Open letter to the University of Michigan Medical Benefits Advisory Committee
On the subject of healthcare for transgender patients, and the ongoing coverage review for the "treatment of Gender Dysphoria"
We write today to inform you -- whether you are aware of this or not -- that you are being thrust into a major role in the movement for transgender healthcare equity. In the last two years, this movement has effected sweeping changes in major insurance networks based in Washington, Oregon, and California. The time is approaching for you to play your part by making a decision that will either take major steps towards adding Michigan to this growing list of national leaders in healthcare equity, or that will publicly cement the University’s complicity in the discrimination that strongly contributes to the 40% of transgender people who attempt suicide (10x the rate of the general population). The recommendations you bring forward to the University administration will likely shape most BCN plans administered by the University of Michigan, and based on recent history in other states (e.g., in Oregon), they will carry significant ramifications for similar healthcare plans throughout the state of Michigan. Your decision will determine access to lifesaving care for hundreds of patients.

Your actions are being closely watched by members of the transgender community at the University of Michigan across the Ann Arbor, Dearborn, and Flint campuses who are experiencing the excruciating trauma of gender dysphoria which they cannot adequately treat, and the debilitating financial strain that results from unjust denial of coverage. Your actions are being closely watched by the friends and family of transgender people gravely worried that their loved ones will become simply a statistic in the national epidemic of trans suicides. Your actions are being closely watched by our numerous cisgender allies standing in solidarity with us, and by a rapidly growing number of medical professionals who affirm their patients' dire need for care, but are rendered powerless to provide it by discriminatory coverage plans.

Because of our role as the labor union of graduate workers at the University of Michigan, the recommendations that we have presented to you (cf. "Necessary Improvements to GradCare Coverage for the Treatment of Gender Dysphoria") are targeted specifically at GradCare, the coverage plan administered to graduate instructors. We are deeply concerned that representatives of University Benefits and HR may not have made you adequately aware of the widespread impact that your decision will directly bear on people’s lives, nor made you aware of the degree to which your decision is being watched and anticipated by the public.

This is not an abstract, academic debate occuring in a vacuum. Somewhere, today, on a health insurance plan you are about to shape, is a trans person who cannot afford vocal therapy for the voice they experience as disfigured. You will directly determine whether they will be able to experience a healthy social life. Somewhere, on one of the health plans you will shape, is a trans woman whose gendered facial dysphoria has driven her to self-harm and to the brink of suicide. You will have to decide whether or not you want her blood on your hands. The onus is on you to enable providers to uphold their Hippocratic oaths by rendering the care that they and their patients understand to be Medically Necessary. The cost to the institution is minimal, and attempting to cut costs at the expense of trans lives is morally reprehensible.

"Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God."
We, the undersigned, implore you to consider the gravity of this situation, and we implore you to implement in a timely manner the coverage improvements that are necessary and minimal steps towards achieving equitable care. We ask you to reflect on the discrimination inherent in a system which forces transgender employees to pay for necessary medical care out of pocket, resulting in a drastic wealth gap between them and their cisgender colleagues. Most importantly, we ask you to act with compassion to those over whom you currently wield significant power. Your decision will reflect not only upon yourselves, but upon the whole of Michigan Medicine and the broader University.

We are closely watching, we are gravely concerned, and we implore you to make the right choice come the end of your review.

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