Wednesday, March 15, 2023

California Insurance Law Linked to Increase in Gender-Affirming Surgery

Individuals with gender dysphoria who lived in California were significantly more likely to undergo gender-affirming surgery following the 2013 implementation of a state law prohibiting insurance discrimination against gender-affirming care compared with those living in Arizona and Washington, where no such law exists. That was the finding from a study of 25,252 transgender and gender-diverse patients in California, Washington, and Arizona that was published yesterday in JAMA.

The increase appeared significant among patients with private insurance or Medicaid, but not patients paying out of pocket.

“The findings suggest that the legislation, which prohibited insurance denial of health care benefits based on patient sex, gender, gender identity, or gender expression, facilitated access to gender-affirming surgery among insured patients with a diagnosis of gender dysphoria,” wrote Anna Schoenbrunner, M.D., of The Ohio State University and colleagues.

The researchers compared the number of gender-affirming surgeries from January 1, 2005, to June 30, 2013 (prior to implementation of California’s Insurance Gender Nondiscrimination Act) and July 1, 2013, to December 31, 2019 (after implementation of the law), for 17,934 individuals with gender dysphoria in California and 7,328 individuals with gender dysphoria in Arizona and Washington.

In California, 2,715 admissions (15.1%) had at least one gender-affirming surgery within the study period. In Arizona and Washington, 203 (2.8%) patients underwent at least one gender-affirming surgery. Patients’ median age at time of surgery was 34 years in California and 39 years in Arizona and Washington; 51.2% identified as female, 46.2% as male, and 2.5% as unknown.

Before the implementation of the Insurance Gender Nondiscrimination Act, 66 California sites performed a median of one gender-affirming procedure per site; after implementation, 106 sites performed a median of two procedures per site. In both Arizona and Washington, the number of sites performing gender-affirming procedures dropped in the same period.

After the implementation of the California law, there was an increase of 5.7 surgeries per quarter in the state compared with 0.41 surgeries per quarter in Arizona and Washington. The law was associated with a 12.1% increase in the probability that a patient with gender dysphoria would receive gender-affirming surgery in California compared with Arizona and Washington.

“These data might inform state legislative efforts to craft policies preventing discrimination in health coverage for state residents, including transgender and gender-diverse patients,” the authors wrote.

For related information, see the Psychiatric News article “APA Joins Amicus Against Arkansas Law Banning Gender Affirming Therapy.”

(Image: iStock/ArLawKa AungTun)

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