Insurance companies put on notice for stranding trans patients who want to reverse surgeries

Rep. Diana Harshbarger, R-Tenn., a lawmaker with a background in pharmacy, is introducing a bill that would require health insurance companies that provide transgender procedures to also pay for detransitions and adverse effects.

Harshbarger fears that under many current plans, transitioners who consider reversing their sex-reassignment procedures are stuck with what is effectively a financial one-way door.

"It's outrageous that a health plan can cover sex-rejecting procedures but refuse to cover the restorative care patients need to address the harm they cause. That's not a fair deal for patients who want to restore healthy bodily function," Harshbarger said.

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Although unlikely to become law over Democratic opposition in the Senate, the bill, titled the TRUTH in Coverage Act, draws attention to a growing number of patients who have regretted sex-reassignment procedures and lawmaker concern over barriers to addressing their fallout.

It would require insurers that cover "sex-rejecting procedures" to also cover items and services needed to address the complications or adverse effects resulting from them. The bill would enact the requirement regardless of state or local laws that mandate such procedures.

If passed, the bill would go into effect Jan. 1, 2027. It has 12 cosponsors, including Rep. Buddy Carter, R-Ga., the former chairman of the Energy and Commerce Subcommittee on Health.

In its current form, Harshbarger’s bill would amend three federal statutes governing private health insurance coverage to create a uniform federal coverage requirement: the Public Health Service Act, employer-sponsored health plans and group health plans. The bill would also prevent insurers from adjusting copays, deductibles or implementing treatment limitations.

Texas Gov. Greg Abbott signed a similar bill into law last year, addressing a similar concern at the local level.

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Senate Bill 1257, sponsored by Texas Sen. Bryan Hughes, published a statement with the Texas Senate Research Senate, arguing the need for his bill.

"Many of these individuals require extensive medical care to manage or reverse the effects of previous treatments, yet they are frequently denied insurance coverage, leading to insurmountable out-of-pocket expenses. Without this coverage, patients face significant health risks, including hormone imbalances, surgical complications, and psychological distress," Hughes wrote.

According to the National Library of Medicine, it’s difficult to determine exactly how many detransitions there are or at what point someone would be considered a detransitioner. Researchers noted that stopping hormones, reversing surgeries or changing legal documents could all be triggers for what it means to begin the detransition process.  

By casting a wide net and including adverse effects, Harshbarger’s bill would circumvent those technicalities.

"Patients should never be abandoned after undergoing life-altering, harmful medical interventions once reality sets in," Harshbarger said.

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"As a pharmacist, I've seen insurance companies find every excuse in the book to avoid paying for the care patients actually need. My TRUTH in Coverage Act restores fairness, promotes transparency and ensures patients aren't left paying the price for care their insurance should cover."

It’s unclear when and if Harshbarger’s bill would reach the House floor for a vote.