Lilo H. Stainton, NJ Spotlight

Inequities in healthcare and insurance coverage are among the targets of a new package of legislation

With growing public consciousness of the challenges transgender individuals face, a pair of Democratic lawmakers wants to ensure New Jersey law protects all citizens — regardless of gender identity and expression — when it comes to health insurance coverage and key social services.

On Monday the Assembly Human Services committee approved a package of legislation that would create a task force to help the state identify and reduce “legal and societal barriers” to equity for transgender individuals and their families, raise awareness around ongoing discrimination toward them, and honor those who have been killed by anti-transgender violence. (Transgender people’s sense of personal identity — and gender — does not correspond with their birth sex.)

The legislation would also update the state’s health insurance laws to ensure that commercial plans — including those covering public workers and teachers — and Medicaid do not deny healthcare services on the basis of gender identity or expression. Four proposals in all were introduced Monday by Assemblywoman Valerie Vainieri Huttle (D-Bergen), who chairs the committee, and Assemblyman Tim Eustace (D-Passaic.)

“As you all know, New Jersey has been a leader in promoting civil rights for our citizens and I think it’s now time for the state to stand with transgender individuals and their families in their continued fight for equality,” Vainieri Huttle said. “There are a lot of antiquated attitudes and policies that have led to discrimination, unfair attitudes and violence toward the transgender community.”

Inspired by 9-year-old Joe Maldonado

Vainieri Huttle said she was inspired in part by the strength of 9-year-old Joe Maldonado who, earlier this month, became the first openly transgender Cub Scout in the nation. The youngster joined a Maplewood pack after he was banned from participating in a pack in Secaucus. “Let’s do our part to support Joe,” the assemblywoman said.

Witnesses who testified before the committee, including several who identified as transgender, described the regular discrimination they faced in school and at work. (According to the latest U.S. Transgender Survey, released in December, more than half transgender students report being harassed at school and 30 percent of transgender employees said they were fired or demoted because of their identity; nearly 40 percent experienced serious psychological distress in the previous month.)

Discrimination in healthcare can mean life or death. Aaron Protenza, director of programs with Garden State Equality, pointed to a national survey of 27,000 transgender individuals which showed one in four had routinely been denied care by physicians or insurance carriers. More than half were told they would not be covered for gender-reassignment surgery, even though experts agree it is a medically necessary procedure.

In addition, transgender individuals have five times the HIV rate of the population at large and are more likely to experience mental illness, with 40 percent attempting suicide at some point in their lifetimes, according to the survey. They also suffer from significant verbal and physical abuse — with nearly half facing sexual abuse. In 2015, 21 transgender individuals in the United States were murdered.

“This is the constant struggle — this is what we have to deal with,” explained Barbra “Babs” Casbar Siperstein, a board leader at Garden State Equality who became the first openly transgender member of the Democratic National Committee, in 2012. Siperstein told the committee of a transgender woman who died when she was denied care for prostate cancer and another woman who bled to death when medical personnel refused to treat her after they discovered male genitalia under her dress.

One positive, Siperstein noted, was the recent opening of New Jersey’s first medical practice dedicated to treating lesbian, gay and transgender patients. The PROUD Family Health clinic began seeing patients in late January at the Robert Wood Johnson University Hospital campus in Somerville. It seeks to address a growing need, especially for transgender patients who have specific health requirements — related to long-term hormone therapy, or cancers in organs that don’t match their outward gender (women with prostate cancer, for example) — that often aren’t addressed in traditional medical practices.

Protenza, with Garden State Equality, said that “like anyone” transgender individuals need regular access to preventive and, at times, acute care, unrelated to hormone treatments or gender reassignment surgery (which are not essential for the person to be considered transgender). But aligning appearance with gender identity — instead of one’s sex organs at birth — can be important for both psychological and safety reasons, he stressed, and insurance providers and physicians must administer these benefits fairly.

“That ability to pass [as the gender we identify with] significantly affects our safety,” explained Protenza, who was born with female genitalia. “And my own ability to pass is directly related to gender surgery and hormones,” he continued, noting that while he paid for these treatments out of pocket, “this shouldn’t be based on someone’s socioeconomic privilege.”

(Siperstein noted she traveled outside the country to undergo her reassignment procedure, in part to protect her family’s privacy.)

Eustace: ‘…rights are eroding across the country’

Protenza said the federal Affordable Care Act required insurance companies to remove any exclusions related to transgender benefits, and state regulators at the Department of Banking and Insurance have incorporated those changes into New Jersey regulations. One proposal approved Monday would ensure these protections remained, regardless of the ACA’s fate, and would also extend them to other patients covered by Medicaid.

“As rights are eroding across the country, we want to make sure we build a firewall to protect all our citizens of this state,” Assemblyman Eustace said. Federal officials are currently discussing how to repeal and replace the ACA.

The insurance bill (A-4568), part of the package of legislation, does not require any additional benefits for transgender patients; hormone therapy and gender reassignment surgery, if considered medically necessary by a doctor, would theoretically be covered through existing regulation. But it spells out that insurance plans must not include provisions that discriminate, cancel or deny care, refuse to renew a policy, or charge extra premiums to any patient based on their status as transgender or their gender identity or expression.

The measure would apply to all plans sold on the individual and small group private insurance market, as well as to state, county and local workers covered by the State Health Benefit Plan, school district employees, and the 1.8 million New Jersey residents covered by Medicaid.

The panel also approved a plan (A-4567) to establish a 17-member Transgender Equality Task Force to assess barriers to equality and recommend changes to state lawmakers on issues like healthcare, residential and transportation programs for seniors, housing and homelessness, employment and criminal justice. (The full text for this and other measures adopted Monday was not yet posted on the Legislature’s website that evening.)

One resolution (AJR-139) that was passed on Monday designates the week of November 14 as “Transgender Awareness Week” to raise visibility around gender-identity equality and another, (AJR-140) names November 20 as “Transgender Day of Remembrance.” Now a national vigil, the event commemorates Rita Hester, a 34-year-old African-American transgender activist who was murdered in her Boston apartment in 1998.

In addition, the committee advanced a bill by Eustace and Deputy Speaker Gordon Johnson (D-Bergen) that would allow LGBT-owned businesses to qualify for certain minority status programs, similar to those owned by minorities or women. Another measure, sponsored by Eustace and Assemblywoman Elizabeth Maher Muoio (D-Mercer) would allow state agencies to collect information about sexual orientation and gender identity, if individuals chose to volunteer the information. Supporters said obtaining accurate data is critical in crafting good policy.