Abbott signs bill requiring health plans cover detransition, if they cover gender transition

AUSTIN (KXAN) -- In May, Texas Gov. Greg Abbott signed Senate Bill 1257, which requires health insurers operating in Texas to cover detransition care if they also cover gender transition-related medications and procedures.

However, transgender rights advocates said they're concerned the law could prompt insurers to drop coverage of necessary medical care. Progressive advocacy group Texas Freedom Network, or TFN, said that the law violates a "fundamental Texas value ... to make personal decisions without government intrusion."

Detransition, or when a person decides to stop or reverse their gender transition, happens to a small subset of transgender people. For some "detransitioners" this comes before ever accessing any medical care.

Bill author Sen. Bryan Hughes, R-Tyler, said in his intent statement that the law would "ensure equitable healthcare coverage for individuals who have undergone gender transition procedures."

"Currently, health benefit plans in Texas provide extensive coverage for gender transition treatments, including surgeries, hormone therapies, and other medical interventions. However, there is a critical gap in coverage for the adverse effects, medical complications, function recovery and reconstruction procedures related to these treatments," Hughes wrote.

According to the 2022 U.S. Transgender Survey, only 9% of respondents returned to a gender identity typical of their sex assigned at birth. Just 4% of that group (0.36% of all respondents) decided that gender transition wasn't for them. The vast majority of respondents who went back (82%) cited "factors that made it difficult to be trans in their community," such as discrimination, social rejection and harassment.

Only 0.43% of Texas adults identify as transgender, according to 2022 data by the Williams Institute. This means that fewer than 500 Texans detransitioned because they felt transition wasn't for them, and it's likely that an even smaller group had any transition-related care.

Hughes also wrote that the number of detransitioners was growing. The number of transgender people in Texas and the U.S. has also increased, and outpaces detransitioners by a large margin.

"Many of these individuals require extensive medical care to manage or reverse the effects of previous treatments, yet they are frequently denied insurance coverage, leading to insurmountable out-of-pocket expenses," he wrote. "Without this coverage, patients face significant health risks, including hormone imbalances, surgical complications, and psychological distress."

TFN Political Director Rocío Fierro-Pérez told KXAN on June 12 that while covering care needed by detrans people could be good, she is concerned that insurers may decide to drop coverage for both groups altogether.

"Insurance companies don't actually want to cover anything that is going to cost them more money, and so we are worried about the kind of care that will be available to trans and queer people that are simply trying to live their lives and have basic healthcare," she said.

KXAN reached out to the Texas Association of Health Plans multiple times following SB 1257's passage in May. The health insurers' lobbying organization did not respond.

We also reached out to Texas' five largest health insurers about the bill. Blue Cross Blue Shield of Texas was the sole respondent.

"We are here to support our customers and members, in compliance with federal, state and local laws," said a BCBSTX spokesperson via email.

The lack of public comments by insurance companies has Fierro-Pérez worried. She doesn't expect the multi-billion dollar industry to protect gender expansive Texans.

"I imagine that this is going to limit the amount of healthcare that trans and non binary people can access, or make it more expensive, right? Health care is already very expensive for most people, especially if you're trans or non-binary," she said. "This bill, regardless of what insurance companies do, is a representation of the way that the Texas Legislature and [its] current leadership feels about trans people."

Other states, such as California, require health insurers cover transition-related care. It is unclear how SB 1257 and other such laws will influence the companies' plans across state lines.

SB 1257 will take effect in September.