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Hawaii expands gender-affirming care for trans residents

In 2016, Hawaii took a seemingly small but significant step forward for its trans residents: The state passed a law barring insurance companies from discriminating against transgender and nonbinary Hawaii residents. But in the years since the anti-discrimination law, trans residents, advocates and lawmakers found that it hadn't done enough - people were still being denied coverage for care that could help them affirm their gender identity.

On Thursday, Hawaii's Democratic Gov. David Ige signed a bill into law that clarifies certain treatments insurers had deemed "cosmetic" - such as laser hair removal, voice therapy and facial feminization surgery - should be covered as long as a medical provider deems it medically necessary. The legislation, H.B. 2405, would also require insurers to give patients clear information about which gender transition services are covered.

"The bill is key to protecting people from discrimination in accessing gender-affirming treatment," Ige said at a signing ceremony, Honolulu Civil Beat reported. The governor also signed two other bills expanding LGBTQ protections in state: one that bars people from being excluded from juries because of their gender identity and expression, and another establishing a commission that will examine the status of Hawaii's LBGTQ residents.

The health-care bill, which was crafted with input from health-care providers, trans advocates and insurers, passed with overwhelming support in both chambers of Hawaii's legislature. The law went into effect immediately on Thursday.

The issue highlights how difficult it is for transgender and nonbinary people to access medically necessary and potentially lifesaving gender-affirming health care, even in areas that embrace and support them, said Democratic Hawaii state Rep. Aaron Ling Johanson, a champion of the bill and chair of the state's Consumer Protection and Commerce Committee.

Johanson said the policy change had been a "passion project" for him.

"One of the things that we came to find was that . . . 'cosmetic' treatments are a very critical part of accomplishing gender-affirming care for the patient," Johanson said. But "clashes" persisted between trans and nonbinary Hawaii residents and insurance companies, he said, because some insurers decided the care was not medically necessary, even if a patient's medical provider had recommended it. (Hawaii Medical Service Association, the state's largest insurer, declined to comment.)

"It's just heartbreaking when you hear from a lot of these folks who have higher rates of depression or thoughts of suicide because they're just stuck in a system that doesn't help them," Johanson added.

Fan Liang, medical director of the Johns Hopkins Center for Transgender Health, said that for trans and nonbinary patients, there tends to be more coverage for "top" and "bottom" surgeries (chest and genital surgeries), but not for procedures such as facial or voice surgeries. That's a big oversight, Liang said, considering how important these characteristics are in everyday life.

"When you engage with somebody, the first thing that they appreciate, really, is your face and facial expressions," Liang said, adding that many of her patients have told her stories of being misgendered over the phone. Some worry their voice is "a telltale giveaway" of their transition.

Generally, Liang said, gender-affirming care, which includes psychosocial and educational resources as well as medical interventions, helps trans and nonbinary people live more freely, whether that's relieving their gender dysphoria or reducing the likelihood they'll be singled out or discriminated against.

"It really is a medical necessity," Liang said. "These patients are living with an incongruence that permeates all aspects of their lives."

In passing its new gender-affirming care bill, Hawaii has joined a handful of states, including Washington and Colorado, that have tried to expand access to transition care.

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by Anonymousreply 43June 24, 2022 12:45 PM

Trans people and their advocates have long noted the structural barriers to receiving care: Even when patients can get their treatments approved and covered, there are not many providers capable of performing these procedures, and it is not unusual for patients to travel out of state or to be put on lengthy waiting lists to receive it.

This is true even in "progressive" places like Hawaii, where some residents have traveled to California - a five-hour flight - to get the transition care they need, advocates say.

Jenn Jenkins, a policy advocate who worked on Hawaii's health-care bill, said that in their eyes, the law simply clarifies what was intended in the state's 2016 nondiscrimination policy.

"This is already the law. It was just not as plainly written as we've done it [now]," Jenkins said. Still, this clarification could greatly expand gender-transition access among trans and nonbinary Hawaii residents, particularly trans women who had been particularly susceptible to having their claims denied, Jenkins added.

Advocates and lawmakers agree the bill is a significant step forward at a time when many state lawmakers are looking to limit access to transition care among trans youth and adults. Conservative lawmakers who have introduced bills curbing access to gender-affirming care for minors say the policies are meant to protect children.

For Johanson, the lawmaker, the state's "aloha spirit," which emphasizes community care, helped make this new law possible. Jenkins, meanwhile, noted that Hawaiians have been "much more open to the idea of a spectrum of gender" because those beliefs are at the root of Hawaiian culture.

Native Hawaiians have long recognized a third gender identity, "mahu." Historically, trans and nonbinary Hawaiians have taken roles as teachers and leaders in their communities, explained Maddalynn "Maddie" Sesepasara, a trans advocate who manages the Kua'ana Project, a transgender support organization.

This cultural reverence was made apparent in 2019, Sesepasara said, when indigenous elders protesting a billion-dollar telescope at the summit of Mauna Kea mountain called on Hawaii's mahu community to join them.

"We know we have a place. We know we are respected," Sesepasara added.

That doesn't mean trans Hawaiians have not faced the same systemic barriers, discrimination and barriers trans people face elsewhere, advocates say. After Christian missionaries came to the islands, "mahu" became a derogatory term, Sesepasara said, though this has slowly changed over the last 40 years.

Medical transitions are a personal choice - one that not all trans and nonbinary people are able to make or willing to seek. But for Hawaii residents who need medical treatments to affirm their gender identity, these procedures could mean the difference between being targeted and being able to "blend in" and be comfortable in society, Sesepasara said.

And a time when the cost of living has soared on the islands, some Hawaii residents have become increasingly desperate to complete their transitions.

"These are not cosmetic surgeries," Sesepasara said. "These are surgeries that are going to save transgender folks in Hawaii."

Jenkins hopes Hawaii's new law could be a "little bulb of light" for trans communities in other parts of the country, where vitriol and attacks against trans people and other LGBTQ individuals have spiked.

"It's our contribution to the possibility that we can change things for the better," they said.

by Anonymousreply 1June 19, 2022 10:15 PM

No wonder everything is so fucking expensive in Hawaii.

They residents have to pay for all this shit.

by Anonymousreply 2June 19, 2022 10:22 PM

"Laser hair removal, voice therapy and facial feminization surgery" = "I have the human right to be fuckable and if people don't foot the bill then they are transphobic and I will kill myself"

by Anonymousreply 3June 21, 2022 1:25 AM

Bingo, R3.

Hawaii politicians are fucked in the head.

What a backwards, 3rd World HELL HOLE.

by Anonymousreply 4June 21, 2022 1:27 AM

GOOD. Suck it, haters

by Anonymousreply 5June 22, 2022 11:12 AM

"Laser hair removal, voice therapy and facial feminization surgery"

If that's called human rights, the first priority should go to women, oh sorry, "Assigned Female At Birth" people, because for women, I mean real women, the pressure to maintain hairless body and decent enough face (often ugly women with bad skin need facial feminisation too) is extreme, since girlhood.

by Anonymousreply 6June 22, 2022 11:19 AM

Are all the grifting Trannies going to move to Hawaii then?

by Anonymousreply 7June 22, 2022 11:27 AM

[quote] "The bill is key to protecting people from discrimination in accessing gender-affirming treatment,"

If this is what Hawaiian voters want, fine, but the labeling of this as “discrimination” is ludicrous. Of course they’re doing so to justify the legislation, but … really? Discrimination? Are they serious?

So in other words, insurance companies are paying for breast reduction surgery for women except those who want to transition to men? Nope, don’t buy it.

The law WILL in fact address discrimination — by causing it. Women with very big tits who want them reduced will be denied payment, but women who are trans will be granted it.

by Anonymousreply 8June 22, 2022 11:35 AM

Transgender people have nothing to do with us and yet they have stolen our movement.

by Anonymousreply 9June 22, 2022 11:35 AM

[quote] insurance companies are paying for breast reduction surgery for women except those who want to transition to men?

Those women are not "transitioning" into anything. The are hacking off their tits for a delusion. Instead of state-sponsored mutilation, the money would be far better spent in psychological counselling for the delusional.

by Anonymousreply 10June 22, 2022 11:46 AM

Women have hairy faces and bodies and I can guarantee you that insurance would deny a claim for laser hair removal even if it was causing the woman mental distress but a tranny can now demand things that would be deemed unnecessary cosmetic procedures.

Facial feminization is expensive, painful and rarely gives men the look they want because it’s impossible to alter the facial structure to that a young woman from a 40 year old man.

This is just unfair on many levels, cancer patients have had to fight tooth and nail for years to get reconstructive surgeries covered by insurance along with things like wigs but a tranny can get all kinds of cosmetic surgery covered because their feelings. Fuck this shit.

by Anonymousreply 11June 22, 2022 12:16 PM




by Anonymousreply 12June 22, 2022 12:24 PM

[quote]Jenkins hopes Hawaii's new law could be a "little bulb of light" for trans communities in other parts of the country, where vitriol and attacks against trans people and other LGBTQ individuals have spiked.

Yeah thanks for that bulb of light, cunt.

by Anonymousreply 13June 22, 2022 12:28 PM

A French friend had her tits done on the government dime after her third kid. Money well spent.

by Anonymousreply 14June 22, 2022 12:29 PM

[quote] Those women are not "transitioning" into anything.

The michfest fatties are so obsessive that even if you basically agree with them on a given point, you’re STILL the enemy unless you 100% use their talking points 100% of the time.

by Anonymousreply 15June 22, 2022 12:43 PM

How crazy is that, R8?

by Anonymousreply 16June 22, 2022 4:12 PM

Laser hair removal as a medical necessity requested by NO WOMAN EVER. If transwomen want to be women, they should pay for it themselves.

by Anonymousreply 17June 22, 2022 4:25 PM

It’s funny, you’ll all make mean spirited comments about trans people ability to pass, how they can be ‘clocked’ and we have thread after thread of threatening comments about and towards trans people. And then none of you understand that that behaviour and mean spiritedness is part of the reason that these procedures are to be free or covered by insurance 😂 because it’s seen as societally required for trans people to live with less anguish and stress due to judgment from others. I can’t tell you enough how stupid you all are.

by Anonymousreply 18June 22, 2022 4:38 PM

Just a shower thought: If sex doesn't matter at all (because penises are feminine now too), why do they insist on "transitioning" into a stereotype? Furthermore: Why is it the "sex" criterion they are obsessing about? Mostly the answer is: It's a paraphilia, but hear me out: What determines our status in society are many factors like education but also our sex, our background and our income. Could we start a movement and identify as millionaires? It's pretty straightforward; the state should give us a million and we will be indiscernible from other millionaires and our suffering would end. Unlike with the sex criterion, being poor is absolutely changeable. But first, we need a fancy name for "poor" like "transpecuniar", and something to decry our enemies, the cis-wealth people whose ego aligns to their means.

by Anonymousreply 19June 22, 2022 4:42 PM

Most trannys are heterosexual men so of course they can get whatever they want.

by Anonymousreply 20June 22, 2022 4:45 PM

R18 actually we know that the studies that show these treatments work are largely inconsequential and inconclusive, yet they are banded about by TRAs and allies like they are the holy grail and prove the whole thing isn't in their heads. Because of that, and people like you, progress in researching cures to gender dysphoria are unfunded and not moving forward, in fact they are trying to get any therapy to help people with the issue banned as "conversion therapy", which leaves them funneled into the highly lucrative billion dollar industry that has grown up around trans medicalization.

These giant pharmaceutical companies - who stand to make a cool $1m or more per lifetime of each trans person - thank you for your efforts to improve their bottom lines.

by Anonymousreply 21June 22, 2022 4:48 PM

[quote] actually we know that the studies that show these treatments work are largely inconsequential and inconclusive

R21 source? Hope your own comments won’t be from inconclusive studies that have been handed (sic) about.

by Anonymousreply 22June 22, 2022 5:09 PM

I'm not r22 but anyone with eyes can tell the treatments don't work.

by Anonymousreply 23June 22, 2022 7:13 PM

So insurance won’t cover breast reconstruction surgery after a necessary mastectomy??? But they will cover breasts for fetishists who make up the majority of the MTF community??

Fuck this world.

by Anonymousreply 24June 22, 2022 9:03 PM

R23 depending on what you mean by ‘work’ but they’re meant to be done alongside hormonal treatment and they do (in concert) have a ‘feminizing’ affect on the face.

by Anonymousreply 25June 22, 2022 9:05 PM

I mean laser hair removal works in that it stops hair growth. Kinda tricky to argue that one lol

by Anonymousreply 26June 22, 2022 9:06 PM

Payment is due on my Lamborghini.

This procedure is 𝑟𝑒𝑎𝑙𝑙𝑦 𝑖𝑠 𝑎 𝑚𝑒𝑑𝑖𝑐𝑎𝑙 𝑛𝑒𝑐𝑒𝑠𝑠𝑖𝑡𝑦,


by Anonymousreply 27June 22, 2022 9:14 PM

R26 It might work but it's not a medical necessity.

by Anonymousreply 28June 22, 2022 9:57 PM

Hawaii is the worst place in the world.

by Anonymousreply 29June 22, 2022 10:12 PM

Bitch please. Hawaiians are such fatties they were all plural anyhow.

by Anonymousreply 30June 22, 2022 11:11 PM

R28 lots of things covered by insurance aren’t ‘necessities’, prep for instance. But it helps the communities it is provided for. Why does it bother you so much? You think the minuscule amount of trans people is going to affect the price of premiums that much? Go complain about the sugar industry that’ll be better use of your time.

by Anonymousreply 31June 22, 2022 11:29 PM

R31 Medication to prevent STIs is a public health issue that ultimately benefits the pockets of the country as a whole by reducing the number of infections. Not sure how you can compare that to some rando Natasha Lilith-Fox (formerly Bob Smith) "needing" a pair of bolt-on tits, full-body electrolysis, and the face of his high school crush.

by Anonymousreply 32June 23, 2022 12:24 AM

r26 r31 Most women also have hair on their bodies and in some case, faces. Many women are hairy. They maintain tiring and costly routines like laser hair removal, waxing, shaving. If male trannies claim to be women, they should do what other real women do, *pay for themselves*.

If medically unnecessary lhr "helps the tranny communities it is provided for", the *same* treatment should be provided for the whole community that male trannies claim to be part of, women's community. Why discriminate... "cis" (bio? real?) women and only the special privilege for the fake women?

by Anonymousreply 33June 23, 2022 1:50 AM

Hawaii should fix its meth, housing, traffic, and cost of living prices, before giving handouts to trannies.

by Anonymousreply 34June 23, 2022 2:53 AM

R22 nice try, but I'm not falling for that tactic.

by Anonymousreply 35June 23, 2022 5:43 AM

[quote] The michfest fatties are so obsessive that even if you basically agree with them on a given point, you’re STILL the enemy unless you 100% use their talking points 100% of the time.

R8 R15 is far more adept at spewing childish pejorative than reading comprehension.

by Anonymousreply 36June 23, 2022 5:55 AM

Hawaii's governor also signed three LGBTQ+ bills into law.

Something about transgender stones too, but I don't understand what's going on.

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by Anonymousreply 37June 23, 2022 5:57 AM

if they allow such for fatties, sluts, the spectrum of intersex babies and sods ungrateful they've survived conditions like cancer, they can't exactly prevent for trannies.

by Anonymousreply 38June 23, 2022 6:06 AM

Pele, Goddess of Fire, will burn them all! 🔥

by Anonymousreply 39June 23, 2022 6:07 AM

r33 there's many avenues that biological non-trans females can and do put the bill to insurance companies and state medical... such as the numerous areas of "cosmetic" reconstructive surgeries and subsequent invasive treatments under arguments of quality of life and mental health. So, don't pretend it's one sided special interests... to have your special interest expenses opens the door to everyone else.

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by Anonymousreply 40June 23, 2022 6:14 AM

R40 Source for those claims? Statistics on usage?

by Anonymousreply 41June 23, 2022 6:18 AM

R40 'biological non trans females'??? Do you mean women? You can't be a 'non trans' female because only females belong in the group 'women'. Men are not women. It doesn't matter how much they want to be women, they're never going to get there. Women - Adult Human Female. Trans women are Adult Human Males. And that's not going to change. It's impossible to change your sex.

by Anonymousreply 42June 23, 2022 6:54 AM

Do Hawaiian tranny pussies smell like spam?

by Anonymousreply 43June 24, 2022 12:45 PM
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