Healthcare is a Human Right: Houston Secures Transition-Related Healthcare Benefits for City Employees

By Megan Smith

Senior police officer Jackie Boniaby is a staple within the Houston Police Department. For the past 26 years, she’s dedicated her life to service, holding various positions throughout the department. The last few months, however, have been a transition—Boniaby recently came out as a transgender woman and is taking steps to live publicly as her authentic self. “I just recently transitioned,” Boniaby tells Spectrum South. “I had to conceal who I was for years. It’s a journey, but I’m simply looking forward to being allowed to live my life authentically and being valued as a member of society. I think that’s all anyone wants.”

Boniaby was surprised and overjoyed to discover that the City of Houston’s healthcare plan covers transition-related services—such as gender confirmation surgery, hormone therapy, and mental health services—for municipal employees whose gender differs from assumed at birth, including trans, non-binary, and genderqueer individuals. “This gives me the support that I need in terms of access to these benefits that I would otherwise not have access to, or be forced to pay significant costs out of pocket,” Boniaby says. “And even though I am gainfully employed, that cost can become a significant burden. So you can only imagine for those who don’t have these benefits, the struggles that they face and the sacrifices they have to make—sometimes it’s the decision of purchasing their medicine or eating.”

These benefits were influenced by a recent initiative of Mayor Turner’s LGBTQ Advisory Board. After being alerted that the City would soon vote on its health insurance contracts, a team of board members—including Harrison Guy, Melanie Toarmina Pang, Chris Busby, Becca Keo-Meier, Brandon Mack, Monica Roberts, and Lou Weaver—quickly organized to ensure transition-related benefits would be secured in this coverage. “This initiative was definitely in our wheelhouse, and we felt we could really make a difference,” says Harrison Guy, co-chair of the Mayor’s LGBTQ Advisory Board. “Our interest was going in [to the City] to say, ‘You actually need to talk to trans people and hear what’s needed from these benefits.”

While transition-related healthcare benefits were technically available to municipal employees prior to this initiative, these benefits hinged on Section 1557 of the Affordable Care Act (ACA), which made it illegal for healthcare providers and insurance companies to discriminate against trans, non-binary, and genderqueer individuals. However, since its implementation, the current Trump administration has threatened to repeal or alter this rule. “Under the current federal administration, we live in very unstable and fearful times, and many efforts have been made to invalidate, minimize, and even erase the progress we have all made as a community to achieve and maintain our rights,” says Becca Keo-Meier, who served as an inaugural member of the Mayor’s LGBTQ Advisory Board. “This forces us, in many cases, to be reactive, instead of proactive in our work together. Specifically in this example around transition-related healthcare, the Trump administration has threatened to roll back healthcare for trans people by removing the protections from discrimination in healthcare and insurance coverage from the ACA. In response to that, we wanted to make sure, even though City of Houston employees had access to transition-related benefits, that those benefits would remain accessible for employees regardless of any potential changes made to the ACA. That was our goal.”

The team worked together to accomplish three objectives: to collect information on the population of individuals who would be impacted by these benefits (those whose gender is different than assumed at birth); to share this knowledge with City of Houston human resources staff and to address any misconceptions they held; and to collaborate with these staff to update and include affirming and non-stigmatizing language in the new insurance policy to explicitly state that the City offers transition-related benefits, not just to rely on the ACA. “We met with people to share the knowledge that we gathered, to address misconceptions, and to be transparent, honest, and truthful with the information,” Keo-Meier says. “We presented this as a human rights issue, that healthcare is a human right, and that we all deserve healthcare.”

“Of an estimated 1.4 million in the U.S., Texas holds one of the largest populations of trans, non-binary, and genderqueer people,” Keo-Meier, who identifies as genderqueer, adds. “We should be proud of that number—that we’re here, and that we exist. What was special and important was that [City HR staff] also had faces of local community come to speak with them and share our own personal experiences around healthcare. So, in addition to the research, there were Houstonians who would be most impacted by this decision there to share our stories. That was really powerful.”

Despite these population statistics, trans Texans have faced healthcare inequities at staggering rates. According to the National Center for Transgender Equality’s 2015 U.S. Transgender Survey, 38 percent of trans Texans did not see a doctor when needed because they could not afford care. Additionally, 20 percent of trans Texans were denied insurance coverage for transition-related or routine care because they were transgender. “One misconception that is floating around is that transition-related care is not medically necessary, but cosmetic, and that’s an absolute false statement. The research shows that transition-related care is absolutely medically necessary for trans, non-binary, and genderqueer people,” Keo-Meier says, noting that providing transition-related benefits isn’t cost prohibitive either, but rather reduces costs associated with providing care for people who experience gender dysphoria.

The City agreed. On July 25, 2018, City of Houston officials unanimously voted to secure transition-related healthcare benefits for municipal employees. “We are fortunate to have always had the support of the mayor on matters of equality/inclusion,” Guy says. “I think it’s a great recruitment tool for the City to say, ‘We understand what it means to be a trans person on a very deep level.’ The current atmosphere and energy of the City is very inclusive—this wasn’t about appeasement, they really wanted to get this right. We hope the City will become the example and when other businesses assess their own benefits, they’ll look to the City.”

“I’m proud of the collaborative approach that we took to advance this priority within the LGBTQ Advisory Board,” Keo-Meier adds. “We understood that this was a human rights issue and an issue of fairness, justice, and commitment to diversity, which is what we, as the board, but also as Houstonians, want to represent as our values. I hope that, moving forward, we can continue to be transparent with one another, communicate effectively, hold each other accountable, truly collaborate with each other within our own community, and encourage each person’s or group’s contribution toward a more inclusive and just Houston, which is this thriving city that many of us call home.”

For Boniaby, this vote signifies that the City respects and validates her identity as a trans woman. “I hope that this decision helps pave the way for other people like myself to be able to access these much-needed healthcare benefits,” she says. “This is something that is critical, because not having access puts you in a place where you feel truly marginalized, like you’re less than a person. So I hope this helps to bridge the gap as far as accessibility, needed treatments, and healthcare as a whole.”