New guidelines from the Health Evidence Review Commission should ease the process for low-income Oregonians to seek care for medical needs related to their transgender identity, but a renewed critique of the policy from a conservative Republican reiterates how common it remains for the population to be misunderstood.
Starting in October, Oregon Health Plan members with a diagnosis of gender dysphoria can get the care they need after a comprehensive mental health evaluation that abides by international standards.
Nico Quintana, a transgender rights activist at Basic Rights Oregon, said patients had experienced uneven care across the state, with arbitrary obstacles that might make them wait up to two years just to start receiving the care they need like hormonal treatments, with high barriers and visits with multiple psychologists.
“It wasn’t tied with the standard of care,” Quintana said. Now, after a revised HERC ruling, it will be clear that the mental health evaluation and recommendation will be the protocol toward receiving counseling, hormones or surgery if appropriate.
Meanwhile, Rep. Carl Wilson, R-Grants Pass, announced Monday that he would introduce a bill next February to bar minors from receiving transgender health services from the state, at least without explicit parental notice.
“The Oregon Health Authority’s Health Evidence Review Commission adopted a policy allowing children 15 years and older to access gender reassignment surgery,” said a statement from Wilson. “This surgery – as well as cross-hormone therapy and puberty-suppressing drugs – are available and would be paid for by taxpayers through the Oregon Health Plan. What’s worse, parents can be completely cut out of the process, as their child can receive these therapies without their knowledge or consent!”
Wilson’s letter follows a similarly scathing article from Fox News this summer that spotlighted Oregon’s policy, sensationalizing the story by lumping Oregon’s longstanding law on the age of medical consent -- 15, with the new ruling to begin state-financed coverage by a group of doctors and other medical professionals on the Health Evidence Review Commission, who govern the coordinated care organizations and the Oregon Health Plan by prioritizing medical needs, including those “requiring life-saving treatment and diagnoses where treatment has a significant impact on reducing suffering, restoring [a] healthy life, has high efficacy and treats a vulnerable population.”
In Oregon, 15-, 16- and 17-year-olds are able to consent to any medical treatment without their legal guardians’ knowledge, often because they may feel uncomfortable or unsafe discussing personal medical issues with their parents, but are capable of making medical decisions if they need to.
According to the Oregon Health Authority, the transgender services approved by the commission meets all of the HERC’s priorities. “Suicide in untreated gender dysphoria patients is a major problem and treatment has been shown to reduce suicide attempt rates from 30 percent down to 5 percent. Treatment with puberty supression hormones, cross-sex hormone therapy, and gender reassignment surgery has been shown to be highly effective in relieving gender dysphoria, reducing depression and anxiety, and reducing rates of suicide/suicide attempts.”
Since coverage began in January, 438 Oregonians, both minors and adults, have accessed transgender-specific health services, but a fact sheet provided by Oregon Health Authority spokeswoman Stephanie Tripp noted that while 10 adults had received surgeries, no minors had.
While Oregon Health & Science University has made a concerted effort to improve its transgender health program, some more extensive surgeries are actually unavailable in Oregon, and would require a trip to Seattle or San Francisco. “As far as I know, that hasn’t happened yet,” said Quintana, who argued that CCOs should provide people who needed care out-of-state, just as they do with other services critical to patient health. “It’s a new standard of care that hasn’t been provided yet.”
The Oregon Health Plan has taken the lead on recognizing transgender health services as genuine healthcare needs, but commercial insurers continue to balk, despite a 2012 Oregon Insurance Division bulletin banning explicit conclusions. That may change, as the Obama administration put health insurers on notice this month that they may face civil rights lawsuits if they continue to deny coverage for people undergoing a gender transition.
While Quintana said the Oregon Health Plan is the most progressive insurer, it has stopped short of adopting the full international standards, dismissing some procedures as cosmetic that have been considered necessary for transgender well-being.
Not all Republicans were ready to go to the mattresses against the new Oregon policy. “I think it’s a little misinformation that went out in the press. I don’t know a surgeon who would go ahead with [surgery on a minor] without a plan. There have been a handful of teenagers dealing with gender identity issues [receiving care],” said Rep. Julie Parrish, R-West Linn. “It’s one of those things that make parents’ jaws drop to the table. … The fact is that there are children with parents where they are not able to talk about healthcare decisions. … I’m not personally opposed to that type of a service. People who are dealing with [gender dysphoria] truly have physiological issues going on.”
