Medical insurers could be banned from denying trans healthcare coverage under Hawaiian bill

A person holds an LGBT+ flag as they participate in a march celebrating Honolulu Pride Month in Hawaii

The Hawaiian House has approved legislation prohibiting insurers from denying gender-affirming treatments for trans people previously deemed cosmetic.

House Bill 2405 (HB 2405) passed through the Democratic-controlled House on Tuesday (8 March), with only two representatives voting against the proposed legislation. It now moves to the Senate.

The bill would prohibit health insurers, health maintenance organisations and societies from excluding medically necessary gender-affirming treatments, which were previously deemed “cosmetic services”. However it will not come into effect until 2060.

This would include gender-affirming facial surgeries, hair electrolysis, mastectomies, breast reductions, breast implants and voice surgeries as well as therapies.

HB 2405 acknowledges that many people in the trans community have “experienced discriminatory treatment from health insurance providers” when seeking coverage for gender-affirming care which are routinely covered for cis people.

“Insurance policies often cover therapies and surgeries like feminising or masculinising hormone therapies, voice therapies, chest augmentations or reductions, and genital surgeries for other purposes but deny the same treatments for purposes of gender affirmation,” the bill states.

The legislature declared there was no “evidence-based” reason behind these “arbitrary assessments of medical necessity” and ultimately “interfere with the patient-physician relationship”.

HB 2405 says the lack of coverage for these gender-affirming treatments also places trans people denied treatment at “higher risk of suicide and depression”.

The bill read: “The legislature recognises that, while federal health care guidelines previously prohibited health insurance and health care providers from discriminating on the basis of gender identity, these protections have been largely rolled back.”

HB 2405 would also require that the medical necessity of any treatment for a trans person would be determined by the “hospital or medical service policy, contract, plan or agreement”. It will be defined in “accordance with the most recent information provided by evidence-based peer-reviewed medical guidance”.

At least 195 anti-LGBT+ bills are pending in state legislatures this year, according to the Human Rights Campaign (HRC). More than half of these bills target trans youth and restrict their ability to fully participate in everyday life.

Needless to say, with the waves of anti-LGBT+ bills making their way across the US, Hawaii’s bill helping the trans community access gender-affirming treatment has received a warm welcome on social media.