Many insurers exclude coverage for transgender individuals. Litigation challenging these exclusions has increased. Most of these cases successfully advance equality claims by arguing that trans exclusions discriminate based on sex. That is, procedures performed on patients for reasons unrelated to gender affirming care are being denied to transgender individuals. There are, however, limitations to this argument. First, some courts may construe care narrowly and hold that some procedures are unique to gender affirming care that have no analog in other contexts. Second, a court that is hostile to the sex discrimination argument might hold that the denial does not arise from sex discrimination, but rather, because of the kind of diagnosis at issue. Further, the sex discrimination argument might force transgender individuals into making claims based on a binarized gender identity which may not conform with their lived experience.Claims based on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) can address these shortcomings. This Act prohibits insurers from discriminating against mental health diagnoses—for example, procedures that insurers cover because of medical or surgical diagnoses should also be covered if indicated for mental health diagnoses. Gender dysphoria is a recognized mental health diagnosis. Transgender individuals seeking gender affirming care arising from gender dysphoria can thus claim that exclusions of coverage violate the MHPAEA. Some transgender individuals might raise concerns that such an approach would lead to increased medicalization of trans identity. However, an MHPAEA claim would only appear in cases where a transgender individual is voluntarily submitting themselves to medical assistance in order to advance their own autonomy.

中文翻译：

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接受性别肯定手术的心理健康平等论据

许多保险公司不承保变性人。对这些排除提出质疑的诉讼有所增加。这些案例中的大多数通过论证跨性别排斥是基于性别的歧视，成功地推进了平等主张。也就是说，由于与性别肯定护理无关的原因而对患者进行的手术被拒绝提供给跨性别者。然而，这一论点也有局限性。首先，一些法院可能会狭隘地解释护理，并认为某些程序是性别肯定护理所特有的，在其他情况下没有类似的程序。其次，对性别歧视论点怀有敌意的法院可能会认为，拒绝并不是因为性别歧视，而是因为所涉及的诊断类型。此外，性别歧视论点可能会迫使跨性别者基于二元化的性别认同提出主张，这可能不符合他们的生活经历。基于 2008 年心理健康平等和成瘾公平法案 (MHPAEA) 的主张可以解决这些缺点。该法案禁止保险公司歧视心理健康诊断，例如，保险公司因医疗或手术诊断而承保的程序，如果需要进行心理健康诊断，也应承保。性别不安是一种公认​​的心理健康诊断。因此，因性别不安而寻求性别肯定护理的跨性别者可以声称排除承保违反了 MHPAEA。一些跨性别者可能会担心这种方法会导致跨性别身份的医疗化程度增加。然而，只有跨性别者自愿接受医疗援助以提高自身自主权的情况下，才会出现 MHPAEA 索赔。