Gender reassignment, cultural realignment

Duke’s faculty and employee health plan will soon cover gender reassignment surgery. In making this change, Duke joins the ranks of a small number of American colleges and universities, among them Harvard, the University of Pennsylvania and Yale. This policy shift follows the administration’s change to the student health plan in April, which now includes similar coverage. At that time, we came out in support of the change. We do so again, offering our support for the expansion of employee health coverage to include gender reassignment surgery, and we commend the University on its decision.

We see this change as an extension of the current policy and laud it for the deeply beneficial impact it will have on its recipients, however few they may be. According to the existing medical literature, gender reassignment is much more than a cosmetic procedure. The American Medical Association considers gender reassignment surgery to be a “medical necessity” for treating Gender Identity Disorder (GID), and many in the transgender community have described it as crucial for their psychological well-being. Gender reassignment surgery can do much to resolve deep issues of personal identity that cause great anguish. When we consider the rarity of such procedures—and that costs would be widely diffused across all of the covered employees—even the maximum coverage of $50,000 seems like a small price to pay for such gains.

On a broader level, the extended coverage demonstrates a commitment by the University to its employees. Beyond providing a robust healthcare package, the University has done much in recent years for its employees, such as launching an affordable housing initiative and committing, in 2007, to pay a living wage to most food service staff.

Perhaps more importantly, we support covering gender reassignment surgery because it signals a pledge to equality on an institutional level. As Sara-Jane Raines, co-chair of the Duke LGBT Task Force, noted, it remains consistent with the University’s commitment to diversity and shows transgender individuals that they are valued as members of the Duke community.

Duke’s action stands in stark contrast to the traditionally conservative ideological currents that course through North Carolina politics. Duke is the largest employer in the state, and its policy changes have significant political pull. The policy will likely have very little impact on everyday life—mostly due to how few surgeries will likely be performed—but it sends a powerful message to those who may have felt alienated by their elected representatives. And here lies the policy’s true value: expanded health coverage is not a way to gain a competitive edge over peer institutions or other employers, but a win for equity.