The term “gender dysphoria” is defined by the American Psychiatric Association (APA) as, “a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify.” North Carolina policy leaders often equate gender dysphoria with psychiatric complications, but it is important to understand that gender dysphoria is not a mental illness.
Years of research by the APA and other medical research organizations have determined that the best course of action in treating transgender patients experiencing gender dysphoria is to transition; the process of aligning one’s physical body with the gender which they identify with can positively impact the progression of mental illnesses resulting from the gender dysphoria experienced by the person. While some transgender individuals do not elect to transition, research agrees that when it is agreed upon as a necessity for a patient, it may be life-saving.
In 2017, North Carolina finalized several laws to expand state employee healthcare plans to include treatment related to gender dysphoria for transgender people, which was done in accordance with federal anti-discrimination laws passed in May 2017. On Jan. 1 of this year, however, healthcare coverage for transgender individuals in North Carolina ended.
While the research that the medical community had presented had not budged, Dale Folwell assumed the position of State Treasurer, and immediately began his work on reversing the enacted laws. His platform included the opposition of coverage for transgender individuals, and he claimed that the state’s financial support of “sex-change procedures” (a term considered offensive and is not used in the medical field) was counterproductive to reducing the debt of North Carolina’s health plan. Blue Cross/Blue Shield coordinates the state employee health plan, including coverage for treatments regarding transition such as hormone therapy and gender confirmation procedures due to the recognition of dysphoria as a legitimate medical issue. Folwell barred the renewal of this plan in 2018.
Folwell’s statement on the matter failed to address the concerns of North Carolinians.
“We empathize with all members’ health conditions, but cannot provide them all with every elective, non-emergency procedure they want,” said Folwell, according to NC Policy Watch.
Aside from reducing transitioning to an elective cosmetic procedure, Folwell failed to acknowledge the hypocrisy of the new health plan. For example, cisgender patients are routinely prescribed estrogen or testosterone, and they are covered without dispute, whereas transgender patients with the same prescription may not be.
This difference may cause North Carolina to face discrimination lawsuits. This discrimination, however, is inevitable with the current Board of Trustees; six of the ten members are appointed by Folwell, who supports the recent claim of the Trump administration that identities outside of the traditional gender binary do not exist, but is instead the result of mental illness. This political statement will likely lead to an even greater increase in the discrimination cases of transgender recipients of the state employee health plan.
UNC-Greensboro freshman and transgender individual Cameron Farrar has already felt the effects of these policies.
“My dad had to change healthcare providers so that I would have access to financial assistance for surgeries and medications. If financial help isn’t there, testosterone and having to be on it for years is so expensive,” said Farrar. Farrar also noted the many obstacles the State Health Plan Board of Trustees put before him.
“Transition therapy is now required, not optional, implying that there is a chance that the person is transitioning for reasons other than wanting to be their true self. As someone who has had to suppress my identity for years, asking me to take a ton of unnecessary steps towards my goal is detrimental,” said Farrar, who wants North Carolina policy makers to understand the burden being placed upon an already marginalized group of people. “This is wrong and North Carolina needs to push for what is right.”