale said. “The American Medical Association has agreed on this for a decade. Living in a body that fits with what you feel is right for you can save your life.”
According to the 2015 U.S. Transgender Survey Report of nearly 28,000 trans individuals across the nation, 55 percent of trans people requesting insurance coverage for help with gender affirming surgery were denied, 23 percent of the respondents avoided their physician out of fear of mistreatment, 40 percent of transgender individuals have attempted suicide in their lifetimes and 7 percent of trans people attempted suicide in the past year.
According to Rackham student Vidhya Aravind, GEO Solidarity and Political Action Committee co-chair during contract negotiations in 2017, GEO and the University agreed to meet at least three times during the 2017-2018 academic year and annually in following years. However, there has only been one meeting. Although GEO has contacted the University five times since that meeting in order to obtain a list of trans health care providers in the University's Health System, they have not recieved the list.
“In that first conference, we asked for a list of all the trans health care providers at University of Michigan Health System organized by procedure, so we could plan for our future negotiations,” Aravind said. “After delaying for three months, HR finally sent us a copy of our own benefits document, a link to the public facing and information devoid UMHS trans health care site, and a copy of a document we brought on our own to the first meeting. Worse than a failure to meet our request, this was insulting.”
The Comprehensive Gender Services Program is the University’s center for transgender medical care, providing services ranging from family care to plastic surgery. However, members of the transgender community in Ann Arbor are reportedly unsatisfied with CGSP’s level of care.
According to Carta Monir, a local transgender woman currently seeking care through CGSP, the University advertises the center as a one-stop shop but does not deliver quality care.
“I’m hopeful that HR will begin to understand how poorly the CGSP is regarded by the Ann Arbor trans community, and how low their standard of care is compared to other universities, even,” Monir said. “This is not a world-class transgender health system, and it’s my hope that HR would like it to be one, instead of the poorly-functioning hindrance it is right now.”
When obtaining hormones and seeking genital surgeries, the process can allegedly take months despite the time-sensitive nature of the treatments.
“The CGSP required a letter from my therapist and then went silent for weeks,” Monir said. “In the end, I waited months for something that could have been done in one or two days … Getting hormones isn’t anything compared to any of the more specific trans medical necessities.”
However, according to CGSP Director Sarah Wiener, the time frame completely depends on each case and how quickly they receive the therapists’ letters.
“The time frame is really dependent on how quickly those letters come in,” Wiener said. “If they come in right away we can look at them and help the person get connected to a provider. It just really depends on the letters. We take up to 10 business days to review letters … So that people aren’t waiting too long for us to review a letter.”
Wiener emphasized all 20 of CGSP providers function under the World Professional Association for Transgender Health Standards of Care, requiring either one or two letters from mental health professionals depending on the level of care. This model is more extensive than informed consent, entailing the individual seeking treatment to simply agree to the care and procedures. In addition to these standards, the CGSP’s lack of multiple providers for various surgeries limits patients’ options.
“Some people may wait a long time for surgery because, for the surgery they want, there’s only one person doing that surgery — that is a little bit more outside of our control,” Wiener said. “We would love to have many providers that provide all the different services and that’s a priority of ours over time. Some of the wait difficulties are due to not having a bunch of providers who are doing particular procedures … That is important to us, to continue to build our network of providers.”
In addition to low numbers of physicians, Monir emphasized CGSP’s lack of insurance recommendations.
“CGSP isn’t even doing the bare minimum of publicly sharing information about the providers of trans health care in the area,” Monir said. “I’m not terribly impressed when they talk about their hands being tied because they’re so unwilling to share even basic details about their extremely mysterious processes.”
The CGSP section of the website states it does not provide recommendations for health care plans. They can only divulge which payment plans are accepted but not which procedures are covered. Wiener highlighted this is due to the diversity of individual cases and plans.
“There is a lot of variation from plan to plan,” Weiner said. “Sometimes people ask ‘What are the good plans?’ and we just don’t know because sometimes employers can customize those plans.”
These policy hurdles tend to stand in the way of individuals receiving care in a timely manner, and with time-sensitive treatments, this could be especially hindering for students.
“The most valuable thing to a trans person is time — the fact that the CGSP is currently set up seemingly to delay transitional health care is especially rough on students,” Monir said. “If someone is a two-year masters student, being asked to wait months to even begin hormones is an enormous sacrifice — care that's delayed to the point of not being possible might as well not even exist.”
On the other hand, Wiener stressed students should contact CGSP if they are in a time-sensitive situation and ensured the center would do their best to help individuals.
“We want to help connect people to resources as quickly as possible and I know that access to care can be difficult and frustrating experience, we will do everything in our power to help facilitate people’s process,” Wiener said. “So if people are ever struggling, frustrated and don’t understand what’s going on or why it’s moving so slowly, they should just reach out to us.”
However, Rackham student Phil Witte emphasized the University’s pride in CGSP and the transgender community is used to solely improve its diversity image.
“Our visibility is profitable to the University,” Witte said. “Our visibility helps raise the institutional diversity profile. The University points to CGSP when they brag that Michigan is a leader on trans health care. CGSP does not provide access to health care. CGSP exists as a gatekeeping institution that manufactures delays and barriers to accessing the health care we need. Visibility minus material support equals disposability. This is gender entitlement at a systemic level.”
Despite the University’s reputation, other colleges, such as Portland State University, are said to provide higher quality care.
“When I needed gender affirming surgery, our trans health advocate met with me and walked me through the process of getting it approved by the student insurance,” Seale said. “When the insurance shot back that no one was in-network for the procedure I needed, he worked with them to make sure I was able to pick any provider in the country and the procedure would be covered as in-network. I was able to get the surgery I needed, from the surgeon I wanted, and I was able to spend my time and energy on my schoolwork instead of fighting with the insurance.”
Renée Cymry, a local Ann Arbor transgender woman pursuing care, stressed the low-cost nature of most transgender health care plans.
“When UC-Berkeley (University of California-Berkeley) decided to insure trans healthcare, they did right by their students, and are now a national leader in this area,” Cymry said. “Going from no trans insurance at all to every trans student now having top-of-the-line insurance caused a mere 1 percent increase in Berkeley’s insurance payouts. So at most we’re talking about a single percent increase in the amount of money that (the) University of Michigan would be paying itself at its own hospital system.”
With many people in the transgender community lacking access to care due to these obstacles, Aravind underlined at the rally that the University needs to step up and improve their services to provide proper care to its transgender community members.
“It’s time that the University does better in its inclusion and its health care for all of us,” Aravind said. “We don’t need to improve our visibility. I already get stared at enough when I walk down the street or try to use a public restroom. We need actual help if we’re going to make it to tomorrow.”