CTA does an about-face on insurance coverage for gender reassignment surgery

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Russia Brown | Provided ACLU of Illinois

Russia Brown is a 28-year-old CTA bus driver born a female who was making the transition to a male, only to have the mass transit agency throw up a roadblock.

After choosing a surgeon and scheduling a date for the breast removal surgery known in medical circles as a “bi-lateral mastectomy,” Brown was informed this fall that the CTA’s insurance policy had rejected the claim.

The policy “only covered bi-lateral mastectomies” for patients diagnosed with cancer.

“It felt like…being kicked while you were already down,” Brown said Wednesday.

“It was just a final blow. I kind of hit rock bottom. I was really distraught. Almost in tears.”

Brown’s despair did not last, thanks to an abrupt about-face spearheaded by a Sept. 26 letter from the ACLU.

Within weeks and without the threat of a lawsuit, the CTA agreed to cover surgeries tied to “gender dysphoria,” the medical term for the distress resulting from, what the ACLU letter calls “the incongruence between a person’s gender identity and their gender assigned at birth.”

“I was ecstatic. I felt on top of the world — like an ant reaching the top of a mole hill,” Brown said.

“I found myself skipping around the yard, just being overjoyed. I was able to incite such a huge change. I never thought of myself being” a change agent.

The policy change allowed Brown to go ahead with, what he called, “top surgery” at a cost of $30,000 he could not afford to pay on his own.

He plans to have “bottom surgery” — at a cost of $80,000-to-$100,000 –– at some point down the road of this long and emotional journey.

“I feel visible now. My whole life, I kind of felt like a shadow. I always wanted to be in the dark. Now, I feel more comfortable with being seen. Willing to spread my wings a bit more. Maybe try some things that I wasn’t gonna try before,” he said.

Brown has known he was “different” — and that there was something about his sexuality that needed to be corrected –– since he was a kid growing up in Bronzeville.

“I remember playing with my little brother and my cousins and being upset because my brother told me, ‘No girls allowed,’ ” Brown recalled.

“I remember talking to my mom. She goes, ‘Why are you upset?’ And I was like, ‘This sucks. I don’t want to be a girl.'”

Even so, Brown is well aware that plenty of people still view treatment for gender identity disorder as elective surgery for which the patient should foot the bill.

“People who feel that way — they just see the good parts about transitioning. They didn’t see the years of self-loathing. The years of depression and crying for no reason. Hating my entire existence just because I felt I had to live a life I didn’t want to live,” Brown said.

CTA spokesman Brian Steele said the insurance policy was reversed “in keeping with our broader efforts toward inclusion and diversity” in the workplace.

“CTA reviewed its existing guidelines related to health care coverage for gender reassignment surgery and determined such coverage should be extended in cases that are supported by proper medical documentation,” Steele wrote in an email to the Sun-Times.

Carolyn Wald, a staff attorney for ACLU of Illinois, said the about-face is particularly gratifying at a time when President Donald Trump is contemplating a policy change that would discriminate against 1.4 million Americans who identify with a gender different from the one they were assigned at birth.

Medical consensus is clear: Gender dysphoria is a medical condition. The only way to treat that distress is to “change the body to bring the body into alignment with that person’s gender identity,” she said.

“That’s a decision that should be made between an individual and their medical provider. These blanket exclusions just don’t take that into account,” Wald said.

“Any time that a doctor thinks it’s necessary and the individual agrees they want to go through with it, then it should be covered.”

Pressed on why beleaguered Chicago taxpayers should cover gender reassignment surgery, Wald said, “You could say the exact same thing about, ‘Why should I pay for someone’s else’s cancer when maybe they smoked or worked with asbestos?’ The employer has agreed to provide insurance for all of their employees. They should cover all medically necessary care. To deny that is also discrimination.”

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