(crossposted at dyssonance,com and thespectrumcafe.com)
There's something special about the concept of independence for me, personally.
Probably because I'm in a situation of great dependence right now, I suppose.
Yesterday, as those who follow events in the US may have been aware, was Independence Day.  A few days ago I wrote a little bit about the stuff behind it, but today I'm going to write about how my day went, and then I'm going to talk about some stuff that may surprise a lot of folks.
Because I'm a pretty complicated gal — and one with “political ambitions”, no less.
And Independence Day means a lot of things to me

On July 4th, in the afternoon of that day, the weather wasn't terrible.  IT only got up to a little over 100 F.  In one of the things I enjoy doing, Dave and I went driving around the city looking at houses.  Dave is really good at and dedicated to monitoring the listings that come out on houses.  He focuses on a specific area, and he's been doing this so long that he has the rather incredible ability to drive through most of the streets in this area and tell you, off the top of his head, what most of the homes sold for the last time they sold.
We stopped at one point in front of a tiny house.  IT was a very small two bedroom one bath home.  Valued currently at around 85K per assessors value, so it's reasonable price, given the neighborhood and location and the house itself, is about 125K.
It is listed presently for 35 thousand dollars.  And it was absolutely perfect for me, personally, were I to get a home.  Indeed, at 35K, it's even the sort of house I could afford to buy and pay for right now, if I had the down payment for such — about 5 grand.
I was enamored of it — it was in very, very good condition (paint, simple stuff like that).  It is not an exaggeration to say that If I'd had the funding right then, I would have called and made my offer.
I probably wouldn't have gotten it, mind you, but I really did love that house.  IT was just the right size for me, personally, as myself, as a woman who admittedly aspires to be a kept woman, on her own.  In the last two years, it's the fifth house that's really grabbed me by the short hairs and tugged at my being.
It's also only the second one that would have been perfect for just me, by myself, in terms of size of the house and yard, layout and work needed, etc etc etc.
And for me, owning my home right now has a potent symbolism attached to it — the symbolism of independence.  It doesn't hurt that a house like that at that price would enable a pretty decent level of equity that could be leveraged rather simply.
Equity that has value when you consider the other aspect of independence that applies not merely in my case, but in the case of many trans folk.
It might not be widely known, but I did, in fact, support health care reform.  I was not particularly fond of some of the end results of it thus far, but it did go a long away towards achieving something that I felt was fairly important.
There are some pretty serious downsides tot he final legislation, however.  Some of which I am extremely displeased with as an activist.
Under the new law, there is a requirement that insurance companies no longer deny coverage on the basis of pre-existing conditions.  Nssty lobbying and several millions of dollars on the part of the Insurance companies combined with the efforts of predominantly Republican Congress critters to allow the Insurance companies to offer pre-exisiting condition insurance.  They even get to charge more for it than they do “regular” insurance at this point.
Insurance plans are also easier to find these days — there's even a government run website that enables such. IT's called http://www.healthcare.gov/
Exciting, huh?
It's rather kludgy in a lot of ways, but I decided I'd check into something, since hey, since treatment for transsexuals in particular (and other trans folk by extension) is explicitly denied so often, and is in fact a medically necessary treatment that is often excused from coverage because it is a pre-existing condition, I figured I'd look into it.
Now, I realize that a lot of folks who have already had their surgeries and all that will bitch about things when I mutter nasty things about insurance companies.  And I don't give a damn.  Just bec ause they had to suffer horrifically to get their surgeries doesn't mean I need to do so, if ya get my drift.
So I followed the little links here and there and I narrowed things down to basically the issues of my having a pre-existing condition, my lifestyle, which includes only one of several bad habits (I smoke, but I drink exceedingly rarely and I typically avoid other activities which are unhealthy for me), and my age.
I picked, for the hell of it, the expensive option of a 1000 dollar deductible basis for plans I would choose.  Since HMO's generally require you to be healthy to join (they are, after all, Health Maintenance, not Health Repair, organizations), I skipped past most of those options.  I dug around into different plans available to me in the State of Arizona, though nowhere near all of them.
All in all, I looked into about 12 plans from the largest providers that I was aware of.  In each case, I dug around to get the exclusions policies for each plan I looked into.
And every last one of them had something to the effect of “sex change surgery” or “Transsexualism” exclusions listed.  Oh, and that deductible level also generally gave plan prices of 350 a month (cheapest one) up to 1200 a month.
Now, I know that most Insurance companies will include a rider that includes trans related care if they are asked for it by a company.  There are even one or two who have been rumored to do the same for individuals.
But you do have to ask, and there is a premium increase associated with it.
But I wasn't getting into that — I was looking at it from the POV that Transsexualism is a recognized medical condition (ignoring all the issues around pathologization, let's be factual: it is currently such in the US), and that surgery is considered a medical necessity for many patients by several health professional organizations.
Now, there's a disconnect there.
One that gets worse.  In 2014, Americans will be required to buy health insurance.  I'm familiar with this — it's also the law in Arizona for Car insurance. Considering that, I have to take a few moments and give it serious thought.
If something isn't done about the issue surrounding insurance coverage for Trans folk in the next four years, then it is entirely conceivable I will be required to pay for health insurance which does not pay for my medically necessary pre-existing condition in direct contravention of law.
The response to that is, of course, that it's not pre-existing, I'm sure.  I say that one, because the medically necessary part is already being supported legally and has the professional association seal of what is and what isn't behind it (the same standard used for all other medically necessary conditions).
So maybe it's not violating the law in terms of pre-existing, and I'm just reaching on that basis.  Well, then, that means that the insurance companies are denying medically necessary care to me, when that is, in the end, their freaking job to provide, and I'll be required to pay for this privilege of not getting health care that I am supposed to be getting, come hell or high water.
That seriously pisses me off.
Now, strictly speaking, I'm not eligible for any of the plans so described.  I am eligible for Arizona's Medicaid program, and that's how I receive the limited services (read, basic health care and then trans related prescriptions) that I do have.
Arizona's Medicaid program, known as the Arizona Health Care Cost Containment System (AHCCCS, or “Access”)  is governed under the Arizona Administrative Code, Title Nine, Chapter 22.
Under section 202.B.1, it notes the following:

Only medically necessary, cost effective, and federally-reimbursable and state-reimbursable services are covered services.

Which passes the buck, for one.
Under section 202.B.7 it says:

A member may receive treatment that is considered the standard of care or that is approved by the AHCCCS Chief Medical Officer after appropriate input from providers who are considered experts in the field by the professional medical community.

Which is important to note that Trans folk have a treatment that is considered the standard of care and held to be medically necessary by experts in the field. Which kinda *should* cover both of the potential options there.
Then, under section 205.B.4.a it notes:

Infertility services, reversal of surgically induced infertility (sterilization), and gender reassignment surgeries;

And there's the rub. A rub made even more nasty since it places trans surgery in what was once considered the old “mayhem” classification.  There's something ugly there.
That said, it is there, in that line, that Trans related surgeries are wiped out.
Note that this does not make such coverage illegal — it's not a factor of law.  It's a rule making policy, justified by the lack of coverage and reimbursement via the federal and state reimbursable aspects of it.
So, even with the changes to health care reform that have been made, barring a change at the federal level (which funds the state level and places the appropriate stipulations normally), there's not going to be any effective opportunity for Trans folk in Arizona to have their medically necessary treatment covered under the most readily available plans — even when they are required to pay for it.
Which is one of those cases of supporting something that comes back to bite you on the ass because of the stigma and discrimination that trans folk, and, in specific, surgery tracked transsexuals, face in this country.
Some news just isn't great.
But, hearing news, learning things, like this, let's you see somehting important:
That it needs to be changed.
In the mean time, I'm going to wave goodbye to a house that I would love to have, a house that's part of the basic American Dream so often spoken of by Republican, “family Values” sorts. A house that could provide me the ability to get my surgery down the road, because it merely could.
And instead focus on coming up with the money to take care of my medically necessary care that should be covered under law but isn't.


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