Transgender teen settles with Kaiser Permanente in landmark health case

Kaiser Permanente's motive was simple: any excuse to save money. Kaiser has narrow treatment guidelines that harm patients, not infrequently causing death, but save a fortune. This is the reason Kaiser, a non-profit company, makes billions in profits each year. Kaiser then channels these untaxed profits into its for-profit Permanente companies.

Transgender teen settles landmark health case
Posted on 17 July 2013
By Katie Kerwin McCrimmon
Healthypolicysolutions.org

FORT COLLINS — An 18-year-old college student who grew up as a girl and now identifies as a young man has settled a landmark civil rights case against Kaiser Permanente of Colorado.

In the rare case, the Colorado Civil Rights Commission found in March that there was probable cause that Miki Alexander Manigault suffered discrimination and unequal access to health care specifically because he is transgender. (Click here to read the determination of probable cause.)

On the same day, after pressure from advocates at One Colorado, Colorado’s Division of Insurance issued a bulletin and became the third state in the country to specifically bar health insurance companies from discriminating against people who are gay, lesbian, bisexual or transgender. (California and Oregon preceded Colorado. The District of Columbia also bans discrimination against LGBT patients and Vermont has since followed suit.)

Faced with charges of unequal treatment, Kaiser Permanente quietly settled Manigault’s case before it was slated to go to a hearing in June. Amy Whited, a spokeswoman for Kaiser Permanente, declined to discuss Manigault’s case. As a result of a settlement with the Civil Rights Commission, however, Kaiser, one of Colorado’s largest health insurance companies, has agreed to work with the commission to convene discussions among insurers regarding health care for transgender people.

Manigault’s case has already prompted at least one other complaint to the Civil Rights Commission and may open the doors for equal health care for LGBT patients in Colorado and elsewhere in the U.S. (Coming next week: read about Kelly Costello, another transgender person who has also filed a civil rights complaint.)

Manigault grew up as Michaela, a girl with irresistible Shirley Temple dimples who nonetheless loathed girly dresses. She has now evolved into Alex, a young man embracing the gender that he believes he was born with. It just never matched his body. Until now.

Alex finally had the chest reconstruction surgery that doctors deemed medically necessary but Kaiser previously failed to cover, according to the determination and complaint.

Alex and his family cannot discuss any details of his settlement with Kaiser. But the Colorado State University art major agreed to share his story of struggle and transformation.

Alex recently traveled to San Francisco to have an experienced surgeon remove his female breast tissue and sculpt a male chest.

They felt like tumors on my chest or phantom limbs,” Alex said of the female breasts, which he used to bind to try to flatten them.

He and his mom decided to bring the civil rights complaint and filed it in January of 2012, when Alex was just 17, because insurance companies provide all sorts of breast surgeries for other patients, including reconstruction for psychological well-being for cancer patients. It seemed fair to them that health insurance should also provide coverage that makes transgender people healthier.v “A lot of transgender people go through so much drama and so much heartache and waiting for years and sometimes decades to even talk about what it is they want and need,” said Alex. “When you can finally admit what you want and feel safe, then the insurance company tells you ‘No,’ and puts another obstacle in front of you, that’s wrong.

“I’m just as surprised as you that I’m transgender,” Alex says.

Alex credits his mom for being in his corner and pressing the case. Deborah Manigault is a civil rights law enforcement officer for the U.S. Department of Housing and Urban Development. So she knew how to file a civil rights complaint and felt it was clear that Alex deserved to win.

“These are not elective surgeries. They are medically necessary for their health, for their mental health and their medical well-being,” she said. “There are many insurance companies who are claiming to be LGBT-friendly, but they are denying coverage based on transgender status.” Alex has not decided how to proceed with what transgender people call bottom surgery. Many transgender people evolving from female to male don’t bother seeking a surgically created penis since the options are poor. Results are much better for males becoming female because an experienced surgeon can essentially tuck the penis into the body and retain sensation. Alex has been taking testosterone injections since his junior year of high school, so his voice is now deep and body hair has sprouted on his stomach and will fill his chest once it fully heals. Now a sophomore in college, he still thinks he looks somewhat feminine because of a long, graceful neck and fine cheekbones that any model would envy. But the testosterone he must inject every two weeks literally empowers him as it bulks up his muscles. In contrast to the famous “It Gets Better” campaign, http://www.itgetsbetter.org/ Alex says it doesn’t get better overnight. Still, he is no longer hiding from friends and the world, afraid to hear his own voice. At last, he is embracing his manhood. He is becoming Alex. ‘I didn’t want to be transgender’ Alex doesn’t remember a light bulb moment when he suddenly knew that he should have been a boy. Instead, growing up in Maryland and the conservative South, he remembers being a weird kid who could beat all the boys in running races, but never fit in. “I went through a long process of feeling I was different in some way and not knowing what that difference was,” Alex says. Way back, at age 2, Michaela was a flower girl in a relative’s wedding. An outgoing toddler, Michaela pitched a fit over wearing the poufy floral dress for the ceremony. At the time, Deborah Manigault attributed the tantrum to a 2-year-old’s fickle independence. Now Deborah wonders if it was an early sign that Michaela didn’t feel right in her body. As a fifth-grader, Michaela remembers once being teased by a group of classmates for not fitting in. She sought solace in a large cubby where she curled up and hid.