Cover gender reassignment

The Duke community should embrace Duke Student Government’s March 20 resolution to add sex reassignment surgery to the list of procedures covered by student and employee health insurance. Sexual reassignment surgery is far from just a cosmetic procedure—students whose gender identities mismatch the sex they were assigned at birth must battle with this identity issue, which can deeply disrupt the agency of transgender individuals.

Of course, the decision to undergo surgery is a highly personal one with some transgender people preferring hormone therapy, no treatment or only “top surgery”—breast augmentation or reduction—over sex reassignment. But for those students and employees who require gender reassignment surgery—the surgical procedure that alters a person’s sex organs—Duke can do the right thing here and cover such procedures with the student health care plan at little cost to itself.

Normally, the moral argument for covering a procedure under health insurance is that the treatment must demonstrate that there will be a fair distribution of moral benefits and burdens amongst insurance holders. But in this case, the consideration is almost irrelevant. The incidence of gender reassignment surgery in the general population is extremely low, and even lower among college students. The rarity of the procedure means that its cost to insurance providers of a large pool of customers will be trivial.

We are aware of no objections to Duke’s current policy, which covers mental health care, hormone therapy and breast reduction and augmentation. The proposal is a sensible extension of the current policy, especially because it will be deeply meaningful to its beneficiaries, some of whom may be estranged from their parents as a result of being transgender and, therefore, don’t receive benefits from their parents’ health insurance. This is also a huge issue for Duke employees, who receive a choice of four insurance plans, none of which cover sex reassignment surgery. With the University as the second largest private employer in the state, it has the opportunity to extend these crucial health benefits to not only students but all those who help the University and health system function.

We appreciate the concern that insurance should not cover any procedures that are done purely for cosmetic reasons. Cosmetic procedures are often motivated by vanity, but many elective procedures undo a fundamental impediment to their beneficiary’s ability to lead a life. The American Medical Association and other major professional organizations have deemed gender reassignment as not cosmetic, but medically necessary. Because we can distinguish in this way between conditions that fundamentally impede the ability to lead a life and those that do not, we can preclude the possibility of a “slippery slope,” in which cosmetic procedures must be covered by student health insurance.

It makes sense that health insurance cover sex reassignment surgery, as well as other surgeries that are identified as vital to the well-being of transgender people. Currently, 36 colleges and universities currently cover sex reassignment surgery, including Harvard University, Stanford University and the University of California system. Enacting DSG’s proposal can put Duke ahead of the curve and, more importantly, affirm the identity and health needs of transgender students in the present and future.