A bill requiring an assessment by the state auditor of the social and financial impacts that occur when health insurance companies deny coverage for certain types of health care to individuals based on gender identity is advancing in the state House.

The bill has generated about 75 pages of written testimony — the vast majority in favor.

The latest version of House Bill 285 is scheduled for a 2 p.m. hearing today by the House Consumer Protection and Commerce Committee via videoconference.

The original version of the bill would have prohibited the denial of coverage to individuals for the purpose of gender transition if the policy would cover the requested procedure for other purposes.

For example, procedures that are a part of gender transition but have other purposes include hormone therapies, hysterectomies and mastectomies.

The bill unanimously passed Feb. 9 — with amendments, including the requirement of the audit — by the Committee on Health, Human Services and Homelessness.

The measure was introduced by Rep. Adrian Tam, a Democrat and openly gay legislator representing the Honolulu district that includes Ala Moana and Waikiki.

Three Big Island Democrats signed on as co-sponsors — Nicole Lowen, who represents North Kona; Jeanne Kapela, whose district stretches from Kailua-Kona to Naalehu; and David Tarnas, whose district includes a portion of North Kona, plus North and South Kohala.

“The Legislature finds that many transgender persons have experienced discriminatory treatment from health care insurance providers when seeking coverage for gender-confirming treatments,” the bill states, and posits that “transgender persons who are denied treatment are at a higher risk of suicide and depression.”

“The Legislature recognizes that, while federal health care guidelines previously prohibited health insurance and health care providers from discriminating on the basis of gender identity, these protections have been largely rolled back,” the measure continues.

The original bill was opposed by Hawaii Medical Insurance Association — the state’s largest health insurer — which requested the auditor’s assessment.

“Should this bill move forward, we respectfully request that the impact assessment be conducted first since it creates new mandated benefits that increase costs for our members,” said Matthew W. Sasaki, HMSA’s director of governmental relations.

In addition to HMSA, only one individual testified against the measure.

Providing commentary for the Department of Commerce and Consumer Affairs, Colin Hayashida, the state’s insurance commissioner, pointed out the statutory requirement that an auditor’s assessment be performed before provisions of the bill become law.

Hayashida said state law requires the auditor’s report to assess “the extent to which insurance coverage of the health care service or provider can be reasonably expected to increase or decrease the insurance premium and administrative expenses of policyholders.”

“If this bill is a new mandate, the department recommends adding language to the bill that would require the auditor’s report to assess the additional cost of a proposed mandate that may be subject to defrayal,” Hayashida added.

Hayashida also pointed out that the language in the original bill didn’t include health maintenance organizations such as the Kaiser Foundation Health Plan in its coverage requirements.

Kaiser, while not taking a position, also pointed to the statutory requirement for the impact assessment.

Lowen said she supports “the intent of it, which is to figure out if there’s been certain health care that’s … been denied to transgender individuals that should be covered.”

“Looking into it, I think an audit is a good place to start,” she said.

Beverly Yates-Tese, president of Hawaii Island LGBTQ Pride, said in a statement to the Tribune-Herald it “supports the right for everyone to have access to medical care.”

“This extends to all LGBTQ+ individuals and the care they need to be whole,” Yates-Tese said. “Whether it be transgender services, mental health care, family practice, or access to all emergency care. Insurance companies should be concerned with the health of the community as a whole. By providing and covering treatment for people of all identities they will greatly improve health outcomes and reduce the risks for an already high-risk population.”

Greg Lupton, Hawaii Island LGBTQ Pride’s treasurer, told the Tribune-Herald, “If we’re even talking about the personal and financial impact on transgender folk, it needs to be talked about. It needs to be investigated.”

“And if auditing is a way they’re going to investigate it … I think they’re going to find that we’d be a helluva lot better off as a state if these procedures were made more easily accessible to people,” Lupton said.

Organizations in favor of the legislation include the Hawaii Civil Rights Commission, the Office of Hawaiian Affairs, Pride at Work – Hawaii, Af3irm Hawaii, the Lavender Clinic and Malama I Ke Ola Health Center.

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