Chicken and the egg



Councilwoman Caitlin Copple confronted the Missoula City Council last week about a discrepancy in the city's anti-discrimination ordinance, which makes it unlawful to discriminate based on sexual orientation or gender identity. Specifically, Copple says that denying sexual reassignment surgery and hormone replacement therapy to transgender municipal staffers runs contrary to the law's intent.

"It feels pretty hypocritical to me that we don't even offer what is unequivocally deemed necessary medical care for transgender employees," Copple said.

As it stands, testosterone and estrogen therapy for transgender people is not covered under the city's insurance policy. But hormone therapy for menopausal biological females is. Similarly, sexual reassignment surgery is listed alongside nearly two dozen insurance plan benefit exclusions the municipal policy won't pay for. Other off-limits procedures include abortion, fertility studies and artificial insemination.

Aiming to ensure that all municipal employees are treated equally, Copple is proposing to add full coverage for transgender employees. The challenge comes in quantifying how much that would cost and identifying where the money would come from. "We don't really know," says Missoula Chief Executive Officer Bruce Bender. "That's one of the problems with this."

According to the city's Human Resources Department, the municipal health plan covers 533 employees, including retirees. Copple says she's not aware of any city employees who are transgender. However, "until we offer trans benefits, we're probably not going to have any out trans employees," she says. "It's a little bit chicken and the egg."

Copple notes that cities offering full coverage, including Seattle, Portland and San Francisco, have experienced a negligible increase in associated insurance claims and premium costs. For example, according to data collected by the Williams Institute at the University of Southern California Los Angeles School of Law, claims filed between 2001 and 2006 under San Francisco's extended coverage totaled $386,417.

"I think one of the biggest misconceptions is that there's gong to be this big run on gender-affirmation surgeries," Copple said in an interview after last week's committee meeting. "We know that certainly a significant number of trans people don't necessary want what's commonly still known as a 'sex-change operation.' They just want hormones. And they want to be able to present their gender effectively in the workplace."

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