Wren Logan
Wren Logan (right, with partner Kale Mabin), is a psychiatry resident at UW Health and a transgender woman advocating for insurance coverage for gender-affirming health care.
Update: On Aug. 22 the Group Insurance Board voted 5-4 to cover gender-affirming surgery for state employees. Wren Logan, a transgender woman and psychiatry resident at UW Health, who lobbied hard for the change, was there for the vote.
“I’m still recovering today,” Logan says on Thursday.
Logan says she and other advocates gathered in a nearby room while the board discussed the policy change in closed session. The vote was conducted in public. When the board voted to lift the exclusion for coverage, Wren says “there was a massive relief of tension in the room. People couldn’t believe what was happening.”
After their surprise victory, “we all filed out in the hallway. There was hugging and a lot of tears. People are jubilant.”
Logan, a University of Illinois at Chicago medical school graduate, matched in 2017 with a psychiatry residency program at UW-Madison. Match day is usually a thrill for future doctors, but Logan was devastated — not because the program wasn’t a good fit, but because as a transgender woman and employee of UW Health, her state-provided health insurance wouldn’t cover her medical needs.
“I don't want to go to a state that's so anti-trans,” Logan wrote to a friend after matching.
With the exception of one month in 2017, coverage for transgender state employees seeking gender-affirming surgery and related treatments has been banned in Wisconsin. The state’s Group Insurance Board, which sets policy and oversees administration of insurance plans for state employees, voted to overturn the ban in July 2016 (effective Jan. 1, 2017) in response to new federal rules from the Affordable Care Act.
But in August 2016, the state Department of Justice — at the request of Gov. Scott Walker — asked the insurance board to reconsider. State Deputy Attorney General Andy Cook sent a memo to the insurance board arguing that the new federal rules are “unlawful” because they improperly reinterpret Title IX to cover “gender identity” when the original text of the law prohibits discrimination on the basis of sex. That same month, Wisconsin joined with Texas, Nebraska, Kentucky and Kansas in a lawsuit challenging the Obama administration over the rule.
In December 2016, the insurance board held a special meeting and spent more than three hours in closed session while transgender people and advocates waited outside. Board members voted to reinstate the coverage exclusion if certain legal contingencies occurred. One such development happened on Dec. 31, when a federal judge in Texas issued an injunction in the lawsuit challenging the ACA rules, deciding that the rules strengthening transgender health care “likely violate” the Religious Freedom Restoration Act. Wisconsin stopped providing coverage on Feb. 1, 2017.
“The exclusion hurts because it perpetuates distress that could otherwise be alleviated with safe and effective treatment,” Logan says. “It hurts because it suggests our suffering is invalid and that [transgender people] aren’t worthwhile. Withholding alleviation when it can be easily given is inhuman, and I’m so very, very frustrated that [opponents] can’t seem to see that.”
On Aug. 22, the Group Insurance Board will again take up the issue of coverage for transgender health care, according to a memo from the state Department of Employee Trust Funds, which houses the board.
“Given recent developments related to the coverage of transgender health benefits and services, the Department of Employee Trust Funds will be presenting the Group Insurance Board with different options to consider,” ETF spokesman Mark Lamkins said in an email. “These include removing the exclusion and deferring to medical necessity for treatment, revising the exclusion to provide incremental coverage, [requesting] the Department to provide more research, or maintaining the exclusion.”
Among the developments is a July decision from U.S. District Court Judge William Conley ruling that Wisconsin can’t bar the use of Medicaid funds to pay for gender-affirming surgery. Also last month, chancellors from UW-Madison and five other UW campuses asked the insurance board to reconsider the exemption, saying in a letter that the lack of coverage “jeopardizes our ability to attract top academic and research talent and puts us at a serious disadvantage retaining our LGBTQ employees.”
On Aug. 14, UW Health CEO Alan S. Kaplan submitted a letter in support of extending coverage, pointing out that transgender people experience higher rates of suicide, homelessness, poverty, interpersonal violence, substance abuse and depression than the general U.S. population, and that treatment of gender dysphoria results in “functional improvements and quality of life” for this vulnerable population.
“Nearly all expert-led professional medical associations in the United States … have issued statements of support for the medical necessity and insurance coverage of gender-affirming care,” Kaplan writes.
Shiva Bidar-Sielaff, UW Health’s chief diversity officer, says the organization has a commitment to making sure everyone has access to gender-affirming care. UW Health has been recognized as a "Leader in LGBTQ Healthcare Equality" by the Human Rights Campaign Foundation, but Bidar-Sielaff says the distinction will be revoked if the insurance coverage ban continues.
“It’s a big deal,” says Bidar-Sielaff, who is also a Madison alderperson. “It’s not just a designation — it’s the fact that you’re offering an environment and services that are inclusive and affirming to the LGBTQ community.”
Lauren Justice
Wren Vetens, a UW-Madison graduate student and a transgender woman, battled unexpected medical bills after her gender-affirming surgery.
Insurance and medical bills can be a nightmare, but the stakes are even higher for transgender patients who face greater obstacles when seeking care. Wren Vetens, a UW-Madison doctoral student in astrophysics and a transgender woman, selected the university specifically because of its reputation as a friendly place for LGBTQ individuals. She was expecting that her gender-affirming surgery would be covered when she enrolled in 2016, but she had to shop for a private plan when Wisconsin’s insurance exemption was reinstated. She eventually got the procedure but had to endure a stressful, confounding experience dealing with UW Health and her insurance company.
“In a lot of ways, the insurance debacle was debilitating,” says Vetens, who at one point faced a bill of nearly $100,000. “I don’t think anyone should have to go through something like that — regardless of whether you’re trans or cis, regardless of procedure.”
Jay Botsford, program coordinator for the Wisconsin Transgender Health Coalition, says the coverage exemption is an “obvious case of discrimination” against transgender individuals. “This is about denying care to people — necessary care,” Botsford says. “Any delay is really inexcusable.”
Transgender people, activists and advocates have launched a letter-writing campaign and plan to attend the Aug. 22 meeting with hopes that they can help sway the vote. The recent displays of support and promising legal developments are heartening, but Botsford is still approaching Wednesday’s meeting with cautious optimism and managed expectations.
“I’m hopeful, but so many things in politics are changing very quickly. So much depends on lawsuits and who’s in power,” Botsford says. “It’s ridiculous — we just need to provide people good health insurance that covers all their care.”