Christina Wood, a 49-year-old transgender woman, moved from New Mexico to Oregon six years ago to access gender-affirming health care. While she was able to receive certain surgeries that helped her transition, permanent hair removal or electrolysis, a crucial procedure for her mental health, was not fully covered under Oregon’s Medicaid plan for low-income residents. Paying out-of-pocket for the procedure ate up nearly half her monthly income.
However, Oregon lawmakers are now poised to pass a bill that would expand insurance coverage for gender-affirming care, including procedures such as electrolysis, facial hair removal, and Adam’s apple reduction surgery, which are currently considered cosmetic by insurers. Such procedures are seen as critical to the mental health of transitioning women.
This wide-ranging bill is part of a wave of legislation in Democratic-led states intended to protect the rights and health of transgender individuals, in the face of a conservative movement that seeks to ban or limit gender-affirming care and eliminate rights and protections for transgender people.
Gender-affirming care includes a wide range of social and medical interventions, such as hormone treatments, counseling, puberty blockers, and surgery. Oregon’s bill would bar insurers and the state’s Medicaid plan from defining procedures like electrolysis as cosmetic when they are prescribed as medically necessary for treating gender dysphoria. It also would shield providers and patients from lawsuits originating in states where such procedures are restricted.
Advocates for gender-affirming health procedures argue that such care is a matter of life or death, as it alleviates depression, anxiety, and self-harm seen in patients with gender dysphoria. Studies show that transgender people, particularly youth, consider and attempt suicide at higher rates than the general population.
While the bill has sparked intense debate, with both supporters and opponents submitting written testimony, it is expected to pass in the Democratic-controlled House and Senate. Oregon’s measure mirrors a nationwide trend in Democratic-led states, with similar bills enacted this year in Colorado, Illinois, New Jersey, and New Mexico, and other bills awaiting the signatures of governors in Washington and Minnesota.
However, some legal experts warn that laws that protect gender-affirming care but lack strong enforcement mechanisms or funding to investigate violations may not result in meaningful change. Oregon already bars insurance companies from discrimination on the basis of gender identity, and the state agency overseeing health insurance rules already requires companies to cover procedures deemed medically necessary by a doctor to treat gender dysphoria and bars them from defining them as cosmetic. But insurers have rarely faced major consequences for violations, and the lack of enforcement can leave transgender individuals with little recourse.
For Christina Wood, the bill’s passage would mean greater accessibility to the health care she needs to live as her authentic self, and she plans to advocate for others in similar situations. “Christopher never had a voice. Christina has a voice. And so that’s what I plan to do,” she said.