A reality check on Colorado's mandate to cover transgender services

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Colorado made a national statement Tuesday, becoming the first state to require some insurers to cover transition-related care for transgender people as an essential benefit.

Driving the news: The Biden administration agreed to the expansion sought by Gov. Jared Polis and affirmed two more mandates approved by Colorado lawmakers to cover more opioid treatments and a yearly mental health exam.

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The big picture: Chiquita Brooks-LaSure, the Centers for Medicare & Medicaid Services administrator, said Colorado's plan represents a historic moment and model for other states.

Yes, but: Lost in all the attention is the fine print.

  • The transgender coverage, including hormone therapy and genital reconstructive surgery, is extremely limited and won't take effect until 2023.

  • The new mandates on private insurers will lead to increased health insurance costs.

By the numbers: The requirement for coverage of what the state labeled gender-affirming care applies only to people with individual and small group health insurance plans.

  • That covers just 9% of the state's insured population because most people get insurance from the federal government or employers that are not subject to state regulations.

The state's insurance division estimates the new mandates will increase health insurance costs 0.16% based on an actuarial study.

  • But the Colorado Association of Health Plans, an industry trade group, predicts a 1.5% rate hike, the Colorado Sun reports.

Reality check: The Democratic governor touted the three-pronged expansion as "a great day for health care in Colorado."

Yet it runs counter to Polis' recent actions.

  • He blocked a 2020 bill to require insurers to cover an annual mental health exam before relenting this year.

  • And he only reluctantly signed into law the legislation to cover acupuncture and other drugs for treatment of opioid addiction because he said that would cost consumers more.

The big picture: State Rep. Brianna Titone, an Arvada Democrat and Colorado's first elected openly transgender lawmaker, said in a statement that the covered services "are critical for the health and safety of LGBTQ+ communities and will provide more Coloradans with the agency they need to affirm their identities."

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