TUCSON – A transgender University of Arizona professor has sued the state over financial access to surgery his doctor said is medically necessary.
Russell Toomey last month filed a class action lawsuit in U.S. District Court in Tucson on behalf of state employees and their dependents. The suit, backed by the American Civil Liberties Union Foundation of Arizona, says the state’s exclusion violates transgender employees’ constitutional and civil rights.
Toomey, an associate professor of family studies and human development at UA, said it’s also a matter of finances and fairness.
“Knowing that my state discriminates based on my gender is never a good feeling,” said Toomey, whose doctor told him he needs a hysterectomy to treat his gender dysphoria. “Mentally, it’s just anxiety-producing, knowing that I have this part of my body that doesn’t feel authentic to me.”
Arizona is one of several states that refuse insurance coverage to transgender state employees for transitional surgeries. According to a national insurance-reform group, at least 15 other states prohibit such exclusions.
Toomey said he knows of at least 20 families and employees affiliated with the University of Arizona who are harmed by what he called the state’s anti-trans health-insurance policy.
“Arizona provides the same discriminatory health plan to nearly all state employees and their dependents. That means hundreds, if not thousands, of transgender state employees or transgender dependents of state employees cannot receive medically necessary care,” he wrote on the ACLU blog Speak Freely.
The Arizona Board of Regents, which oversees the state’s three public universities, declined to comment on pending litigation.
Toomey doesn’t know what the surgery would cost without insurance, but, in 2004, he had a double mastectomy that cost him $8,000. He said paying for this surgery out-of-pocket isn’t feasible because he and his wife have two young children and are caring for an aging parent.
Steve Kilar, ACLU of Arizona spokesman, said employee health-care plans are a valuable part of compensation, and the exclusion means transgender employees are receiving inferior care.
Public and private health insurance companies in the U.S. historically excluded transition-related care and surgeries on the assumption the treatments were either cosmetic or experimental, according to the Yale Journal of Health Policy, Law, and Ethics.
In May 2014, the federal government halted its practice of excluding Medicare coverage of sex reassignment surgery, according to the National Center for Transgender Equality. Many private insurers and state plans updated their health-care guidelines, but not all.
The national ACLU challenged a Wisconsin law and won the case last year before turning its attention to other states.
State-funded health-insurance in Arizona generally covers medically necessary care but has a specific exclusion for gender reassignment surgery or related medical treatment, even if doctors say it’s medically necessary, according to the suit by the ACLU Foundation of Arizona.
“The Plan provides coverage for the same hysterectomies when prescribed as medically necessary treatment for other medical conditions,” the suit says. “But, the Plan categorically excludes coverage for hysterectomies when they are medically necessary for purposes of ‘gender reassignment.’”
The American Psychiatric Association defines gender dysphoria as the emotional distress experienced by people whose gender identity doesn’t align with their assigned sex. U.S. health professionals rely on standards outlined in the Diagnostic and Statistical Manual of Mental Disorders to diagnose gender dysphoria.
According to the World Professional Association of Transgender Health, transition-related treatment may include hormone therapy, surgery – sometimes called “sex reassignment surgery” or “gender confirmation surgery” – and other medical services that align peoples’ bodies with their gender identities.
Toomey’s lawsuit says that, under the state health plan, employees denied coverage for most medical procedures can appeal those decisions, but there is no such review process for gender dysphoria.
“The ultimate goal is to have the exclusion removed from the policy so that all transgender employees of the state as well as dependents of employees who are transgender can have their medical claims reviewed just like any other claim,” Toomey said.