Biden uses Trump-era policy to expand health care for transgender Coloradans

The Biden administration is using a Trump-era policy to approve the expansion of health care coverage for transgender Coloradans, forcing many of the state’s private insurers to cover gender-affirming care.

Former President Donald Trump’s 2018 policy allows states to redefine the essential health care benefits insurers are required to cover under the Affordable Care Act. On Tuesday, the Biden administration used it to approve Colorado’s request to add gender-affirming care among its health plans’ guaranteed benefits.

The move will force individual and small-group insurers to cover transition-related procedures, including hormone therapy, breast augmentation and laser hair removal, starting Jan. 1, 2023.

Federal officials and Colorado Gov. Jared Polis, one of two openly LGBTQ governors, said they hoped the measure would serve as a model to expand gender-affirming care in other states. The Biden administration also cited discriminatory barriers that transgender Americans frequently face when they seek transition-related care, often described as cosmetic.

“Health care should be in reach for everyone; by guaranteeing transgender individuals can access recommended care, we’re one step closer to making this a reality,” Health and Human Services Secretary Xavier Becerra said in a statement Tuesday. “I am proud to stand with Colorado to remove barriers that have historically made it difficult for transgender people to access health coverage and medical care.”

Medicaid covers gender-affirming care in more than a dozen states, including Colorado. But only a handful of states, including Massachusetts and Washington, have policies similar to the new Colorado measure, requiring many private insurers to cover transition-related care.

As a result, nearly half of transgender Americans — including 54 percent of trans people of color — say that their health insurers covered only some of their gender-affirming care or that they had no providers in network, according to a survey last year by the Center for American Progress. The report found that 46 percent of trans respondents and 56 percent of trans respondents of color were denied gender-affirming care by their insurers.

Dr. Alex Keuroghlian, the director of the National LGBTQIA+ Health Education Center at Boston’s Fenway Institute, who works directly with transgender patients, applauded the Biden administration’s new measure.

“What we’ve learned the hard way is that private insurers and employers won’t necessarily have these equitable policies around coverage of medically necessary gender-affirming care without the government enforcing such expectations,” he said.

Keuroghlian said that when Massachusetts similarly expanded coverage for transgender patients in

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