(Part II of this story appeared on March 11, 2010.)

Gregory M. Sensing works at the Harvard School of Public Health. He goes to work, he goes home, he decides what to make for dinner and when to do the laundry. But for most of his life, he’s faced a struggle that something internal does not seem quite right.

“I don’t have any sort of debilitating disease or disorder that keeps me from moving through life, but there’s always this underlying static hum every minute of every day, saying that this is not my body.”

Sensing was born female but has been living as a man for six years. Although he is taking sex hormones and plans on getting sex reassignment surgery, not all transgender people approach the process of transition in the same way, and some decide not to make medical changes at all. For many, finding a way to pay for medical treatment is a hindrance in their transition, but the increasing visibility of the transgender community in the United States has brought issues of discrimination, medical care, and compassion into the public eye.

As transgender people struggle to pay the bills and feel comfortable in their own skin, institutions are working to address their needs. In the continuing effort to create an equitable and inclusive campus, Harvard University Health Services modified its insurance policy last fall to cover top surgery for transgender people covered by the University’s Blue Cross Blue Shield health insurance.

EXCLUDING EXCLUSIONS

At Harvard’s behest, Blue Cross Blue Shield modified their University-specific policy on transgender services. Employee coverage went into effect on Jan. 1, and student coverage will begin on Aug. 1, 2010.

Blue Cross developed a policy outlining generic medical coverage criteria for both top and bottom surgeries. However, Harvard has decided to remove the exclusion only for top surgeries—that is, breast augmentation and mastectomies—for now, as the possibility of covering genital surgeries is still being investigated.

“One concern they have is with the lack of qualified local providers,” says Noah E. Lewis, staff attorney for the Transgender Legal Defense and Education Fund and a 2005 graduate of Harvard Law School. “Which, of course, is the result of insurance exclusions in the first place.”

Prior to the modification, Harvard subscribed to a standard plan from Blue Cross that specifically excluded “services and supplies that are related to sex change surgery or to the reversal of a sex change.”

According to Lewis, the UHS exclusion forced transgender people to pay the same insurance premiums as other members of the Harvard community, without receiving equal benefits in return.

“The exclusion for transgender services stuck out like a sore thumb,” he says. “If transgender health care were not explicitly singled out for exclusion, these services would be covered, as would any other medically necessary drug or surgery.”

Lewis says that such insurance exclusions reflect outdated prejudices against transgender people.

The new policy states that “gender reassignment surgery is one treatment option for Gender Identity Disorder, a condition in which a person feels a strong and persistent identification with the opposite gender accompanied by a strong sense of discomfort with their own gender.”

While members of the transgender community dispute the label of a “disorder,” most are hopeful that this is the first step in a more inclusive policy of medical treatment.