Category Archives: Mara Keisling

Transgender advocates applaud new Social Security policy

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Mara Keisling, executive director of the National Center for Transgender Equality (Washington Blade file photo by Michael Key)

The U.S. Social Security Administration on Friday announced transgender people will be able to update their gender on agency records without having undergone sex-reassignment surgery.

Trans people under the new policy can either submit a passport or birth certificate that notes their gender or a letter from their doctor that confirms they have received transition-related treatment.

The National Center for Transgender Equality, which had sought the policy change for seven years, noted the State Department and the Veterans Health Administration are among the other federal agencies that have implemented similar policies. The Pentagon still requires trans servicemembers and veterans to prove they have undergone sex-reassignment surgery in order to change their gender for military pensions and other beneficiary programs.

“Most people may not see this as a big deal, but transgender people know that this seemingly small technical change will protect their privacy and give them more control over their own lives” NCTE Executive Director Mara Keisling said.

Rea Carey, executive director of the National Gay and Lesbian Task Force, described the new policy as a “big win for LGBT equality.”

“This new policy is in line with how transgender people live their lives and is in line with the medical community’s consensus on when a person’s gender should be recognized,” she said.

The National Center for Lesbian Rights and the Sylvia Rivera Law Project also worked with NCTE and the Task Force to secure the policy change.

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Oregon bans anti-trans health care discrimination

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Mara Keisling, executive director of the National Center for Transgender Equality (Washington Blade file photo by Michael Key)

Transgender advocates have applauded new regulations that ban private health insurance companies in Oregon from discriminating against trans policy holders.

The guidelines the Oregon Insurance Division of the state Department of Consumer and Business Services announced on Dec. 19 specifically prohibit health care providers from discriminating against a policy holder based on their actual or perceived gender identity and expression. Under the guidelines, providers cannot deny coverage of hormone therapy, hysterectomies, mastectomies and other medically-necessary treatments for gender dysphoria and sex-reassignment surgery that are covered for non-trans policy holders.

The agency also prohibited insurance companies from denying coverage of a particular treatment simply because the policy holder is trans. The guidelines also expand Oregon’s statewide mandate for mental health services to include trans Oregonians.

Basic Rights Oregon, a statewide LGBT advocacy group, had been working with the agency to expand these protections to trans policy holders since 2009.

Lawmakers in 2007 approved a law that explicitly banned discrimination based on sexual orientation — they defined it to include gender identity and expression, but Basic Rights Oregon had sought clarification from the agency after it received complaints from trans policy holders.

“What this means is that trans Oregonians will have access to basic medically necessary care,” Tash Shatz, trans justice program manager at Basic Rights Oregon, told the Washington Blade on Monday. “It’s a huge victory for the transgender community in Oregon. It really represents a sea change in terms of this issue.”

Michael Silverman, executive director of the Transgender Legal Defense and Education Fund, agreed.

“Oregon has correctly recognized that the well-established medical consensus is that transgender-related health care is medically necessary care,” he said. “This care is designed to treat a recognized medical condition. Transgender individuals pay the same premiums as everyone else and simply want the same benefits.”

The agency released its new guidelines two days after Oregon Health and Science University announced it would cover trans-specific health care. Intel, which is headquartered in Hillsboro, Ore., is among the 25 percent of Fortune 100 companies that currently offer trans-inclusive health care policies to their employees.

The cities of Portland, Seattle and San Francisco and Multnomah County, Ore., also cover trans-specific treatments in their health care plans. The California Department of Insurance has also enacted regulations similar to those in Oregon.

The American Psychiatric Association, the American Psychological Association and the Internal Revenue Service have said trans-specific treatments are medically-necessary care. The American Psychiatric Association on Dec. 2 announced it would remove Gender Identity Disorder from its list of mental disorders and replace it with Gender Dysphoria.

National Center for Transgender Equality Executive Director Mara Keisling told the Blade that colleges and universities, professional agencies and labor unions are among those that continue to advance efforts to ensure health insurance providers cover trans-specific treatments and procedures. She noted the SEIU, which covers full transitionary care for its staff, passed a resolution in May that asked local affiliates to advocate for these benefits in contract negotiations.

“There’s a lot of really, really great advocacy going on in this area right now,” Keisling said. “[What’s] really going on here is just updating these policies now that we have better understanding of medical science, of who trans people are, now we have lots of trans people in the workplace, so we’re going to see more and more of this. This will not be the last state to do that.”

Md. rally focuses on trans rights

Rich Madaleno, gay news, Washington Blade, Annapolis, Maryland, Maryland Coalition for Trans Equality

Sen. Rich Madaleno spoke at a rally in Annapolis this week. (Washington Blade photo by Steve Charing)

A diverse crowd of nearly 200 gathered at Lawyer’s Mall in Annapolis on Monday to rally behind SB449, the Fairness for All Marylanders Act of 2013. The bill, if passed, would ban discrimination in employment, housing, credit and public accommodations based on gender identity or expression. The Maryland Coalition for Trans Equality sponsored the event and organized the subsequent lobbying efforts for individuals and groups by district.

“We must put our foot on the gas pedal until there is equality all over the state,” Carrie Evans, executive director of Equality Maryland and who emceed the rally, told the crowd.

Sen. Rich Madaleno (D-Montgomery County) attended the event. He, along with Sen. Jamie Raskin (D-Montgomery County), introduced the measure on Jan. 29. Madaleno expressed confidence in the bill’s passage by telling the crowd, “We are on the verge of this last big victory in Maryland,” noting that 23 senators sponsored SB449 and 24 are needed for passage. “I think all of the stars are finally in alignment,” he said.

Last year, a similar bill was passed in the House of Delegates by a margin of 86-52 only to die in the Senate. This year there is much more optimism given that Senate President Thomas V. “Mike” Miller is supporting the bill. Therefore, it is likely to pass in the Senate as well as the House if it can make it out of the Senate’s Judicial Proceedings Committee. The JPR is scheduled to hear testimony on Feb. 26 at 1 p.m.

Other speakers at the rally included Rev. Larry Brumfield, Maryland Black Family Alliance; Mara Kiesling, National Center for Transgender Equality; Blake Wideman, Black Trans Men, Inc.; Del. Luke Clippinger (D-Baltimore City); and Darlene Nipper, National Gay and Lesbian Task Force.

Obama signs LGBT-inclusive domestic violence bill

President Obama signed into law an LGBT-inclusive reauthorization of the Violence Against Women Act (Blade file photo by Michael Key)

President Obama signed into law an LGBT-inclusive reauthorization of the Violence Against Women Act (Blade file photo by Michael Key)

Flanked by lawmakers and women’s rights advocates, President Obama on Thursday afternoon signed into law LGBT-inclusive legislation aimed at combating domestic violence and helping its victims.

Obama signed the reauthorization of the Violence Against Women Act during a ceremony in the auditorium of the Department of the Interior, concluding the signing by saying, “There you go, everybody!”

The law reauthorizes the 1994 anti-domestic violence measure written by Vice President Biden, which provides funding for the investigation and prosecution of violent crimes crimes against women as well as funding for victims assistance services.

Additionally, the reauthorization institutes new provisions to help more victims of domestic violence, such as those in the LGBT community and individuals in Native American tribes.

In remarks before the signing the bill, Obama emphasized the importance of VAWA reauthorization as a means to continue the protections put in place by the 1994 version of the law while making an oblique reference to the LGBT community.

“Because of this bill, we’ll keep in place all the protections and services that Joe described, and, as he said, we’ll expand them to cover even more women,” Obama said. “Because this is a country where everybody should be able to pursue their own measure of happiness and live their lives free from fear, no matter who you are, no matter who you love.”

At one point as Obama was offering his remarks someone in audience shouted, “We love you, Mr. President!” Obama replied, “I love you back!”

Among those joining Obama on stage was Sharon Stapel, executive director of the New York-based National Coalition of Anti-Violence Programs.

The president thanked her for her work on domestic violence issue as he noted the LGBT protections in the bill.

“Today is about all the Americans who face discrimination based on sexual orientation and gender identity when they seek help,” Obama said. “So I want to thank Sharon Stapel… for the work she’s doing–the great work she’s doing with the Anti-Violence Project. But Sharon and all the other advocates who are focused on this community, they can’t do it alone. And then now they won’t have to. That’s what today is all about.”

In a statement, Stapel said the VAWA reauthorization includes the LGBT community “in truly historic, unprecedented ways.”

“For the first time in history, federal law includes LGBT anti-discrimination provisions, a huge victory for the LGBT communities and a great step forward for LGBT inclusion in our nation’s laws,” she said. “By including LGBT people in VAWA, we can say to all survivors of violence: you matter and there is support for you.”

Also on stage with Obama was U.S. Attorney General Eric Holder as well as lawmakers like House Minority Leader Nancy Pelosi (D-Calif.,) Senate Judiciary Chair Patrick Leahy (D-Vt.) and House Minority Whip Steny Hoyer (D-Md.) Sen. Mike Crapo (R-Idaho,) Rep. Gwen Moore (D-Wis.), sponsors of the reauthorization measure, were onstage, as well as 1994 co-author Rep. John Conyers (D-Mich.)

Also standing behind Obama was Biden, who offered his own thoughts on the importance of the legislation.

“Those of you who have been around a while with me know that I quote my father all the time who literally would say, the greatest sin that could be committed, the cardinal sin of all sins was the abuse of power, and the ultimate abuse of power is for someone physically stronger and bigger to raise their hand and strike and beat someone else,” Biden said. “In most cases that tends to be a man striking a woman, or a man or woman striking a child. That’s the fundamental premise and the overarching reason why John Conyers and I and others started so many years ago to draft the legislation called the Violence Against Women Act.”

The VAWA reauthorization helps protect the LGBT community against domestic violence and supports it victims in three ways:

• First, the law requires all programs that receive funding under VAWA to provide services regardless of a person’s actual or perceived sexual orientation or gender identity.

• Second, the law explicitly includes the LGBT community in the largest VAWA grant program, the “STOP Grant Program,” which provides funding to providers who collaborate with prosecution and law enforcement officials to address domestic violence.

• Lastly, the bill sets up a grant program specifically aimed at providing services and outreach to underserved populations, including programs that provide care specifically for LGBT people.

The LGBT community continues to face issues with domestic violence along the same level as straight people. A 2012 report from the National Coalition of Anti-Violence Programs found 3,930 incidents of domestic violence in the LGBT and HIV/AIDS community in that year. Additionally, the report found that 61.6 percent of LGBT domestic violence victims were denied access to shelters — nearly a 20-point increase from the 44.6 percent in the previous year.

VAWA reauthorization is the second-ever piece of legislation signed into law with explicit pro-LGBT protections. The first legislation with both a reference to sexual orientation and gender identity was the hate crimes protections legislation Obama signed into law in 2009. The Hate Crimes Statistics Act, which collects data on hate crimes, was the first to mention sexual orientation, not gender identity.

The repeal of “Don’t Ask, Don’t Tell” lifted the ban on openly gay servicemembers from the books, but didn’t institute any pro-LGBT protections in its place.

A number of LGBT advocates were present in the auditorium and hailed the enactment of the legislation as yet another milestone for the advancement of LGBT rights.

David Stacey, deputy legislative director for the Human Rights Campaign, lauded VAWA reauthorization for its historical inclusion and its practical impact on LGBT people.

“From a movement perspective, this is a really an important step forward,” he said. “Then, of course, the substantive fact that more and more victims of domestic violence and sexual assault that are LGBT will have access to services when they need them when they are in crisis.”

Mara Keisling, executive director of the National Center for Transgender Equality, said VAWA will be particularly important for the transgender community, which faces high levels of domestic violence as it does with other kinds of violence.

“It really does some really important things for victims of violence and trans people tend to overrepresented in that as victims of that,” she said. “It’s a really important bill on its own, but politically it’s also the second bill to become a law with LGBT people in it, and there was relatively little problem with the LGBT components.”

VAWA reauthorization is also significant because it marks the first time the House under Speaker John Boehner (R-Ohio) allowed a bill with pro-LGBT language to pass.

However, House Republicans only allowed the bill to pass after a version without LGBT language failed on the House floor. Then, they took up the LGBT-inclusive bill already passed by the Senate.

Julie Kruse, policy director of Immigration Equality, said she’s “thrilled” with the LGBT-inclusion in VAWA reauthorization and hopes that passage in the House bodes well for passage of immigration reform legislation for bi-national same-sex couples.

“We’re thrilled at how much support the president gave to LGBT inclusion, and this is where we are,” she said. “We think it’s a very awesome precedent for the comprehensive immigration reform that’s coming up.”

But Stacey cautioned against giving House Republicans credit for passage of the domestic violence legislation.

“There still was very significant Republican opposition in the House, however, the fact that at the end of the day, they let a bill go that had every Democrat voting for it and a large number of Republicans is a good step forward,” he said. “I think the really significant side is the Senate, where we had a majority of the Republican conference voting for this bill with the sexual orientation and gender identity provisions in it.”

Medicare asked to review ban on gender reassignment surgery

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LGBT groups are askng Medicare to lift its ban on gender reassignment surgery. (Image public domain)

Medicare is being asked to review a policy that prohibits transgender people from receiving coverage for gender reassignment surgery.

Last week, a quartet of LGBT rights groups — the National Center for Lesbian Rights, the American Civil Liberties Union, Gay & Lesbian Advocates & Defenders and civil rights attorney Mary Lou Boelcke — filed an administrative challenge to eliminate Medicare’s ban on coverage for the procedure.

Joshua Block, a staff attorney with the ACLU’s LGBT Project, said the challenge was filed because a policy change is “overdue.”

“It is completely out of line with any scientific or medical evidence or standards of practice,” Block said. “There are people out there who are in desperate need of the surgery. Their doctors have told them they need the surgery. And they’re being told it’s not covered because it was allegedly experimental 30 years ago.”

The challenge, sent on March 26, was filed on behalf of Denee Mallon, a transgender woman in Albuquerque, New Mexico. A Medicare recipient who’s age 73, Mallon was recommended to have gender reassignment surgery by doctors to treat her gender dysphoria.

A veteran of the U.S Army, Mallon joined the the service when she was 17 and worked as a forensics investigator for a city police department. She was later diagnosed with gender identity disorder.

Mara Keisling, executive director of the National Center for Transgender Equality, said she’s “very excited” about the challenge.

“Americans, in general, are really tired of health care decisions being made by legislators and bureaucrats and insurance companies,” Keisling said. “Most of us believe that health care decisions should be made by patients and doctors, and the medical community is pretty unified. This is a legitimately necessary surgery.”

Keisling said NCTE isn’t directly involved in the challenge because it involves lawyers representing clients, and the organization doesn’t provide those legal services.

The ban, which is codified as National Coverage Determination 140.3, was put in place in 1981 during the Reagan administration. Keisling said the ban was put in place as a result of the stigma on transgender people at the time and lobbying from insurance groups.

The National Coverage Determination from 1981 spells out why transgender people are unable to receive this coverage under Medicare.

“Transsexual surgery for sex reassignment of transsexuals is controversial,” the regulation states. “Because of the lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental. Moreover, there is a high rate of serious complications for these surgical procedures. For these reasons, transsexual surgery is not covered.”

Despite this policy, the American Medical Association and the American Psychological Society support gender reassignment surgery for transgender people.

Block said the challenge has been filed at this time — more than 30 years after the ban was put in place — because “each year that goes by, it becomes ever more clear how unfounded the categorical sweeping ban is.”

“Each year that goes by, there’s more and more evidence that just reaffirms the widely accepted view that these surgeries are safe, medically necessary and effective to treat a serious medical condition,” Block said.

Now that the challenge has been filed, the Department Appeals Board of the Department of Health & Human Services is set to review the ban, determine if it’s reasonable under current standards of care and make a decision on whether to reverse it. It’s estimated the process could take months to resolve.

It’s unclear how many transgender people the change would affect. A recent study from the Williams Institute found that one-third of one percent of Americans identify as transgender, and an estimated 48 million people receive coverage under Medicare. Given those numbers, about 144,000 transgender people are receiving coverage under Medicare.

In an apparently separate development last week, the Centers for Medicare & Medicaid Services included a statement on its website asking for public comment because it would reconsider the ban. But the notice was removed on Friday from the agency’s website after conservative media, such as Drudge Report, took note of it.

Brian Cook, a CMS spokesperson, told the Blade solicitation for public comment was removed as a result of the legal challenge from LGBT groups coming to light.

“An administrative challenge to our 1981 Medicare national coverage determination concerning sex reassignment surgery was just filed,” Cook said. “This administrative challenge is being considered and working its way through the proper administrative channels. In light of the challenge, we are no longer re-opening the national coverage determination for reconsideration.”

Although the challenge was filed last week, LGBT groups didn’t notify the press about it until Monday. Block said the notice that went up on the Medicare website — and its subsequent removal — prompted the news statement.

“I think there were a lot of questions — particularly by members of the transgender community — about the status of NCD and what this administrative challenge was, and so we thought it was important to give affirmative clarification about what this challenge is and how it’s separate from the CMS process,” Block said.